Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal Fallopian tube obstruction

A total of 66 patients with proximal Fallopian tube (113 tubes)obstruction, as diagnosed by both laparoscopy and hysterosalpingogram,were each subjected to a transcervical recanalization proceduresequentially using selective salpingography followed, if necessary,by tubal catheterization with a soft Teflon 2-French catheterand finally, if needed, wire-guide cannulation. Each procedurewas terminated once patency had been achieved without recourseto the next technique. Bilateral obstruction was present in47 patients and unilateral in 19 patients. Patency was achievedin 39 (34.5%) Fallopian tubes by selective salpingography alone,in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wireguide, with 12 (10.6%) tubes remaining obstructed. Pregnancyoccurred in 24 (36.4%) patients without recourse to other treatment(mean follow-up, 17 months). Where patency was achieved (59patients), 19 out of 43 (44.1%) of those treated for bilateralobstruction and five out of 16 (31.3%) of those treated forunilateral obstruction achieved a pregnancy. Pregnancy occurredin six out of 22 patients (27.3%) where selective salpingographywas used to produce tubal patency, in 17 out of 30 patients(56.7%) where tubal catheterization was used and in one outof seven (14.3%) where a wire guide was used, which was an ectopicpregnancy. The difference between the ongoing pregnancy ratesfollowing tubal catheterization (50.0%) and wire-guide cannulation(0.0%) was significant (P = 0.033). While wire-guide cannulationis the most effective method used to achieve tubal patency,these results indicate that when it is truly necessary, as opposedto electively used by clinicians, the prognosis with regardto pregnancy is poor and alternative therapy such as microsurgeryor in-vitro fertilization should be considered early.