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Fallopian Tube Recanalization

Fallopian Tube Recanalization Procedure

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Fallopian Tube Recanalization Pre-Procedure Prep

Indications

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

Contraindications

• 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

Fallopian Tube Recanalization Podcasts

Listen to leading physicians discuss fallopian tube recanalization on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #169

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Dr. Renato Abu Hana walks us through how to perform fallopian tube recanalization for infertility, including patient selection, HSG and recanalization technique, as well as pitfalls to avoid.

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Fallopian Tube Recanalization 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

Fallopian Tube Recanalization Post-Procedure

Post-Operative Care

• Fallopian tube recanalization 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

Fallopian Tube Recanalization Demos

Watch video walkthroughs of fallopian tube recanalization on the BackTable VI expanded content network.

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

Disclaimer: The Materials available on https://www.BackTable.com/ are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Podcasts

Fallopian Tube Recanalization with Dr. Renato Abu Hana on the BackTable VI Podcast)
Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz on the BackTable VI Podcast)

Articles

Contributors

Dr. Renato Abu Hana on the BackTable VI Podcast

Dr. Renato Abu Hana

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