Catheters reopened proximal tube blockages in 8 to 9 of 10 patients
A 1993 review of published reports covered women with a blockage in the tube segment nearest the uterus. Catheters passed through the cervix reopened the tube in about 8 to 9 of 10 women with that blockage. Pregnancy rates within 6 to 12 months ranged from 23% to 39% in the studies listed.
Key Findings
Catheter treatment of proximal tubal occlusion reopened the tube in approximately 8 to 9 of 10 patients.
Pregnancy rates within the first 6 to 12 months ranged between 23% and 39% across the quoted studies, which had patient selection bias.
Among patients with earlier tubal damage, 5% to 13% had an ectopic pregnancy.
In the five series tabulated, long-term tubal patency ranged between 35% and 82%.
Tubal perforation was reported in less than 2% of patients having balloon tuboplasty and in 5% having selective salpingography.
Interpretation
This narrative review by Risquez and Confino summarized published studies on transcervical catheter procedures for the fallopian tubes. Tubal occlusion causes infertility in about one third of infertile patients. Proximal occlusion alone accounts for 10% to 20% of those cases. The authors say more trials are needed to find the best catheter technique. The findings support larger trials of these methods.
RRM Context
A blocked tube can be located and reopened from inside the body. IVF goes around the tube and leaves the blockage in place. Restorative reproductive medicine finds the cause of a blockage and treats it directly. Transcervical catheter treatment fits that cause-based principle.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To evaluate publications that introduced novel diagnostic and therapeutic transcervical procedures on the fallopian tubes.
Design
Major studies that conceptually changed the therapeutic approach to the fallopian tubes were reviewed. Minor publications were also included if they introduced a new concept or contributed to the topic. Clinical publications were selected if they involved transcervical diagnosis and treatment of fallopian tubes.
Results
Transcervical tubal catheterization procedures for diagnosis of tubal disease, tubal obliteration, tubal recanalization, and tubal medication are minimally invasive procedures that can improve our understanding and diagnostic accuracy of tubal disease. These procedures allow transcervical treatment of proximal tubal occlusion. Further improvements in equipment and methodology are promising. Transcervical tubal occlusion, gamete and embryo deposition, and treatment of ectopic pregnancy may all be performed using the transcervical approach.
Conclusion
Transcervical tubal catheterization can replace microsurgery and IVF in selected patients with proximal tubal occlusion, improve the diagnostic accuracy of tubal disease, and deliver medications to the fallopian tubes. Cumulative knowledge suggests that transcervical tubal catheterization should become a universally accepted, taught, and practiced approach in the diagnosis and treatment of the fallopian tubes.
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