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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: Conclusion

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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]