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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.

CME

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

  • Authors: Gautam N. Allahbadia, MD; Rubina Merchant, PhD
  • CME Released: 7/2/2010
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 7/2/2011, 11:59 PM EST
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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


Disclosures

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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.


Author(s)

  • Gautam N. Allahbadia, MD

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

    Disclosures

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

  • Rubina Merchant, PhD

    Rotunda -- Center for Human Reproduction, Mumbai, India

    Disclosures

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

Editor(s)

  • Elisa Manzotti

    Editorial Director, Future Science Group, London, United Kingdom

    Disclosures

    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

    Disclosures

    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

    Disclosures

    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

  • Marilyn W. Edmunds, PhD, CRNP

    CME Accreditation Specialist, Nurse Practitioner Alternatives

    Disclosures

    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.

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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]


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CME

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges: Future Challenges

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Future Challenges

Despite the diagnostic superiority of falloposcopy in the visualization of endotubal disease and in vivo exploration of tubal physiology and its therapeutic advantages, technical shortcomings associated with falloposcopy (e.g., white-out due to the intense light in close proximity of tissues, kinking leading to catheter damage and impediment of successful falloposcope insertion) as well as personal expertise required with the technique, limit the usefulness of this method in routine clinical practice. Hence, we envisage a robotically assisted hysteroscopic–falloposcopic FTR technique under ultrasonic vision using the atraumatic Cook echotip embryo-transfer catheters to facilitate visualization and cannulation. While overcoming the necessary technical shortcomings associated with the technique, a robotically assisted manipulation would facilitate the catheter maneuver along the tortuous trajectory of the proximal Fallopian tube. Ultrasound-guided cannulation would help map the catheter path, avoiding tubal perforations during guidewire cannulation. The micromanipulation could alternatively be simulated on a monitor akin to that used for intracytoplasmic sperm injection. The use of thermally controlled catheters/guidewires may present the possibility of effectively clearing fibrotic occlusions that have so far evaded recanalization.