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.

Deaton JL, Gibson M, Riddick DH Jr: Diagnosis and treatment of cornual obstruction using a flexible tip guidewire. Fertil. Steril. 53, 232–236 (1990).
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Das S, Nardo LG, Seif MW: Proximal tubal disease: the place for tubal cannulation. Reprod. Biomed. Online 15, 383–388 (2007).
Watrelot A: Place of transvaginal fertiloscopy in the management of tubal factor disease. Reprod. Biomed. Online 15, 389–395 (2007).
Allahbadia GN, Naik P, Allahbadia SG: Should tactile-guided trans-uterine cannulation always be the first line treatment for all proximal tubal blocks or are there exceptions In: The Fallopian Tube. Allahbadia GN, Djahanbakhch O, Saridogan E (Eds). Anshan Publishers, UK 236–245 (2009).
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Spiewankiewicz B, Stelmachów J: Hysteroscopic tubal catheterization in diagnosis and treatment of proximal oviductal obstruction. Clin. Exp. Obstet. Gynecol. 22, 23–27 (1995).
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Kerin JF, Surrey ES, Williams DB, Daykhovsky L, Grundfest WS: Falloposcopic observations of endotubal isthmic plugs as a cause of reversible obstruction and their histological characterization. J. Laparoendosc. Surg. 1, 103–110 (1991).
•Reports on the therapeutic success of endoscopic tubal cannulation and their histological characterization.
Fortier KJ, Haney AF: The pathologic spectrum of uterotubal junction obstruction. Obstet. Gynecol. 65, 93–98 (1985).
•Reports on the pathologic spectrum of uterotubal junction obstruction.
Letterie GS, Sakas EL: Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization. Fertil. Steril. 56, 831–835 (1991).
•Provides a classification of proximal tubal obstruction facilitating management.
Wiedemann R, Sterzik K, Gombisch V, Stuckensen J, Montag M: Beyond recanalizing proximal tube occlusion: the argument for further diagnosis and classification. Hum. Reprod. 11, 986–991 (1996).
Schill T, Bauer O, Felberbaum R, Küpker W, Al-Hasani S, Diedrich K: Transcervical falloscopic dilatation of proximal tubal occlusion. Is there an indication? Hum. Reprod. 14(Suppl. 1), 137–144 (1999).
Valle RF: Tubal cannulation. Obstet. Gynecol. Clin. North Am. 22(3),519–540 (1995).
•Discusses the advantages of tubal recanalization methods over traditional surgical methods.
Milad MP, Corfman RS: Falloposcopy. Curr. Opin. Obstet. Gynecol. 4, 406–411 (1992).
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Papaioannou S, Jafettas J, Afnan M: The use of selective salpingography and tubal catheterization in the management of infertility. In: The Fallopian Tube. Allahbadia GN, Djahanbakhch O, Saridogan E (Eds). Anshan Publishers, UK 180–190 (2009).
Kerin JF: New methods for transcervical cannulation of the Fallopian tube. Int. J. Gynaecol. Obstet. 51(Suppl. 1), S29–S39 (1995).
••Highlights the therapeutic advantages of endoscopic tubal recanalization methods.
Confino E, Friberg J, Gleicher N: Transcervical balloon tuboplasty. Fertil Steril 46, 963–966 (1986).
Finas D, Diedrich K: Tubal catheterization: when and how In: The Fallopian Tube. Allahbadia GN, Djahanbakhch O, Saridogan E (Eds). Anshan Publishers, UK 222–227 (2009).
••Highlights the advantages of tubal cannulation methods over invasive surgical alternatives and its limitations.
Flood JT, Grow DR: Transcervical tubal cannulation: a review. Obstet. Gynecol. Surv. 48, 768–776 (1993).
Wenzl R, Kiss H, Schurz B, Huber J, Husslein P: Tuboscopy – new developments for accurate tubal diagnosis [Article in German]. Geburtshilfe Frauenheilkd. 54, 47–50 (1994).
Kiss H, Wenzl R, Egarter C: Tuboscopy. Initial experiences with microendoscopic tubal diagnosis [Article in German]. Wien Klin. Wochenschr. 105, 719–722 (1993).
Risquez F, Confino E: Transcervical tubal cannulation, past, present, and future. Fertil. Steril. 60, 211–226 (1993).
Confino E, Radwanska E: Tubal factors in infertility. Curr. Opin. Obstet. Gynecol. 4(2), 197–202 (1992).
Hayashi M, Hoshimoto K, Ohkura T: Successful conception following Fallopian tube recanalization in infertile patients with a unilateral proximally occluded tube and a contralateral patent tube. Hum. Reprod. 18, 96–99 (2003).
Hayashi N, Kimoto T, Sakai T et al.: Fallopian tube disease: limited value of treatment with Fallopian tube catheterization. Radiology 190, 141–143 (1994).
Li QY, Zhou XL, Qin HP, Liu R: Analysis of 1006 cases with selective salpingography and Fallopian tube recanalization [Article in Chinese]. Zhonghua Fu Chan Ke Za Zhi 39, 80–82 (2004).
Lang EK, Dunaway HE Jr: Salpingographic demonstration of ‘cobblestone’ mucosa of the distal tubes is indicative of irreversible mucosal damage. Fertil. Steril. 76, 342–345 (2001).
Lundberg S, Rasmussen C, Berg AA, Lindblom B: Falloposcopy in conjunction with laparoscopy: possibilities and limitations. Hum. Reprod. 13, 1490–1492 (1998).
•Discusses the possibilities and limitations of falloposcopy.
Menashe Y, Rosen DJ, Surrey E, Kerin JF: Falloposcopy – a new method for evaluation and treatment of infertility due to tubal factors [Article in Hebrew]. Harefuah 124(1), 8–12, 64 (1993).
Lee KK: Diagnostic and therapeutic value of nonhysteroscopic transvaginal falloposcopy with a linear everting catheter. Zhonghua Yi Xue Za Zhi (Taipei) 61, 721–725 (1998).
Kerin JF, Williams DB, San Roman GA, Pearlstone AC, Grundfest WS, Surrey ES: Falloposcopic classification and treatment of Fallopian tube lumen disease. Fertil. Steril. 57, 731–41 (1992).
••Reports on the success of tubal cannulation methods, its limitations and indications for alternative therapy.
Kerin J, Surrey E, Daykhovsky L, Grundfest WS: Development and application of a falloposcope for transvaginal endoscopy of the Fallopian tube. J. Laparoendosc. Surg. 1, 47–56 (1990).
••Examines the coaxial falloposcopy procedure, the characterization of tubal disease with endoscopic tubal cannulation, the technical difficulties with the procedure and how these may be overcome.
Kerin J, Daykhovsky L, Grundfest W, Surrey E: Falloposcopy. A microendoscopic transvaginal technique for diagnosing and treating endotubal disease incorporating guide wire cannulation and direct balloon tuboplasty. J. Reprod. Med. 35, 606–612 (1990).
Rimbach S, Wallwiener D, Bastert G: Tubal catheterization and Fallopian tube endoscopy for expanded diagnosis in tubal sterility. [Article in German]. Zentralbl Gynakol. 118, 87–93 (1996).
Surrey ES, Adamson GD, Nagel TC et al.: Multicenter feasibility study of a new coaxial falloposcopy system. J. Am. Assoc. Gynecol. Laparosc. 4, 473–478 (1997).
Rimbach S, Bastert G, Wallwiener D: Technical results of falloposcopy for infertility diagnosis in a large multicentre study. Hum. Reprod. 16, 925–930 (2001).
•Reports the technical difficulties with falloposcopic coaxial tubal cannulation and reports the failure rate.
Pennehouat G, Risquez F, Naouri M et al.: Transcervical falloposcopy: preliminary experience. Hum. Reprod. 8, 445–449 (1993).
Sueoka K, Asada H, Tsuchiya S, Kobayashi N, Kuroshima M, Yoshimura Y: Falloposcopic tuboplasty for bilateral tubal occlusion. A novel infertility treatment as an alternative for in-vitro fertilization Hum. Reprod. 13, 71–74 (1998).
Surrey ES, Adamson GD, Surrey M et al.: Introduction of a new coaxial falloposcopy system. J. Am. Assoc. Gynecol. Laparosc. 3(4 Suppl.), S48 (1996).
Deichert U, Schlief R, van de Sandt M, Göbel R, Daume E: Deichert for the assessment of Fallopian tube patency [Article in German]. Geburtshilfe Frauenheilkd. 50, 717–721 (1990).
Aghssa MM, Ansari S, Khazali K: Investigation of tubal disease. In: The Fallopian Tube. Allahbadia GN, Djahanbakhch O, Saridogan E (Eds). Anshan Publishers, UK 203–212 (2009).
Porcu E, Dal Prato L, Seracchioli R, Petracchi S, Fabbri R, Flamigni C: Births after transcervical gamete intraFallopian transfer with a falloposcopic delivery system. Fertil. Steril. 67, 1175–1177 (1997).
Dechaud H, Daures JP, Hedon B: Prospective evaluation of falloposcopy. Hum. Reprod. 13, 1815–1818 (1998).
•Predictive value of falloposcopy in terms of pregnancy outcome.
Scudamore IW, Dunphy BC, Cooke ID: Outpatient falloposcopy: intra-luminal imaging of the Fallopian tube by trans-uterine fibre-optic endoscopy as an outpatient procedure. Br. J. Obstet. Gynaecol. 99, 829–835 (1992).
Shinmoto H, Ido K, Sumi K et al.: Fallopian tube recanalization with a catheter system – experience in the use of a balloon catheter [Article in Japanese]. Nippon Igaku Hoshasen Gakkai Zasshi 51, 143–148 (1991).
Rösch J, Thurmond AS, Uchida BT, Sovak M: Selective transcervical Fallopian tube catheterization: technique update. Radiology 168, 1–5 (1988).
Gleicher N, Redding L, Parrilli M, Karande V, Pratt D: Wire guide cannulation alone is no treatment of proximal tubal occlusion. Hum. Reprod. 9, 1109–1111 (1994).
Novy MJ, Thurmond AS, Patton P, Uchida BT, Rosch J: Diagnosis of cornual obstruction by transcervical Fallopian tube cannulation. Fertil. Steril. 50, 434–440 (1988).
Grow DR, Coddington CC, Flood JT: Proximal tubal occlusion by hysterosalpingogram: a role for falloposcopy. Fertil. Steril. 60, 170–174 (1993).
Valle RF: Hysteroscopy. Curr. Opin. Obstet. Gynecol. 3, 422–426 (1991).
Rimbach S, Wallwiener D, Rauchholz M, Bastert G: New aspects in therapy of proximal tubal occlusion: hysteroscopic proximal tubal catheterization [Article in German]. Zentralbl Gynakol. 116, 230–235 (1994).
Zhu GJ, Luo LL, Lin H: Diagnosis and treatment of cornual obstruction by transcervical Fallopian tube cannulation under hysteroscopy [Article in Chinese]. Zhonghua Yi Xue Za Zhi 74, 203–205 (1994).
Burke RK: Transcervical tubal catheterization utilizing flexible hysteroscopy is an effective method of treating cornual obstruction: a review of 120 cases. J. Am. Assoc. Gynecol. Laparosc. 1(4 Pt 2), S5 (1994).
Lin BL, Iwata Y, Liu KH, Valle RF: Clinical applications of a new Fujinon operating fiberoptic hysteroscope. J. Gynecol. Surg. 6, 81–87 (1990).
•Discusses the clinical applications of a new Fujinon operating fiberoptic hysteroscope.
Lin BL, Iwata Y, Liu KH, Valle RF: The Fujinon diagnostic fiber optic hysteroscope. experience with 1,503 patients. J. Reprod. Med. 35, 685–689 (1990).
•Discusses the clinical results using the Fujinon operating fiberoptic hysteroscope.
Lei ZW, Xiao L, Xie L, Li J, Chen QX: Hysteroscopic hydrotubation for treatment of tubal blockage. Int. J. Gynaecol. Obstet. 34, 61–64 (1991).
Li SC, Liu MN, Hu XZ, Lu ZL: Hysteroscopic tubal catheterization and hydrotubation for treatment of infertile women with tubal obstruction. Chin. Med. J. (Engl.)107, 790–793 (1994).
Sakumoto T, Shinkawa T, Izena H et al.: Treatment of infertility associated with endometriosis by selective tubal catheterization under hysteroscopy and laparoscopy. Am. J. Obstet. Gynecol. 169, 744–747 (1993).
Li SC: Selective salpingography and tubal cannulation through hysteroscopy [Article in Chinese]. Zhonghua Fu Chan Ke Za Zhi 28, 411–413 (1993).
Sowa M, Shimamoto T, Nakano R, Sato M, Yamada R: Diagnosis and treatment of proximal tubal obstruction by fluoroscopic transcervical Fallopian tube catheterization. Hum. Reprod. 8, 1711–1714 (1993).
Honoré GM, Holden AE, Schenken RS: Pathophysiology and management of proximal tubal blockage. Fertil. Steril. 71, 785–795 (1999).
Ransom MX, Garcia AJ: Surgical management of cornual-isthmic tubal obstruction. Fertil. Steril. 68, 887–891 (1997).
Das K, Nagel TC, Malo JW: Hysteroscopic cannulation for proximal tubal obstruction: a change for the better Fertil. Steril. 63, 1009–1015 (1995).
Possati G, Seracchioli R, Melega C, Pareschi A, Maccolini A, Flamigni C: Gamete intraFallopian transfer by hysteroscopy as an alternative treatment for infertility. Fertil. Steril. 56, 496–499 (1991).
Seracchioli R, Possati G, Bafaro G et al.: Hysteroscopic gamete intra-Fallopian transfer: a good alternative, in selected cases, to laparoscopic intra-Fallopian transfer. Hum. Reprod. 6, 1388–1390 (1991).
Schmitz-Rode T, Neulen J, Günther RW: Fluoroscopically guided Fallopian tube recanalization with a simplified set of instruments [Article in German]. Rofo 176, 1506–1509 (2004).
Thurmond AS, Machan LS, Maubon AJ et al.: A review of selective salpingography and Fallopian tube catheterization. Radiographics 20, 1759–1768 (2000).
Woolcott R, Petchpud A, O’Donnell P, Stanger J: Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal Fallopian tube obstruction. Hum. Reprod. 10(6), 1423–1426 (1995).
Gleicher N, Confino E, Corfman R et al.: The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies. Hum. Reprod. 8, 1264–1271 (1993).
Lasry JL, Guillet JL, Madelenat P, Marotel M: Proximal tubal obstruction. Treatment by recanalization and transcervical dilatation [Article in French]. Presse Med. 22, 622–625 (1993).
Osada H, Kiyoshi Fujii T, Tsunoda I, Tsubata K, Satoh K, Palter SF: Outpatient evaluation and treatment of tubal obstruction with selective salpingography and balloon tuboplasty. Fertil. Steril. 76, 427–428 (2001).
Confino E, Tur-Kaspa I, Gleicher N: Sonographic transcervical balloon tuboplasty. Hum. Reprod. 7, 1271–1273 (1992).
Stern JJ, Peters AJ, Bustillo M, Coulam CB: Colour Doppler ultrasound guidance for transcervical wire tuboplasty. Hum. Reprod. 8(10), 1715–1718 (1993).
Sohn C, Wallwiener D, Rimbach S, Bastert G: Initial results of intraluminal ultrasound in gynecologic diagnosis. J. Am. Assoc. Gynecol. Laparosc. 2, 323–326 (1995).
Wiedemann R, Rösch T, Stuckensen J, Hepp H: Trans-uterine Fallopian tube catheterization – a noninvasive, ambulatory evaluation of Fallopian tube patency [Article in German]. Geburtshilfe Frauenheilkd. 54, 39–46 (1994).
Lisse K, Sydow P: Fallopian tube catheterization and recanalization under ultrasonic observation: a simplified technique to evaluate tubal patency and open proximally obstructed tubes. Fertil. Steril. 56, 198–201 (1991).
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Letterie GS, Luetkehans T: Reproductive outcome after Fallopian tube canalization and microsurgery for bipolar tubal occlusion. J. Gynecol. Surg. 8, 11–13 (1992).
•Discusses the significance of assisted reproduction in severe tubal disease inamenable to tubal cannulation.
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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

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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.

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
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:

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

Disclosures

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.

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Conclusion

The diverse applications, safety, efficacy, credibility, noninvasiveness, reduced risks, costs and morbidity and encouraging results with endoscopic FTR in the evaluation and treatment of tubal obstructions make this procedure an excellent alternative to surgical invasive procedures (e.g., microsurgical tubal anastomosis and assisted reproduction), and should be offered as the initial method to treat proximally obstructed Fallopian tubes in well-selected patients. Falloposcopy is a diagnostically accurate procedure for evaluating and grading tubal disease with a good predictive value for future fertility, and falloposcopically-guided interventions under hystero–laparoscopic control have been therapeutically used to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, severe tubal disease with poor mucosal health, obliterative fibrosis, distal tubal obstruction and bipolar tubal damage are not amenable to recanalization techniques, and following an accurate diagnosis of the tubal mucosa and tubo-peritoneal environment, such cases must directly be referred for IVF. Moreover, technical shortcomings associated with falloposcopy limit the routine application of this procedure. The latest improvements in sonographic equipment and catheter technology may help eliminate radiation and replace fluoroscopy during the performance of transcervical balloon tuboplasty, making sonographic transcervical tubal catheterization a simple and cost-effective procedure for the diagnosis and treatment of patients with PTO.^[76]

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Page 7 of 7

CME Information

Abstract and Introduction
Clinical Discussion
Applications of FTR
Fallopian Tube Recanalization Techniques
Tubal Cannulation or IVF?
Future Challenges
Conclusion

Table 1.

Box 1.

Table 2.

CME

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

Target Audience and Goal Statement

Disclosures

Author(s)

Gautam N. Allahbadia, MD

Rubina Merchant, PhD

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

Marilyn W. Edmunds, PhD, CRNP

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges: Conclusion

Conclusion

Table of Contents

Reprint Address

Table 1.

Box 1.

Table 2.

References

Faculty and Disclosures

Author(s)

Gautam N. Allahbadia, MD

Rubina Merchant, PhD

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

Marilyn W. Edmunds, PhD, CRNP

CME

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

Target Audience and Goal Statement

Disclosures

Author(s)

Gautam N. Allahbadia, MD

Rubina Merchant, PhD

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

Marilyn W. Edmunds, PhD, CRNP

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges: Conclusion

Conclusion

Table of Contents

Reprint Address