Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation

Hystero-Salphingography in current clinical practice-old flames, die hard!

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.

[Impact of Endometriosis on the Therapeutic Effect of Hysteroscopic Fallopian Tube Catheterization Combined With Laparoscopy in Infertile Patients With Proximal Tubal Obstruction]

Objective

To investigate the impact of endometriosis on the therapeutic effect of hysteroscopic fallopian tube catheterization combined with laparoscopy in infertile patients with proximal tubal obstruction.

Methods

We conducted a retrospective analysis of patients who underwent hysteroscopic fallopian tube catheterization combined with laparoscopy for infertility caused by proximal fallopian tube obstruction between January 19, 2016 and March 20, 2020 at the Department of Reproductive Endocrinology, West China Second Hospital, Sichuan University. During the operation, hydrotubation was performed to verify whether there was proximal tubal obstruction. Then, the patients were categorized into an endometriosis group and a non-endometriosis group according to whether their proximal tubal obstruction was combined with endometriosis. The baseline data were balanced by propensity score matching and the rate of successful surgical unblocking of proximal tubal obstruction in infertile patients by hysteroscopic fallopian tube catheterization combined with laparoscopy was calculated. Treating cases lost to follow-up in both groups as non-pregnant cases according to the principle of intention-to-treat analysis, we followed up the pregnancy outcomes after surgery. The primary indicators included overall successful surgical unblocking rate, clinical pregnancy rate, and spontaneous pregnancy rate, while the secondary indicators included live birth rate, miscarriage rate, ectopic pregnancy rate, and the mean time to spontaneous pregnancy after surgery. The primary indicators included overall successful surgical unblocking rate, clinical pregnancy rate, and spontaneous conception rate, while the secondary indicators included live birth rate, miscarriage rate, ectopic pregnancy rate, and the mean time to spontaneous pregnancy after surgery.

Results

After propensity score matching, 113 cases were included in each of the two groups, with the overall successful surgical unblocking rate being 72.6%. The successful surgical unblocking rate of patients in the endometriosis group was higher than that of the non-endometriosis group, with the difference being statistically significant (78.8% vs. 66.4%, P<0.05). A total of 38 patients were lost after follow-up matching. Postoperative follow-up was performed to date and, through intention-to-treat analysis, the spontaneous conception rate was found to be higher in the endometriosis group than that in the non-endometriosis group (44.2% vs. 30.1%, P<0.05), while the mean time to spontaneous pregnancy after surgery was shorter in the endometriosis group than that in the non-endometriosis group (46 months vs. 53 months, P<0.05). There was no significant difference in clinical pregnancy rate, live birth rate, miscarriage rate, and ectopic pregnancy rate between the endometriosis group and the non-endometriosis group ( P>0.05).

Conclusion

When infertility caused by proximal tubal obstruction is combined with endometriosis, performing hysteroscopic fallopian tube catheterization combined with laparoscopy contributes to the improvement of reproduction outcomes.

Dose-Effect Relationship of Chitosan and Danshen Combined Injection for Fallopian Tube Recanalization

Objectives: This study examined the dose-effect relationship of chitosan and danshen combined injections on the long-term prevention of fallopian tube re-obstructions, with increased pregnancy rates in infertile women.

Methods: High-performance liquid chromatography was used to determine the content changes of combined chitosan and danshen injection. Two hundred and eighty patients with fallopian tube obstructions were randomly assigned to four groups. Group A (control group, saline), Group B (2 ml chitosan, 4 ml danshen), Group C (2 ml chitosan, 10 ml danshen), and Group D (1 ml chitosan, 10 ml danshen). Injections were administered after tubal recanalization.

Results: The effective constituent of chitosan and danshen injection was stable. Tubal patency rate was 94.2% and 87.3% in Group C after 1 and 3 years, respectively, which was significantly higher than Groups A (38.6%, 31.5%), B (73.5%, 64.1%), and D (68.5%, 50.7%). Intrauterine pregnancy rates were 61.8% and 79.4% in Group C after 1 and 3 years, respectively, and were significantly higher than Groups A (31.8%, 34.8%), B (40.1%, 62.5%), and D (38.5%, 58.5%) (p < 0.05).

Conclusion: Combined Chitosan and danshen injections prevented tubal obstruction and increased pregnancy rates for long periods using an optimal ratio of 1 part chitosan and 5 parts danshen.

Factors affecting the success of fallopian tube recanalization in treatment of tubal obstructive infertility

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.

Conception rates after fluoroscopy-guided fallopian tubal cannulation: an alternative to in vitro fertilization for patients with tubal occlusion

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.

The pregnancy rate of infertile patients with proximal tubal obstruction 12 months following selective salpingography and tubal catheterization

OBJECTIVE

To assess the efficacy of selective salpingography (SSG) with additional tubal catheterization (TC) among infertile patients diagnosed with PTO and analysis of reproductive outcome.

STUDY DESIGN

Retrospective cohort study.

RESULTS

Of a total of 399 tubes with confirmed proximal tubal occlusion, 383 successfully restored their patency resulting in 96 % technical success rate. Thirty-five percent of oviducts that had their patency restored was treated with SSG and 65% required additional TC. Reproductive outcomes at minimum 12 months following the treatment were collected by a telephone survey. 21/221 women were lost to follow up. Out of remaining 200 patients with at least one patent tube, 80 patients conceived which resulted in 40 % overall pregnancy rate.

CONCLUSION

Selective salpingography and tubal canalization offer patient-friendly, minimally invasive and cost-effective alternatives to tubal microsurgery and IVF-ET in women with tubal occlusion with very high technical success rate and promising clinical results which depend also on the complexity of couple infertility. Specific indications and limitations make a careful assessment of fallopian tubes and comprehensive evaluation of partners' reproductive situation prior to therapy an absolute requirement.

Combined chitosan and Dan-shen injection for long-term tubal patency in fallopian tube recanalization for infertility

To prospectively study the efficacy of different anti-adhesion agents for the prevention of tubal obstruction after recanalization, this trial was approved by our hospital ethics committee. Four hundred patients with fallopian tube obstruction were randomly assigned to four groups. The control group underwent recanalization alone, whereas the other groups were injected with chitosan, Dan-shen, or combined chitosan and Dan-shen after recanalization. The tubal patency rate in all four groups was recorded after 12 day, 3 months, and 12 months. The pregnancy rates were noted after 12 months. The recanalization rates after 1 day in the control, chitosan, Dan-shen, and combined chitosan and Dan-shen groups were 94.1, 97.1, 96.5, and 98.2%, respectively (p = 0.18, p > 0.05). The rates of tubal patency after 3 months were significantly higher in the combined chitosan and Dan-shen (96.5%), chitosan (88%), and Dan-shen (85.2%) groups compared with the control group (73.9%) (p = 0.0001, p < 0.05). The recanalization rate and intrauterine pregnancy rate after 12 months was significantly higher in the combined chitosan and Dan-shen group (93.8 and 63.9%, respectively) compared with the other groups (control 39 and 30.6%, chitosan 78.4 and 46.9%, and Dan-shen 77.3 and 43.3%) (p = 0.0029 and p = 0.0001, p < 0.05). Chitosan, Dan-shen, or a combination of the two compounds could be effective for preventing tubal obstruction after interventional recanalization, possibly increasing the rate of pregnancy in affected women. The combined chitosan and Dan-shen injection has unique advantages in the interventional recanalization of obstructed fallopian tubes.

Factors Affecting Pregnancy Rate Following Fallopian Tube Recanalization in Women with Proximal Fallopian Tube Obstruction

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.

Clinical observation of fallopian tube obstruction recanalization by ozone

OBJECTIVE

To investigate the clinical effect of fallopian tube obstruction recanalization by ozone.

METHODS

Total 116 cases of patients undergoing the fallopian tube obstruction were randomly divided into the experimental group and control group, with 58 cases in each group. All patients underwent the interventional fallopian tube recanalization. The patients in the experimental group underwent the fallopian tube perfusion by the ozone water. Meanwhile, the patients in the control group were treated with the conventional anti-inflammatory and anti-adhesion drugs. After the follow-up visit for 6 months, the pregnancy rate and fallopian tube re-occlusion rate were counted and compared between the two groups. Meanwhile, the symptoms were evaluated and compared between the two groups after the operation for two weeks.

RESULTS

The success rate of fallopian tube recanalization was 93.1% (54/58), the pregnancy rate was 79.3% (46/58) and the recurrence rate was 5.2% (3/58) in the experimental group. While the success rate of fallopian tube recanalization was 91.4% (53/58), the pregnancy rate was 60.3% (35/58) and the recurrence rate was 17.2% (10/58) in the control group. Analysis showed that there was no significant difference in the recanalization success rate between the two groups (P>0.05). However, the pregnancy rate and re-occlusion rate in the experimental group were significantly lower than those of the control group (P<0.05), and the difference was statistically significant. There was no significant difference in the discomfort symptoms between the experimental group and control group (P>0.05).

CONCLUSION

Fallopian tube recanalization by ozone perfusion can effectively increase the postoperative pregnancy rate and reduce the fallopian tube re-occlusion.

The place of selective hysterosalpingography and tubal canalization among sub-fertile patients diagnosed with proximal tubal occlusion

OBJECTIVE

To evaluate the efficacy of selective salpingography and tubal canalization (TC) procedure among patients diagnosed with proximal tubal occlusion (PTO).

METHODS

We conducted a retrospective cohort study on 61 sub-fertile patients aged 32.6 ± 4.9 years that were referred between the years of 2011 and 2013 with the diagnosis of PTO by prior hysterosalpingography. Patients underwent TC and were classified as bilateral PTO or unilateral PTO. Information regarding the patient's reproductive outcome within the 12 months following the procedure was collected by a telephone survey.

RESULTS

During the study period, 58/61 (95 %) patients underwent TC, resulting in bilateral open tubes in 54 patients (93.1 %). 53/58 (91.3 %) patients answered our survey. There were 23/53 (43.4 %) patients with a successful procedure who conceived after spontaneous or COH + IUI resulting in 15/23 live births (65.2 %).

CONCLUSION

Tubal canalization is a safe and minimally invasive procedure that can be used effectively to restore patency in a proportion of cases of PTO thus avoiding the need for expensive and invasive procedures such as assisted reproductive techniques.

Fallopian tube recanalisation using dedicated radiographic tubal assessment set in angiography suite

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.