Fallopian Tube Recanalization

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Pre-Procedure

Indications:
• Female infertility secondary to isolated proximal tubular obstruction
• Infertility: unable to conceive after 12 months of unprotected intercourse

Preprocedural Evaluation:
• H&P
• Confirm negative Pap smears
• Confirm negative gonorrhea and chlamydia cultures
• Negative pregnancy test
• Will need hysterosalpingogram before the procedure to evaluate for patency of fallopian tubes
• Bilateral vs unilateral occlusion
• Critical to identify site of occlusion - proximal vs distal

Anatomy:
• 4 sections of fallopian tube: intramural, isthmic, ampullary and infundibular
• Debris and mucous prone tend to clog the intramural and proximal isthmic segment
• Tube diameter is ~1 mm

Preparation:
• Recanalization during days 1-10 of menstrual cycle: after menses and before ovulation
• Doxycycline 100 mg BID x 5 days. Begin antibiotics 2 days prior to procedure
• NSAIDs
• Can have patient take ibuprofen prior to procedure
• Ketorolac (Toradol) 30 mg IV immediate prior to procedure
• Moderate sedation

Procedure

Antibiotic:
• Doxycycline 100 mg BID x 5 days. Begin antibiotics 2 days prior to procedure
• Not covered in 2018 SIR antibiotic prophylaxis guidelines

Positioning:
• Need patient in the lithotomy position
• Wedge under pelvis may help access cervix

Equipment:
• Plastic speculum
• Tenaculum often helpful to anchor cervix
Cervical access devices such as:
• Intrauterine Access Balloon Catheter (Cook)
• 9.0 Fr or Thurmond-Rosch Hysterocath (Cook)
Catheter to access the Fallopian tubes - many options
• 5 Fr Kumpe or MPA
Fallopian Tube Catheterization Set (Cook)
• Can get the 9 Fr Intrauterine Access Balloon Catheter
• Comes with 5 Fr and 3 Fr catheters

Procedure Steps
• Place trans-cervical sheath
• Perform HSG with dilute contrast
• Dilute Omnipaque 300 by 50% with normal saline
• Slow injection of contrast to reduce spasm

Engage ostium of fallopian tube then clear blockage by:
• Gentle contrast injection
• Pass glidewire through obstruction
• Pass microcatheter and microwire
• Reinject contrast to document patent tubes with spillage of contrast into peritoneum

Post-Procedure

Postoperative Care
• Recovery time: 1 hour
• Counsel patient and partner
• Spotting and cramping is expected up to 3 days following procedure
• Ok to resume intercourse

Results
• Technical success rates: up to 90%
• Pregnancy: ~30%

Complications:
• Tubal perforation 2% - may not be clinically significant
• Infection <1%
• Ectopic pregnancy ~3% if tubes are abnormal following recanalization

Related Procedures

No related procedures.

 

References

[1] Thurmond AS. Fallopian tube catheterization. Semin Intervent Radiol. 2013;30(4):381‐387. doi:10.1055/s-0033-1359732
[2] Allahbadia GN, Merchant R. Fallopian tube recanalization: lessons learnt and future challenges. Womens Health (Lond). 2010;6(4):531‐549. doi:10.2217/whe.10.34
[3] Thurmond AS, Machan LS, Maubon AJ, et al. A review of selective salpingography and fallopian tube catheterization. Radiographics. 2000;20(6):1759‐1768. doi:10.1148/radiographics.20.6.g00nv211759

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Demos

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Fallopian Tube Recanalization and Selective Salpingography

Animation by the Johns Hopkins Department of Interventional Radiology on fallopian tube recanalization and selective salpingography.

Opening A Fallopian Tube

Dr. Randy Morris performs a hysterosalpingography (HSG) exam in a patient with persistent fallopian tube blockage. A wire is passed into the fallopian tube to clear the obstruction.

 

Tools

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Literature

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New England Journal of Medicine (May 2017)

Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women

Potential therapeutic effects of oil-based vs. water-soluble contrast on rates of ongoing pregnancy and live births in women undergoing hysterosalpingography.

Seminars in Interventional Radiology (Dec 2013)

Fallopian Tube Catheterization

This article discusses endovascular techniques for well-established procedures such as fallopian tube catheterization to open occluded tubes causing infertility. It also discusses the development of fallopian tube catheterization for occluding open tubes as a method of tubal sterilization.

 

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