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GYNAECOLOGY AND OBSTETRICS Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 521-523
Efficacy of Fallopian tube catheterization for treatment of infertility


Govt. Medical College; Nagpur., India

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   Abstract 

Material and Methods: - Fluoroscopic transcervical fallopian tube catheterization was performed in two hundred and four patient with infertility in whom proximal tubal obstruction was documented by at least two hysterosalpingography procedures. Bilateral block in 147 and unilateral block was seen in 57 cases. All patients were submitted to selective salpingography, patients were followed up for six months at bimonthly interval. Results: - H.S.G revealed proximal tube obstruction in total of 264 tubes of these 258 tubes were successfully cannulated complete tubal patency was achieved in 249 cases. In 12 Cases recanalization was incomplete and hydrosalpinx was seen in 7 tubes. In six months follow up 72 out of 200 patients had pregnancy confirmed by material urine test for pregnancy and subsequent ultrasound examination. All pregnancies were intra uterine. Conclusion: - Fallopian tube catheterization is an effective procedure for infertility caused by proximal tubal obstruction.

Keywords: Fallopian tubes, Infertility, Hysterosalpingography

How to cite this article:
Dwivedi M K, Pal R, Jain M, Sherwani P, Nimbalkar N, Agrawal V. Efficacy of Fallopian tube catheterization for treatment of infertility. Indian J Radiol Imaging 2005;15:521-3

How to cite this URL:
Dwivedi M K, Pal R, Jain M, Sherwani P, Nimbalkar N, Agrawal V. Efficacy of Fallopian tube catheterization for treatment of infertility. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Apr 10];15:521-3. Available from: http://www.ijri.org/text.asp?2005/15/4/521/28787

   Introduction Top


Proximal obstruction of  Fallopian tube More Details is the cause of infertility in approximately 25-30% of women with tubal disease [1]. Fallopian tube catheterization for improved diagnosis and treatment is now an established procedure with technical success rates for catheterization of the proximal tube in the 85 to 90 % range. Treatment options for proximal tubal obstruction are either tubal microsurgery, which is associated with a 30-50% pregnancy rate after two year [1]. or in vitro fertilization, which is associated with a 10 to 15% pregnancy rate [2]. Both these procedures are expensive and are associated with significant morbidity. Recent developments in the field of assisted reproduction have led to renewed interest in the diagnosis and treatment of proximal tubal pathology under fluoroscopic guidance which is a non surgical procedure and allows the patient to conceive naturally [3],[4],[5],[6],[7]. In four-year period we have performed diagnosis as well as cannulation of fallopian tubes for proximal tubal obstruction and in the same sitting and found it to be extremely effective procedure.


   Material and Methods Top


Two hundred and four patients over a period of 4 years in whom the diagnosis of unilateral or bilateral proximal tubal obstruction was made by at least two hysterosalpingography procedures underwent fallopian hysterosalpingography procedures underwent fallopian tubal catheterization under image intensifier. Age of the patients were 24 to 41 Years and mean age 32 years. On the basis of hysterosalpingographic findings of proximal tubal obstruction (bilateral in 147 cases and unilateral in 57 cases) all patients were submitted to selective salpingography. Average duration of infertility was three years. The procedure was performed during follicular phase of the menstrual cycle. Three days before the procedure the patient was put on antibiotics. Patient was premedicated with 0.5 mg of intra muscular atropine sulfate half an hour before procedure. Under all aseptic precautions initially conventional hysterosalpingography was performed and if proximal tubal injection failure of either tube was observed [Figure - 1], selective salpingography with intra tubal catheterization was immediately attempted. Cook fallopian tube catheterization set was used in all cases. Cook cervical cannula was used to stabilize the system in the cervix and a 5.5 F catheter placed in the uterine cornua followed by placement of catheter in to the ostium of tube with the help of 0.035inch safety guide wire [Figure - 2]. If resistance was encountered again the co-axial guide wire was passed beyond the point of obstruction, 2 ml of contrast was injected to verify recanalization. Conventional HSG was performed at the end of the procedure to verify tubal patency. The entire procedure lasts for 20 mts and average fluoroscopic time for each tube was 20 to 30 seconds. All patients were followed up for six months at bimonthly interval. All pregnancies were confirmed by patients and obstetrician on the basis of maternal urine test and subsequent pelvic ultrasound examination.

If bilateral proximal tubal injection failure was observed second tube was recanalized immediately [Figure - 3].


   Results Top


Hysterosalpingography revealed proximal tubal injection failure in a total of 264 tubes. Catheterization was attempted in all 264 tubes in 6 of these proximal resistance was encountered, which could not be over come even with the use of guide wire with several attempts. Of the 258 tubes that were successfully cannulated, complete tubal patency (recanalization) was achieved in 249, Recanalization of remaining 12 tubes was considered to be incomplete or absent; distal tubal obstruction or hydrosalpinx was revealed in 7 tubes. In five other the amount of contrast material emptying in to peritoneal cavity after attempted recanalization was quite small indicating partial obstruction. 72 of 200 patients had pregnancy in six months follow up.


   Discussion Top


Uterine insufflations with gas or iodinated contrast agent was used at the time of ovulation in the period as early as 1940 [8]. Amys thurmond et al had used co-axial catheter in 1988 for selective connulation of uterine cornua with success rate of 94%. We have included in our study the patients in whom at least two hysterosalpingography procedures shows cornual block and thus we have avoided tubal spasm as cause of obstruction. In our series we have successfully cannulated 249 out of 258 fallopian tubes with pregnancy rate of 36 % in six months follow up (72 of 200 patients). forty of seventy two patients had pregnancy occurred in less than one month suggests that the time where women has the best chance of conceiving is shortly after procedure. High recanalization rate in our series and also reported by other studies [7],[8] indicates, that the abnormality in most of the tubes is probably occlusion of tubes due to amorphous debris and mild adhesions [1]. Such obstruction may very well be resistant to hydrostatic pressures that can be exerted during conventional hysterosalpingography but can be overcome by fallopian tubal canalization procedures. Since organic occlusions are for less common than tubal spasms we believe that at least two attempts of diagnostic hysterosalpingography should be made before resorting to alternative of selective connulation [10].

We believe that co-axial fallopian tube recanalization technique is relatively inexpensive and has very low morbidity, above study also conclude that the procedure could be performed during hysterosalpingography it self with significant saving in terms of time and cost and thus the necessity of more invasive Laproscopic procedures can be avoided.

 
   References Top

1.M.C. Comb, Gomel, Cornual occlusion and its microsurgical reconstruction, clinical obstrcties gynecology 1980; 23:1229-1241  Back to cited text no. 1    
2.Raymond CA. IVF registry notes more centers, more births, slightly improved odds JAMA 1988 ; 259 ; 1920 - 1921.  Back to cited text no. 2    
3.Platia MP, Krudy AG. Transvaginal fluoroscopic recanalization of a proximally occluded oviduct. Fertil stesil 1985 ; 44 ; 704-706.  Back to cited text no. 3    
4.Thurmond AS, Novy M, Uchida BT, Rosch J. Fallopian tube obstruction: selective salpingography and recanalization. Radiology 1987 ; 163 ; 511-514.  Back to cited text no. 4    
5.Novy MJ, Thurmond AS, Patton P, Uchida BT, Rosch J. Diagnosis of connal obstuctin by trans cervical fallopian tube connulation, Fertil Stril 1988;50;434-436  Back to cited text no. 5    
6.Thurmond AS, Rosch J, Patton PM, Burry KA, Novy M Fluroscopic transcervical fallopian tube catheterization for diagnosis and treatment of female inferlity caused by tubal obstruction. Radiographic 1988;8;621-640.  Back to cited text no. 6    
7.Rosch J, Thurmond AS, Uchida BT. Fallopian tube catheterization technique update. Radiology 1988;168;1-5.  Back to cited text no. 7    
8.Verell M. Mudltiple uterotubal insufflations in cases of sterility due to tubal occlusion AM. J Obstet Gynecol 1954;68;810-814  Back to cited text no. 8    
9.Thurmond AS, Rosch J, Fallopian tubes improved technique for catheterization Radiology 1990;174;572-573.  Back to cited text no. 9    
10.Thurmond AS, Rosch J, Novy, terbutaline in diagnosis of interstitial Fallopian tube obstruction. Invest Radiol 1988;23;209-210.  Back to cited text no. 10    

Top
Correspondence Address:
M K Dwivedi
Dept. of Radio-diagnosis, Govt. Medical College, Nagpur - 440 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28787

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Evaluation of hysteroscopic tubal cannulation under laparoscopic control versus intracytoplasmic sperm injection in cases with proximal tubal obstruction
Ahmed T. Soliman,Hesham A. Salem
Evidence Based Women's Health Journal. 2013; 3(3): 147
[Pubmed] | [DOI]



 

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    Abstract
    Introduction
    Material and Methods
    Results
    Discussion
    References
    Article Figures

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