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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Ghonge NP, Ghonge SD. Hystero-Salphingography in current clinical practice-old flames, die hard! Abdom Radiol (NY) 2024:10.1007/s00261-024-04456-9. [PMID: 38913135 DOI: 10.1007/s00261-024-04456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
Hysterosalpingography (HSG) remains a valuable diagnostic tool in current clinical practice, offering crucial insights into endometrial cavity, fallopian tubes and the adjoining part of the pelvic peritoneal cavity. Despite the emergence of alternative imaging and non-imaging options, HSG continues to be widely utilized due to its diagnostic accuracy, cost-effectiveness, and easy accessibility. Due attention to the correct technique and optimal image interpretation will further enhance its diagnostic accuracy and precision in the work-up of patients with fertility problems.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospitals, New Delhi-76, India.
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Mody P, Salazar G, Kohi MP. Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility. Semin Intervent Radiol 2023; 40:379-383. [PMID: 37575349 PMCID: PMC10415059 DOI: 10.1055/s-0043-1771042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress.
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Affiliation(s)
- Priya Mody
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maureen P. Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Yip JY, Kanneganti A, Binte Ahmad N, Lim MXK, Chew SLS, Huang Z. Optimizing intrauterine insemination and spontaneous conception in women with unilateral hydrosalpinx or tubal pathology: A systematic review and narrative synthesis. Eur J Obstet Gynecol Reprod Biol 2023; 286:135-144. [PMID: 37267890 DOI: 10.1016/j.ejogrb.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Tubal surgery's role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear. OBJECTIVE To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive. SEARCH STRATEGY Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles. DATA COLLECTION AND ANALYSIS Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO) MAIN RESULTS: Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle. CONCLUSIONS Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed. While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients.
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Affiliation(s)
- Jia Yun Yip
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Nurulhuda Binte Ahmad
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Mei Xian Karen Lim
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Siong Lin Stephen Chew
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), #04-02, 28 Medical Drive Center for Life Sciences Building, NUS Yong Loo Lin School of Medicine, 117456, Singapore.
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Roberts A. Fallopian tube recanalization for the management of infertility. CVIR Endovasc 2023; 6:13. [PMID: 36912985 PMCID: PMC10011273 DOI: 10.1186/s42155-023-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023] Open
Abstract
Infertility is a world-wide problem, defined as failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. There are multiple causes for infertility involving both male and female factors. Fallopian tube occlusion is a common reason for female infertility. The initial attempts to treat proximal obstruction involved the use of a whalebone bougie positioned in the uterine cornua to dilate the proximal tube by Smith as early as 1849. Fluoroscopic fallopian tube recanalization for the treatment of infertility was first described in 1985. Since that time, there have been over 100 papers describing various methods for recanalization of occluded fallopian tubes. Fallopian tube recanalization is a minimally invasive procedure which is performed on an outpatient basis. It should be a first line therapy for patients with proximal occlusion of fallopian tubes.
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Affiliation(s)
- Anne Roberts
- University of California, San Diego, 9300 Campus Point Drive, La Jolla, CA, 92037, USA.
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Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Howard C, Rice PFS, Keenan M, Dominguez-Cooks J, Heusinkveld J, Hsu CH, Barton JK. Study of fallopian tube anatomy and mechanical properties to determine pressure limits for endoscopic exploration. J Histotechnol 2022; 45:10-20. [PMID: 34496720 PMCID: PMC10566563 DOI: 10.1080/01478885.2021.1972250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Falloposcopy is the endoscopic examination of the fallopian tubes, which are challenging to access due to their deep body location, small opening from the uterus, and lumen filled with plicae. We and others have developed endoscopes that are inserted through the uterus guided by a hysteroscope into the tubal ostium. To better understand how to utilize these endoscopes either as standalone devices or in concert with everting delivery balloons, a preliminary study of anatomy and mechanical behavior was performed ex vivo on porcine and human fallopian tubes. Segments of fallopian tubes from the isthmus, ampulla and infundibulum were inflated with saline either to bursting or held at sub-burst pressures with saline or a saline-filled balloon. Formalin fixed, paraffin embedded tissue sections stained with Masson's trichrome were examined for damage to the mucosa and muscularis. Porcine fallopian tubes tolerated saline pressurization at 15 psi for 1 minute without morphological damage. Balloon inflation to 15 psi caused no apparent damage to the muscle layer or rupture of the fallopian tube, but balloon movement within the tube can denude the mucosal epithelial layer. Human fallopian tubes averaged higher burst pressure values than porcine tubes. Under pressurization, the external tube diameter expanded by minimal to moderate amounts. Human and porcine tissues were similar in histological appearance. These studies suggest that moderate pressurization is acceptable but will not appreciably expand the fallopian tube diameter. The results also indicate that pigs are a reasonable model to study damage from falloscopy as seen in human tissue.
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Affiliation(s)
- Caitlin Howard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Photini F S Rice
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Molly Keenan
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | | | - John Heusinkveld
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Jennifer K Barton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
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Grigovich M, Kacharia VS, Bharwani N, Hemingway A, Mijatovic V, Rodgers SK. Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know. Radiographics 2021; 41:1876-18961. [PMID: 34597232 DOI: 10.1148/rg.2021210033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Impaired tubal patency accounts for up to 35% of cases of subfertility and infertility. Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) represents a first-line test in evaluating fallopian tube patency. Despite the association of HSG with ionizing radiation, HSG is a reference standard in assessing fallopian tube patency and tubal conditions such as tubal occlusion, salpingitis isthmica nodosa, and hydrosalpinx. HSG is widely available and utilizes either a water-soluble contrast medium (WSCM) or an oil-soluble contrast medium (OSCM). Compared with WSCM, HSG with OSCM results in a higher incidence of non-in vitro fertilization pregnancies and, therefore, may be preferred in women younger than 38 years with unexplained subfertility. HSG may also be helpful in assessment after sterilization or before fallopian tube recanalization. US-based tubal tests are free of ionizing radiation and include HyCoSy, with either air-saline or microbubble US contrast material, and hysterosalpingo-foam sonography (HyFoSy), a tubal patency test that utilizes a gel foam. A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion sonohysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromopertubation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Maria Grigovich
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
| | - Vidhi S Kacharia
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
| | - Nishat Bharwani
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
| | - Anne Hemingway
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
| | - Velja Mijatovic
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
| | - Shuchi K Rodgers
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098 (M.G., V.S.K., S.K.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (N.B., A.H.); and Endometriosis Center, Amsterdam, University Medical Center, Amsterdam, the Netherlands (V.M.)
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Shen H, Cai M, Chen T, Zheng D, Huang S, Zhou M, He W, Li Y, Tan Q. Factors affecting the success of fallopian tube recanalization in treatment of tubal obstructive infertility. J Int Med Res 2021; 48:300060520979218. [PMID: 33322979 PMCID: PMC7745608 DOI: 10.1177/0300060520979218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine potential risk factors associated with the success rate following fallopian tube recanalization (FTR) in infertile women with obstruction of the proximal fallopian tube. METHODS We retrospectively studied patients who underwent FTR for tubal obstructive infertility between January 2016 and December 2018 at the Third Affiliated Hospital of Guangzhou Medical University. FTR was performed using a catheter and guidewire system to clear tubal obstruction. Predictive factors potentially associated with the success rate were assessed by logistic regression. RESULTS A total of 762 patients were included. Multivariable analysis showed that age (odds ratio [OR] = 2.38, 95% confidence interval [CI]: 1.24-4.58), infertility type (OR = 2.82, 95% CI: 1.36-6.21), history of ectopic pregnancy (OR = 7.87, 95% CI: 4.05-15.81), history of abdominal surgery (OR = 4.30, 95% CI: 2.22-8.60), history of artificial abortion curettage (OR = 4.08, 95% CI: 2.12-8.03), and duration of infertility (OR = 2.03, 95% CI: 1.06-3.85) were independently associated with postoperative tubal patency. CONCLUSIONS Our findings suggest that risk factors, such as age ≥35 years, secondary infertility, duration of infertility ≥5 years, and histories of ectopic pregnancy, abdominal surgery, and artificial abortion curettage, affect the success rate of FTR. These factors may also predict surgical success in treating tubal obstructive infertility.
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Affiliation(s)
- Huawei Shen
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingjin Cai
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingwei Chen
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Duzhou Zheng
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shikuan Huang
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mimi Zhou
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wanling He
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongsen Li
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qianyan Tan
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
Fallopian tube obstruction (FTO) is a common cause of female infertility. In the setting of proximal FTO, fallopian tube recanalization (FTR) is a minimally invasive, ambulatory procedure with a technical success rate of up to 100%, with minimal postprocedural adverse events. One-year pregnancy rate following FTR is approximately 41%, with successful delivery of full-term infants in 84% of pregnancies. This minimally invasive, outpatient, image-guided procedure is an alternative to vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and should be top-of-mind in the setting of infertility due to proximal FTO.
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Affiliation(s)
- Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Marlow JA, Picus D, Gould J, Connolly S, Mani NB. Outcomes after successful fallopian tube recanalization: A single institution experience: Observational Retrospective study. Clin Imaging 2021; 76:70-73. [PMID: 33578132 DOI: 10.1016/j.clinimag.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram. METHODS A retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had hysterosalpingogram confirmed unilateral or bilateral tubal occlusion from a single tertiary academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within 1 year of the procedure. Data was collected from the medical record. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26-42 years). All patients received peri- and post-procedure antibiotics. The study was conducted with institutional IRB approval. RESULTS Average follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. One patient had a urinary tract infection a week after FTR. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. CONCLUSION Infertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility.
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Affiliation(s)
- Joshua Antranig Marlow
- Mallinckrodt Institute of Radiology, Vascular Interventional Radiology Section, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Daniel Picus
- Mallinckrodt Institute of Radiology, Vascular Interventional Radiology Section, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Jennifer Gould
- Mallinckrodt Institute of Radiology, Vascular Interventional Radiology Section, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Sarah Connolly
- Mallinckrodt Institute of Radiology, Vascular Interventional Radiology Section, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Naganathan Bhagvathysubra Mani
- Mallinckrodt Institute of Radiology, Vascular Interventional Radiology Section, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA.
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12
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Wang JW, Rustia GM, Wood-Molo M, Tasse J, Tabriz D, Turba UC, Arslan B, Madassery S. Conception rates after fluoroscopy-guided fallopian tubal cannulation: an alternative to in vitro fertilization for patients with tubal occlusion. Ther Adv Reprod Health 2020; 14:2633494120954248. [PMID: 33103116 PMCID: PMC7549323 DOI: 10.1177/2633494120954248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: Previous studies show good technical success rates for fallopian tube
recanalization. Scarce literature exists regarding advance techniques
currently used by interventional radiologists during fallopian tube
recanalization procedures. This study investigates the level of intervention
and tubal patency and its association with technical success and associated
pregnancy outcomes. Methods: We retrospectively evaluated fallopian tube recanalization procedures
performed at a single center in a 24-year period. A total of 160 couples
undergoing a basic infertility evaluation were included.
Hysterosalpingography with high pressure contrast injection followed by
selective contrast, guidewire catheterization at the tubal ostium, and/or
microcatheter/microwire recanalization were performed. Comparisons of the
tubal fertilization rate by relevant characteristics were tested for
statistical significance with t tests for continuous data
or with Pearson chi-square tests for categorical data. Results: Technical success rate was 94% (319 of 341 tubes). High pressure contrast
injection alone (184 of 341, 54%), selective catheterization (40%), and
microcatheter/microwire (6%) interventions yielded technical success rates
of 98%, 90%, and 73%, respectively. The overall rate of conception was 35%
(17 of 48). Conclusion: Current techniques of fallopian tube recanalization offer a desirable and
safe option with high technical success for patients seeking treatment for
infertility due to proximal fallopian tube obstruction.
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Affiliation(s)
- Jeffrey W Wang
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Gabriella M Rustia
- Department of Infertility and Reproductive Endocrinology, Rush University Medical Center, Chicago, IL, USA
| | - Mary Wood-Molo
- Department of Infertility and Reproductive Endocrinology, Rush University Medical Center, Chicago, IL, USA
| | - Jordan Tasse
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - David Tabriz
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Ulku C Turba
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Bulent Arslan
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Sreekumar Madassery
- Division of Vascular and Interventional Radiology, Department of Radiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
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Explorations de la perméabilité et des pathologies tubaires par imagerie. IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Factors Affecting Pregnancy Rate Following Fallopian Tube Recanalization in Women with Proximal Fallopian Tube Obstruction. J Clin Med 2018; 7:jcm7050110. [PMID: 29748467 PMCID: PMC5977149 DOI: 10.3390/jcm7050110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022] Open
Abstract
Fallopian tube obstruction is a major cause of female infertility. We aimed to evaluate the factors potentially affecting pregnancy rate following fallopian tube recanalization (FTR) in infertile women with proximal fallopian tube obstruction. Data was retrospectively collected for 61 women (25, primary infertility; 36, secondary infertility) who underwent FTR at our institution. Bivariable and multivariable analyses of clinical pregnancy rates in relation to the following factors were performed: primary vs. secondary infertility, duration of infertility, age at the time of FTR, unilateral vs. bilateral obstruction, and previous pelvic interventions. All women who underwent fluoroscopically guided transcervical FTR of one or both proximally obstructed tubes were successfully recanalized (technical success rate, 100%). Within a year after FTR, 41% of women had conceived. None of the studied variables was significantly associated with pregnancy rate on bivariable analysis. Nevertheless, on multivariable analysis, the type and duration of infertility were significantly associated with pregnancy among women aged <35 years at the time of FTR. Our findings regarding pregnancy rates following FTR reflect the diversity of the patient population and suggest the presence of multiple contributing factors. Younger women with secondary infertility for <5 years are highly likely to achieve conception following FTR.
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Vickramarajah S, Stewart V, van Ree K, Hemingway AP, Crofton ME, Bharwani N. Subfertility: What the Radiologist Needs to Know. Radiographics 2017; 37:1587-1602. [DOI: 10.1148/rg.2017170053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Saranya Vickramarajah
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Victoria Stewart
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Katherine van Ree
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Anne P. Hemingway
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Mary E. Crofton
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Nishat Bharwani
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
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Patil E, Thurmond A, Edelman A, Fu R, Lambert W, Seguin J, Jensen JT. Pressure dynamics in the non-gravid uterus: intrauterine pressure cannot confirm tubal occlusion after non-surgical permanent contraception. Contraception 2017; 96:330-335. [PMID: 28687179 DOI: 10.1016/j.contraception.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective was to determine if intrauterine pressure can distinguish bilateral tubal occlusion (BTO) from unilateral or bilateral tubal patency (TP) in women following a permanent contraception procedure. STUDY DESIGN We used a small inline pressure sensor to continuously monitor intrauterine pressure during hysterosalpingogram (HSG) in a cross-sectional study that enrolled women having HSGs for any indication. The primary outcome was the peak intrauterine pressure compared between women with BTO and TP as verified by HSG. RESULTS We enrolled 150 subjects, of which 111 (74.0%) provided usable pressure readings. Of these, 98/111 (88.3%) had TP, and 13 (11.7%) had BTO. There was no difference in peak intrauterine pressure for subjects with TP (mean 293.8±58.7 mmHg) compared to those with BTO (292.7±71.3 mmHg, p=.95). Among parous women, peak intrauterine pressure in subjects with BTO (311.9±78.0 mmHg) was higher but not significantly different from subjects with TP (282.7±49.2 mmHg, p=.20). In linear regression analysis, peak intrauterine pressure was not associated with age, body mass index, gravidity or having at least one prior live birth. CONCLUSIONS Measurement of peak intrauterine pressure does not distinguish between women with patent and blocked fallopian tubes. This approach would not be clinically useful to verify occlusion following permanent contraception. IMPLICATIONS Peak intrauterine pressure does not differ between women with patent and occluded fallopian tubes and cannot be used to confirm tubal occlusion after nonsurgical permanent contraception.
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Affiliation(s)
- Eva Patil
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Amy Thurmond
- Womens Imaging & Intervention, 17050 Pilkington Rd, Suite 130, Lake Oswego, OR 97035, USA
| | - Alison Edelman
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Rongwei Fu
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - William Lambert
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jacqueline Seguin
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jeffrey T Jensen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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Seyam EM, Hassan MM, Tawfeek Mohamed Sayed Gad M, Mahmoud HS, Ibrahim MG. Comparison of Pregnancy Outcome between Ultrasound- Guided Tubal Recanalization and Office-Based Microhysteroscopic Ostial Dilatation in Patients with Proximal Blocked Tubes. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 9:497-505. [PMID: 26985337 PMCID: PMC4793170 DOI: 10.22074/ijfs.2015.4608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/08/2014] [Indexed: 11/22/2022]
Abstract
Background The current research to the best of my knowledge is the first to compare the
pregnancy outcome between ultrasound-guided tubal recanalization (UGTR) using a special
fallopian tubal catheter, and office-based micrhysteroscopic ostial dilatation (MHOD) using
the same tubal catherter in infertile women with previously diagnosed bilateral proximal tubal
obstruction (PTO). Materials and Methods This prospective study reported the pregnancy outcomes for 200
women in private infertility care center in Arafa hospital in Fayoum and in El Minya University Hospital in the period between January 2010 and October 2013 treated as outpatients for
their bilateral PTO after the routine hysterosalpingography (HSG). A Cook’s catheter, special
fallopian tubal catheter, were used to recanalize the blocked tubes in 100 women (group A)
under UGTR, and the same Cook’s tubal catheter was used through 2mm microhysteroscope
to cannulate both ostia using MHOD in another 100 women (group B). Pregnancy outcome
was determined after the procedures for a 12-month period follow-up. Results The number of the recanalization of PTO was not significantly different between two
groups. As of the 200 blocked fallopian tubes in group A, 140 tubes (70%) were successfully
recanalized by passing the ultrasound-guided special cannula, while 150 tubes (75%) were
successfully recanalized in group B, using the same tubal catheter through a 2mm microhysteroscope. The cumulative pregnancy rate after the two procedures was not statistically different
between two groups. It was 25.9% in group A, while it was 26.3% in group B, after a 12-month
period follow-up. Conclusion UGTR is highly recommended as the first step to manage infertile women due to
PTO, as it is easier procedure; however, there is possible to obtain nearly similar results after
MHOD.
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Affiliation(s)
- Emaduldin Mostafa Seyam
- Department of Obstetrics and Gynecology, College of Medicine, El Minya University, Minya, Egypt
| | - Momen Mohamed Hassan
- Department of Obstetrics and Gynecology, College of Medicine, El Minya University, Minya, Egypt
| | | | - Hazem Salah Mahmoud
- Department of Obstetrics and Gynecology, Al Fayoum General Hospital, Faiyum, Egypt
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The history and current status of fallopian tube pressures - developing alternate methods for confirmation of tubal occlusion. Contraception 2015; 92:124-7. [PMID: 25592081 DOI: 10.1016/j.contraception.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 11/21/2022]
Abstract
Permanent contraception with hysteroscopic tubal ligation is an increasingly popular choice for women around the world. However, inconveniences associated with the required confirmation test for tubal occlusion can be prohibitive. As new methods of permanent contraception are being investigated, ways of making all aspects of the procedure more accessible and comfortable for women should be considered. Means of examining tubal patency in the infertility population, such as tubal perfusion pressures measured at the time of hysterosalpingogram (HSG), provide inspiration for alternative methods of tubal occlusion confirmation after contraception. Evaluation of intrauterine pressures measured by a manometer attached to an intrauterine balloon catheter could serve as a preliminary tool for verification of tubal occlusion; higher pressures would indicate tubal occlusion and lower pressures would indicate the need for confirmatory HSG. The development and validation of this technique is ongoing and could reduce overall costs and patient burdens associated with the current tubal occlusion confirmation procedure.
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Knuttinen MG, Jajko R, Scoccia B. Fluoroscopic tubal recanalization in tubal factor related infertility. Semin Intervent Radiol 2014; 31:269-71. [PMID: 25177090 DOI: 10.1055/s-0034-1382797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Martha-Grace Knuttinen
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - R Jajko
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - B Scoccia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, Illinois
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Al-Omari M, Al-Mnayyis A, Obeidat N, Amarin Z, Zayed F, Rousan L, Al-Balas H, Alawneh K, El-Heis M, Omari Z, Hanania R. Fallopian tube recanalisation using dedicated radiographic tubal assessment set in angiography suite. J Med Imaging Radiat Oncol 2014; 58:415-21. [PMID: 24592879 DOI: 10.1111/1754-9485.12169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 01/16/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Fallopian tube recanalisation (FTR) for proximal fallopian tube obstruction (PFTO) is considered a good treatment option for tubal infertility. The aim of this study was to assess the safety and the technical and clinical success rates of FTR using a dedicated radiographic tubal assessment set (FluoroSet(®) ) in the angiography suite. METHODS This study is a retrospective analysis of data prospectively collected between February 2007 and June 2011 at King Abdullah University Hospital, Irbid, Jordan. During this period, 61 patients affected by PFTO underwent FTR using FluoroSet(®) at our institution. The mean age of patients was 34 years (range 20-45 years), and the mean duration of infertility was 4 years (range 2-14 years). The procedure was performed with conscious sedation under fluoroscopic guidance in the angiography suite. The obstructed tube was accessed with a 5-Fr multipurpose catheter, and the obstruction was crossed with a 0.35-Fr hydrophilic guide wire until the wire coiled freely into the peritoneal cavity. Patency of the tube was then confirmed by selective salpingiogram. Technical success rate was recorded, and patients were followed up for evidence of pregnancy over 12 months. RESULTS The procedure was technically successful in all patients. Minor bleeding and postprocedural pain occurred in most patients; however, there were no major complications encountered. Twenty-five patients (41%) became pregnant. Successful deliveries of full-term infants were reported in 21 patients (84%). Miscarriage was reported in four patients (16%). No ectopic pregnancies were detected, and all deliveries were full-term. The technical success rate was 100% and the clinical success rate was 41%. CONCLUSION Selective salpingography and FTR using FluoroSet(®) is a safe and effective method. FTR is recommended as the first intervention in patients with PFTO. In experienced hands with dedicated equipment and in an appropriate setting, the success rate is high, and this treatment should be offered to infertile women with PFTO before other, more complex techniques are attempted.
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Affiliation(s)
- Mh Al-Omari
- Department of Radiology, King Abdullah University Hospital, Irbid, Jordan
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Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am 2013. [PMID: 23182560 DOI: 10.1016/j.ogc.2012.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The diagnosis of tubal occlusion can be established by a combination of clinical suspicion based on patient history and diagnostic tests, such as hysterosalpingogram, sonohysterosalpingography, and laparoscopy with chromopertubation. Depending on several patient factors, tubal microsurgery or more commonly in vitro fertilization with its improving success rates are the recommended treatment options.
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Tang S, Zhang CY, Huang MN, Luo YF, Liang ZQ. Fallopian tube occlusion with a shape memory polymer device: evaluation in a rabbit model. Contraception 2013; 87:235-41. [DOI: 10.1016/j.contraception.2012.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Cobellis L, Argano F, Castaldi MA, Acone G, Mele D, Signoriello G, Colacurci N. Selective salpingography: preliminary experience of an office operative option for proximal tubal recanalization. Eur J Obstet Gynecol Reprod Biol 2012; 163:62-6. [DOI: 10.1016/j.ejogrb.2012.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 03/08/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
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Anil G, Tay KH, Loh SF, Yong TT, Ong CL, Tan BS. Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation. J OBSTET GYNAECOL 2012; 31:746-50. [PMID: 22085068 DOI: 10.3109/01443615.2011.593647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study is a retrospective review of the transcervical fluoroscopy-guided fallopian tube recanalisation (FTR) procedures done in a multi-ethnic south-east Asian population, over 9 years. A total of 100 patients with infertility and documented proximal tubal obstruction (PTO) were referred for FTR. On-table hysterosalpingography under sedation demonstrated true PTO in 96 patients. At selective-salpingography, the PTO cleared in 16 patients; 78 required FTR and two had fimbrial blockage. The technical success rate of FTR was 86.8% and the post-FTR pregnancy rate was 36.84% at a mean follow-up interval of 12.2 months. There were no major, immediate procedure-related complications. There was an ectopic pregnancy in a single treated patient. Fluoroscopy-guided FTR is a safe treatment option in patients with infertility from PTO, with high technical success rate, low complication rate and increased chances of pregnancy; therefore it should be preferred before attempting more expensive and resource-intensive procedures.
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Affiliation(s)
- G Anil
- Department of Radiology, National University Hospital, Singapore.
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Kotrotsou M, Strandell A, Trew G. The current place of tubal surgery in the management of subfertility. HUM FERTIL 2012; 15:75-81. [PMID: 22339337 DOI: 10.3109/14647273.2012.659004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment of tubal disease can be challenging and complex. It requires accurate assessment of the extent of disease and evaluation of all fertility parameters. Although traditionally treatment involved salpingectomy or IVF or a combination of the two, less invasive treatment options may prove beneficial. We evaluated the various diagnostic tools for disease assessment and the treatment options available.
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Affiliation(s)
- Maria Kotrotsou
- Division of Reproductive Medicine, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
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Mekaru K, Yagi C, Asato K, Masamoto H, Sakumoto K, Aoki Y. Hysteroscopic tubal catheterization under laparoscopy for proximal tubal obstruction. Arch Gynecol Obstet 2011; 284:1573-6. [PMID: 21779770 DOI: 10.1007/s00404-011-2007-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 07/08/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the fertility outcomes of infertile patients having proximal tubal obstruction treated with hysteroscopic tubal catheterization (HCT) for recanalization under diagnostic laparoscopy. METHODS From January 2000 to December 2008, diagnostic laparoscopy was used to assess the tubal status of 61 patients with unilateral or bilateral proximal tubal obstruction, as confirmed by hysterosalpingography. Among them, 35 patients with tubal obstruction confirmed by chromopertubation under laparoscopy subsequently underwent HCT. The pregnancy outcomes and success rates of recanalization were investigated. RESULTS In the 35 patients with confirmed tubal obstruction, HCT was performed in 54 fallopian tubes. The success rate of recanalization was 25.9% (14/54) per tube and 37.1% (13/35) per patient. Of the patients in whom tubal patency was restored, 4 achieved pregnancy, including 1 tubal pregnancy and 1 miscarriage. Among the 61 patients, excluding 14 who underwent in vitro fertilization-embryo transfer (IVF-ET) after laparoscopy, 13 were pregnant (27.7%), 9 gave live births, 1 had tubal pregnancy, and 3 had miscarriages. CONCLUSIONS HCT under laparoscopy is an option for couples with tubal infertility who do not prefer IVF-ET.
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Affiliation(s)
- Keiko Mekaru
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
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Allahbadia GN, Merchant R. Fallopian tube recanalization: lessons learnt and future challenges. ACTA ACUST UNITED AC 2011; 6:531-48, quiz 548-9. [PMID: 20597618 DOI: 10.2217/whe.10.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Technological advances in fiberoptics and endoscopy have resulted in the development of minimally invasive transcervical tubal catheterization procedures with the potential of improved diagnostic accuracy of tubal disease and transcervical treatment of proximal tubal obstruction (PTO) with reduced risks, costs and morbidity compared with surgical procedures. Fallopian tube recanalization can be performed with catheters, flexible atraumatic guidewires or balloon systems under endoscopic (falloposcopy/hysteroscopy/laparoscopy), sonographic, fluoroscopic or tactile guidance. Falloposcopy provides a unique possibility to accurately visualize and grade endotubal disease, characterize and document endotubal lesions, identify the segmental location of tubal pathology without complications, objectively classify the cause of PTO and guide future patient management. This is in contrast to the surgical and radiological gold standards, laparoscopy and hysterosalpingography, respectively, that are often associated with poor or misdiagnosis of PTO. Nonhysteroscopic transuterine falloposcopy using the linear eversion catheter is a successful, well-tolerated, outpatient technique with a good predictive value for future fertility. Hysteroscopic-falloposcopic-laparoscopic tubal aquadissection, guidewire cannulation, guidewire dilatation and direct balloon tubuloplasty may be used therapeutically to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, guidewire cannulation of proximally obstructed tubes yields much lower pregnancy rates compared with other catheter techniques, despite the high tubal patency rates. Laparo-hysteroscopic selective tubal catheterization with insufflation of oil-soluble radiopaque dye has been reported to be an effective treatment for infertility associated with endometriosis. The various disadvantages associated with fluoroscopic and sonographic techniques limit their application, despite the reportedly high patency and intrauterine pregnancy rates. Recanalization is contraindicated in florid infections and genital tuberculosis, obliterative fibrosis and long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertilitY and previously performed tubal surgery. Distal tubal obstruction is not amenable to catheter recanalization techniques. Tuberculosis, salpingitis isthmica nodosa, isthmic occlusion with club-changed terminal, ampullar or fimbrial occlusion, and tubal fibrosis have been cited as reasons for recanalization failure. In lieu of the poor pregnancy outcomes in patients with severe tubal disease and poor mucosal health following tubal recanalization, as well as poor available technical skills and results with microsurgery, in vitro fertilization and embryo transfer is a valid option in such women. Despite the high diagnostic and therapeutic power of falloposcopic interventions, technical shortcomings with falloposcopy must be overcome before the procedure gains widespread acceptance.
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Verma A, Krarup K, Donuru A. Selective salpingography and fallopian tube catheterisation by guidewire. J OBSTET GYNAECOL 2009; 29:315-7. [DOI: 10.1080/01443610902888469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ganeshan A, Nazir SA, Hon LQ, Upponi SS, Foley P, Warakaulle DR, Uberoi R. The role of interventional radiology in obstetric and gynaecology practice. Eur J Radiol 2009; 73:404-11. [PMID: 19251387 DOI: 10.1016/j.ejrad.2008.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 11/18/2008] [Accepted: 11/21/2008] [Indexed: 11/28/2022]
Abstract
Interventional radiology is continuing to reshape current practice in many specialties of clinical care. It is a relatively new and innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. The aim is to provide image-guided, minimally invasive alternatives to traditional surgical and medical procedures in suitable cohorts of patients. Procedures which previously required major surgery can now be performed by interventional radiologists, sometimes on an outpatient basis, with little patient discomfort. In this review, we highlight the importance of interventional radiology in treating a comprehensive range of obstetric and gynaecological pathologies.
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Affiliation(s)
- Arul Ganeshan
- Department of Radiology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
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The role of tubal reconstructive surgery in the era of assisted reproductive technologies. Fertil Steril 2008; 90:S250-3. [PMID: 19007640 DOI: 10.1016/j.fertnstert.2008.08.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 07/28/2006] [Accepted: 07/28/2006] [Indexed: 11/27/2022]
Abstract
Tubal reconstructive surgery has fewer indications in the era of assisted reproductive technologies than in the past, but is still appropriate and effective treatment for properly selected individuals.
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Maubon A, Pouquet M, Piver P, Mazet N, Viala-Trentini M, Rouanet J. Imagerie de l’infertilité féminine. ACTA ACUST UNITED AC 2008; 89:172-83. [DOI: 10.1016/s0221-0363(08)70391-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papaioannou S, Afnan M, Jafettas J. Tubal assessment tests: still have not found what we are looking for. Reprod Biomed Online 2007; 15:376-82. [PMID: 17908397 DOI: 10.1016/s1472-6483(10)60361-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interest in tubal assessment is as old as interest in fertility and infertility. The Fallopian tube is a particularly complex structure and, as such, an ideal method for its clinical assessment is very difficult to obtain. As a result, a number of different methods have been suggested. Some of these methods are more complementary to each other rather than potential substitutes for one another. Some have been used for many years with a clear evidence base for their performance as diagnostic tests. For other, relatively new tests, very little evidence about their performance is available. Research is moving from a purely anatomical approach (are the tubes open or blocked?) to encompassing functional enquiry (are the open tubes functional and, if not, are there interventions with which fertility performance can be improved?). The available evidence, or lack thereof, for the most commonly used tubal assessment tests is reviewed in this paper. Many questions remain, which, despite the increasing success of IVF, will continue to challenge and stimulate specialists and the public, who are interested in ways to maximize spontaneous as opposed to assisted fertility.
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Affiliation(s)
- Spyros Papaioannou
- Heart of England NHS Foundation Trust, Heartlands Hospital, Bordsley Green East, Bordsley Green, Birmingham B9 5SS, UK.
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The role of tubal reconstructive surgery in the era of assisted reproductive technologies. Fertil Steril 2006; 86:S31-4. [PMID: 17055842 DOI: 10.1016/j.fertnstert.2006.07.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 07/28/2006] [Accepted: 07/28/2006] [Indexed: 10/24/2022]
Abstract
Tubal reconstructive surgery has fewer indications in the era of assisted reproductive technologies than in the past, but is still appropriate and effective treatment for properly selected individuals.
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Bhargava S, Arora P, Mohan S. Fluoroscopic Guided Fallopian Tube Recanalisation. Med J Armed Forces India 2005; 61:224-6. [DOI: 10.1016/s0377-1237(05)80158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 09/22/2004] [Indexed: 11/16/2022] Open
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Al-Jaroudi D, Herba MJ, Tulandi T. Reproductive performance after selective tubal catheterization. J Minim Invasive Gynecol 2005; 12:150-2. [PMID: 15904619 DOI: 10.1016/j.jmig.2005.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Accepted: 10/25/2004] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate the reproductive performance of women after selective tubal catheterization. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING University teaching hospital. PATIENTS Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.
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Affiliation(s)
- Dania Al-Jaroudi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- Gavin Sacks
- Department of Reproductive Medicine, Hammersmith Hospital, London, UK
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Papaioannou S, Afnan M, McHugo JM, Coomarasamy A, Ola B, Sharif K. Modification of the coaxial technique for selective salpingography with measurement of tubal perfusion pressures. HUM FERTIL 2003; 6:84-8. [PMID: 12869791 DOI: 10.1080/1464770312331369113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes the use of the fallopotorque catheter system for transcervical selective salpingography and tubal catheterization under fluoroscopic guidance for the diagnosis and treatment of obstruction of the proximal Fallopian tube. The technique of tubal perfusion pressure assessment during the procedure, using the same catheter system, is also described. The relative advantages of this method of selective salpingography and tubal catheterization are then discussed in the background of previously described techniques.
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Affiliation(s)
- Spyros Papaioannou
- The Assisted Conception Unit, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK
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