You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.

Table 1.  

Etiology of Proximal Tubal Obstruction.

Box 1.  

Fallopian Tube Recanalization Techniques.

Table 2.  

Summary of Results Following Various Endoscopic Fallopian Tube Recanalization Techniques.


Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

  • Authors: Gautam N. Allahbadia, MD; Rubina Merchant, PhD
  • CME Released: 7/2/2010
  • Valid for credit through: 7/2/2011
Start Activity

Target Audience and Goal Statement

This activity is intended for primary care clinicians, infertility specialists, gynecologists, and other specialists who care for women with fallopian tube obstruction.

The goal of this activity is to review procedures for the diagnosis of fallopian tube obstruction and its management to improve fertility outcomes.

Upon completion of this activity, participants will be able to:

  1. Describe the prevalence of false-positive and false-negative diagnoses of proximal tube obstruction (PTO) with hysterosalpingography
  2. Describe the frequency of PTO as a cause of subfertility
  3. Identify indications for and contraindications to transluminal salpingoplasty
  4. List different uses of falloposcopy in the management of PTO
  5. Identify advantages and disadvantages of falloposcopy over hysterosalpingography and laparoscopy in PTO


As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Gautam N. Allahbadia, MD

    Deccan Fertility Clinic, Mumbai, India; Rotunda -- Center for Human Reproduction, Mumbai, India


    Disclosure: Gautam N. Allahbadia, MD, has disclosed no relevant financial relationships.

  • Rubina Merchant, PhD

    Rotunda -- Center for Human Reproduction, Mumbai, India


    Disclosure: Rubina Merchant, PhD, has disclosed no relevant financial relationships.


  • Elisa Manzotti

    Editorial Director, Future Science Group, London, United Kingdom


    Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
    Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

CME Reviewer(s)

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC


    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

  • Marilyn W. Edmunds, PhD, CRNP

    CME Accreditation Specialist, Nurse Practitioner Alternatives


    Disclosure: Marilyn W. Edmunds, PhD, CRNP, has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Future Medicine Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


Fallopian Tube Recanalization: Lessons Learnt and Future Challenges: Applications of FTR


Applications of FTR

Transcervical tubal catheterization procedures for the diagnosis of tubal disease, obliteration, recanalization and medication are minimally invasive procedures that allow transcervical treatment of PTO and can improve our understanding and diagnostic accuracy of tubal disease.[26] True occlusion by amorphous material, flimsy adhesions or a polyp can only be successfully treated by various uterotubal cannulation methods and guidewiring the Fallopian tubes can re-establish tubal patency and fertility.[2] By restoring tubal patency, tubal cannulation can be used effectively in the management of female subfertility secondary to isolated PTO, thus avoiding the need for expensive assisted reproductive techniques.[3] By identifying patients with proximal and distal occlusion (bipolar tubal occlusion) and differentiating between true and false diagnoses of PTO, tubal cannulation eliminates or postpone the need for a costly hysteroscopy or laparoscopy. In contrast to invasive laparotomic and laparoscopic microsurgical interventions, tuboplasty is advantageous because it is minimally invasive with lower peri- and post-operative morbidity, takes less time, anesthesia is rarely required and the risks (e.g., injury of the bowel or bleeding after vessel perforation) are reduced thus resulting in shortened convalescence.[22]

Although radical changes have occurred in the treatment of PTO, the repair of distal and peritubal damage frequently yields disappointing results.[27] Fallopian tube catheterization is diagnostically useful and technically highly successful for treating occluded tubes, however, patients with distally blocked tubes are not good candidates for this procedure.[28,29] Distal isthmic, ampullary or fimbrial occlusions, commonly due to previous pelvic infection or endometriosis, are difficult to recanalize with poor pregnancy rates.


Contraindications to transluminal salpingoplasty include florid infections and genital tuberculosis, long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertility and previously performed tubal surgery. Because of the inflammation reaction in florid infections, the tubal wall is vulnerable, susceptible to rupture and, consequently, at risk for peritonitis, while long tubal obliterations that are difficult to bypass with the catheter may also result in a perforation of the tubal wall.[22] 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.[30] Cobblestone appearance of the distal tubes heralds significant mucosal damage, which is prone to progressive disease and, hence, there is a poor chance for conception.[31] Restoration of the tubal function (i.e., gamete or blastocyst transport) after tuboplasty is unlikely in cases with severe tubal damage. Cases with previous surgery must be well selected prior to tubal interventional surgery.[22] The rate of long-term post interventional re-occlusion seems to be high and must be evaluated in case of a failure to achieve a pregnancy after successful recanalization.