Outcome of Laparoscopy-Guided Hysteroscopic Tubal Catheterization for Infertility Due to Proximal Tubal Obstruction |
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| Affiliation: | 1. Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People''s Armed Police Force Logistics College, Tianjin, China;2. Jessop Wing, Sheffield Teaching Hospitals, Sheffield, England;1. Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;2. Fetal Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;1. Institut Robert B. Greenblatt, Bordeaux, France;2. Department of Obstetrics, Gynecology and Reproduction, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France;3. Centre de Fécondation in Vitro, Polyclinique Jean Villar, Bruges, France;4. Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Bichat, Paris, France;1. AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France;2. Faculty of Medicine, University Paris-Saclay, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;3. Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France |
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| Abstract: | Study ObjectiveTo determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization.DesignClinical cases series (Canadian Task Force classification II-3).SettingReproductive surgery center.PatientsPatients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included.InterventionsLaparoscopy-guided hysteroscopic tubal catheterization.Measurements and Main ResultsOnly the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years).ConclusionSuccessful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization. |
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| Keywords: | Hysteroscopic tubal catheterization Infertility Laparoscopy Proximal tubal obstruction |
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