Introduction:
Infertility, or in the inability to conceive after one year of
unprotected intercourse under age 35 or six months of unprotected
intercourse in women age 35 and older, affects approximately 6.0% of
married U.S. women [1]. Infertility rates are higher in select
patient populations including those with known risk factors for
infertility including those who are of advanced age, endometriosis,
malformation of the genitourinary system, and those who have a history
of pelvic inflammatory disease. In 81% of women who suffer from
infertility, there is an identifiable cause, with 11% having a tubal
blockage [2].
Fallopian tubes are the conduit for the transportation of the oocyte
into the uterus and when damaged prevent normal transport of the oocyte
and sperm through the tube. The most common cause for tubal factory
infertility is secondary to pelvic inflammatory disease associated with
chlamydia or gonorrhea [3]. Diagnosis of tubal occlusion is often
made via hysterosalpingogram (HSG). In one study, in women who were
found to have proximal occlusion, 40% was caused by mucus plugging or
debris, while another 20% was secondary to uterotubal spasm [3-5].
In women who have a distal occlusion, laparoscopy and reconstructive
surgery is the treatment of choice, however, pregnancy rates were found
to be 12% [6]. In women who are diagnosed with a proximal tubal
occlusion, there are both surgical and non-surgical options. In women
who have true cornual obstruction, tubocoronual anastomosis can be
performed, however, often requires laparotomy, and intrauterine
pregnancy rates range from 16-55% and ectopic pregnancy rate from
7-30% [7]. Alternatively, a nonsurgical option such as selective
tubal catheterization, also known as fallopian tube recanalization
(FTR), can be performed.
Current application of fallopian tube recanalization (FTR), was first
described by Thurmond, et al in 1987. This procedure has the advantage
of both being diagnostic via selective salpingography and in the event
of tubal occlusion, therapeutic [8]. Historically, FTR has a
technical success rate of 60-80% with intrauterine pregnancy rate of
20-60%, with half achieving spontaneous pregnancy within one year
[9-11]. Complication rates of FTR are low with studies demonstrating
tubal perforation, infection, and ectopic pregnancy occurring from 1-9%
[12-19].
Even with data demonstrating FTR is a safe and effective procedure for
women who suffer from infertility secondary to proximal tubal occlusion,
the procedure is underutilized [19]. Reasons for underutilization is
multifactorial, but includes limited specific patient population,
perceived technical difficulty, and radiation dose to the ovaries
[19]. Given the limited data on this procedure, this study was
performed to determine outcomes in a large cohort of patients in a
tertiary medical center, after technically successful FTR in women who
suffer infertility secondary to tubal occlusion.