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, 11:59 PM EST
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: Tubal Cannulation or IVF?


Tubal Cannulation or IVF?

In patients with documented tubal disease, options for management would essentially include expectant management, tubal surgery or IVF. Advances in minimally invasive endoscopic cannulation techniques and the soaring acceptance and applications of IVF question the surgical management of patients presenting with tubal damage. Until the widespread use of IVF in the beginning of the 1980s, tubal surgery was the only available option for restoration of fertility in patients with PTO. Although tubal microsurgery and IVF may be complementary options in the management of patients with tubal obstruction following failed FTR, and although microsurgery to correct localized damage has the advantage of long-standing restoration of fertility, poor pregnancy rates with tubal microsurgery in patients with severe tubal damage and the lack of technical skill required to perform these procedures has resulted in a liberal referral to IVF. Selection of patients with tubal disease for future therapeutic management is based on tubal lesions, including the aspect of tubal mucosa and tubo-peritoneal environment,[4] and the severity of the tubal damage and the health of the mucosa is key in determining the outcome. Where the mucosa is unhealthy, surgery is not justified; early referral for IVF is indicated.[81]

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] and distal tubal obstruction, caused by fibrosis and peritubal disease, is often not amenable to catheter recanalization techniques. While a functional obstruction may be amenable to conservative management, true occlusion may require management by microsurgical techniques or IVF.[14] Cases of failed fluoroscopically guided tubal canalization have been attributed to severe intrinsic tubal disease and tubal occlusion rather than to the technique.[14] Significantly higher pregnancy rates have been reported in patients without distal disease than those with bipolar tubal disease (49 vs 12%, life table-adjusted rate; p = 0.0002) independent of underlying etiology for tubal disease.[73] Dechaud et al. reported no pregnancies in patients with severe endotubal lesions despite a high tubal catheterization rate following falloposcopically guided cannulation.[47] Following nonhysteroscopic falloposcopy under laparoscopic control, Lee reported that while interstitial tubal obstruction was overcome with the LEC, among the 15 cases with hydrosalpinx or fimbrial obstruction, 67% of the cases with flattened mucosa in the endosalpinx and endotubal adhesions were suitable for IVF and 27% cases with normal mucosa were suitable for tuboplasty.[34] Letterie and Luetkehans reported no pregnancies following Fallopian tube canalization and microsurgery in patients with bipolar tubal occlusion after 12 and 18 months follow-up.[82] They suggested that in lieu of the lower patency rates and higher recurrence rates of PTO when compared with data of prior studies, IVF, although more costly, may ultimately represent the most expedient and effective method of management of coexistent proximal and distal tubal disease (bipolar disease).[82] Microsurgical repair of bipolar tubal damage yields poor pregnancy rates and the expertise required to perform these techniques is not always available. Because distally obstructed tubes cannot be successfully catheterized, the potential impact of FTR depends on the percentage of cases in which the occlusion is proximal. Tubal surgery or IVF treatment is not influenced adversely by prior transcervical tubal recanalization and remains an option for patients who failed to attain pregnancy.[83]