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.