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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
  • Valid for credit through: 7/2/2011
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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

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.


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

Authors: Gautam N. Allahbadia, MD; Rubina Merchant, PhDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 7/2/2010

Valid for credit through: 7/2/2011

processing....

Executive Summary

  • Minimally invasive transcervical tubal catheterization procedures provide an excellent alternative to invasive and expensive surgical procedures and assisted reproductive technologies for the diagnosis of tubal disease and treatment of minimally diseased proximal Fallopian tubes.
  • Fallopian tube recanalization (FTR) can be performed with catheters, flexible atraumatic guide wires or balloon systems under endoscopic (falloposcopy/hysteroscopy/laparoscopy), sonographic, fluoroscopic or tactile guidance.
  • Falloposcopy provides a unique possibility to accurately visualize, characterize and grade endotubal disease, identify the segmental location of tubal pathology without complications, objectively classify the cause of proximal tubal obstruction and guide future patient management in contrast to laparoscopy and hysterosalpingography that are often associated with poor or misdiagnosis of proximal tubal obstruction.
  • Nonhysteroscopic transuterine falloposcopy, using the linear eversion catheter, is a well-tolerated technique that can be performed in an outpatient clinic with high rates of luminal cannulation and visualization and a good predictive value for future fertility.
  • Techniques of tubal aquadissection, guide wire cannulation, wire guide dilatation and direct balloon tubuloplasty, under hysteroscopic–falloposcopic–laparoscopic control, have been therapeutically used to breakdown intraluminal adhesions, and dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates.
  • The difficulty in ruling out tubal spasm, inability to evaluate distal tubal disease and other pelvic abnormalities and radiation exposure with fluoroscopy, and requirement of fluoroscopy for successful cannulation of the internal tubal ostia and failure to effectively evaluate the tubal mucosa with sonographic techniques limit the application of these techniques despite the reportedly high patency and intrauterine pregnancy rates.
  • Guidewire cannulation of proximally obstructed tubes yields much lower pregnancy rates compared with other catheter techniques despite the high tubal patency rates.
  • Recanalization is contraindicated in florid infections, genital tuberculosis, obliterative fibrosis, long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertility and previously performed tubal surgery.
  • Distal tubal obstruction is not amenable to catheter recanalization techniques, and 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.
  • In lieu of the poor pregnancy outcomes in patients with severe tubal disease, poor mucosal health following tubal recanalization and poor available technical skills and results with microsurgery, such women should be provided with the option of IVF and embryo transfer.
  • Despite the high diagnostic and therapeutic power of falloposcopic interventions, technical shortcomings with falloposcopy must be overcome before the procedure gains widespread acceptance.
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