Ultrasonography-guided hysteroscopic tubal catheterization of proximally occluded tubes - reproductive outcomes

Abstract

Ultrasonography-guided hysteroscopic tubal catheterization of proximally occluded tubes - reproductive outcomes S. B. Cohen1, M. Shapira1, A. Baron1, J. Bouaziz1, R. Mashiach1, M. Goldenberg1, R. Orvieto1 1Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, and Sackler Faculty of Medicine, Tel - Aviv University, Tel- Hashomer (Israel) Summary Objective: To evaluate the reproductive outcomes of infertile patients suffering from proximal tubal occlusion (PTO) following ultrasonography- guided hysteroscopic tubal catheterization (HTC). Materials and Methods: A retrospective cohort study of infertile patients who underwent ultrasonography-guided HTC in a tertiary hospital, between 2010 and 2016. All patients included were diagnosed with unilateral/bilateral PTO on hysterosalpingograpy (HSG). HTC was performed using a modified Novy cornual cannulation set which was inserted through a 5F working cannel during an office operative hysteroscopy, followed by fallopian tube irrigation with saline-air mixture under ultrasonographic imaging. Patients who did not conceive in the following 6-12 months were referred to IVF treatment. Results: Sixty-one patients were included. Tubal recanalization rate was achieved in 25/25 of unilaterally occluded tubes (100%), and in 63/72 of bilaterally occluded tubes (87.5%). Median duration of follow up after catheterization was 40.57 months. In a median of 3.5 months following the procedure, 16 (26.2%) patients conceived spontaneously (n=14) or following intrauterine insemination (n=2), 12 (19.6%) of them delivered . Twenty-two additional patients underwent IVF after a median of 11 months following HTC. Sixteen of them conceived following a median of two cycles, of whom 75% failed IVF treatment prior to HTC. Conclusion: Ultrasonography- guided HTC may form an acceptable treatment modality in cases of PTO. Further research is needed to investigate the role of HTC in cases of PTO and repeated implantation failure. Key words: Reproductive outcomes; Proximal tubal occlusion (PTO; Ultrasound-guided hysteroscopy.