Fallopian tube recanalization may reduce need for more invasive fertility treatments
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Implementing fallopian tube recanalization — an interventional radiology procedure — after selective salpingography may enable infertile women to conceive without undergoing more invasive treatments, according to researchers.
The conclusion was based on findings presented at the Society of Interventional Radiology Annual Scientific Meeting, showing that nearly 80% of women with “tubal blockage” had open tubes after the procedures.
“The procedures of selective salpingography and fallopian tube recanalization have been around for many years,” Lindsay Machan, MD, FRCP(C), FSIR, an associate professor in the department of radiology at the University of British Columbia in Vancouver, Canada, told Healio. “Although we do many in our practice, and our infertility clinic and colleagues find it useful in patient management, there are very few or even no procedures performed in many centers in North America.”
Hysterosalpingogram (HSG) indicates tubal blockage and, according to Machan, the study was conducted to quantify the outcomes of the researchers' approach "to investigating infertile women with tubal non-filling [with contrast material] on hysterosalpingogram in order to clarify the impact we are having on our patients.”
Machan and colleagues reviewed the radiographic images of 956 women (mean age, 36.5 years) referred between June 1, 2015, and June 1, 2021, and collated them with prior diagnostic HSG results. In the case of incomplete filling of one or both fallopian tubes, patients underwent selective salpingography followed by fallopian tube recanalization if necessary.
Technical, clinical success
Clinicians achieved technical success in 96.2% of patients, according to the study. Technical failures consisted of failed cannulation of either tube in two (0.2%) patients, failed cannulation of one tube in 27 (2.8%) patients and no attempt to cannulate in eight (0.8%) patients. There were 10 tubal perforations, although they were not manifested clinically.
In 724 patients with only one tube blocked on prior HSG:
- 193 (26.6%) had bilateral normal tubes on HSG under sedation;
- 320 (44.1%) underwent recanalization of one normal tube;
- 81 (11.1%) needed recanalization of both normal tubes;
- 106 (14.6%) had tubal disease identified during selective salpingography; and
- 24 (3.3%) were unsuccessful or not attempted.
Among 227 patients with both fallopian tubes blocked:
- 33 (14.5%) had bilateral normal tubes on HSG under sedation;
- 107 (47.1%) underwent recanalization of both tubes;
- 31 (13.7%) only needed recanalization of one tube;
- 45 (19.8%) had tubal disease identified during selective salpingography; and
- 11 (4.8%) were unsuccessful or not attempted.
Overall, “79.9% of women who had been told they had ‘tubal blockage’ left our department with open tubes,” Machan said. “Therefore, they have at least the possibility of conceiving normally or being treated with a lesser infertility treatment, such as intrauterine sperm injection. Another 15.8% had definitive clarification of tubal disease, allowing specific treatment.”
Clinical implications
According to Machan, selective salpingography followed by fallopian tube recanalization could be implemented for “any woman undergoing investigation for infertility with non-filling of one or both tubes on hysterosalpingogram,” with costs in the United States for such a procedure totaling $4,000.
Moving forward, Machan expressed that more awareness of the procedure is needed.
“Many infertility clinics are not aware of this procedure or may be aware of it but not have ready access to an interventional radiologist who performs the procedure,” he said. “In turn, many interventional radiologists may not be aware of the procedure or how many potential patients can be helped.”
Perspective
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Infertility can affect as many as one in six women in the United States and can have multiple causes. Blockage of the fallopian tube prevents the sperm and egg from being able to meet or transit normally into the uterus. An HSG is a study that evaluates the patency of the fallopian tubes. Treatment of tubal occlusion involves laparoscopic removal of the fallopian tube and IVF or opening the end of the tube either surgically or by using an interventional radiology procedure.
This study by Sharma and colleagues evaluated fallopian tube recanalization in women with a diagnosis of infertility who were found to have tubal occlusions on their HSG. They were able to cannulate — essentially open up an occluded fallopian tube — in 96% of patients while avoiding a surgical procedure. This study does not evaluate the pregnancy and delivery rates of women who have a successful procedure, which would be an interesting next step in determining the clinical utility of this procedure. Given the large impact of infertility, any options that we can offer to our patients are a welcome addition to infertility treatments.
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Sharma AK, et al. Radiologic findings in infertile women referred for selective salpingography and fallopian tube recanalization. Presented at: Society of Interventional Radiology Annual Scientific Meeting; June 11-16, 2022; Boston.
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