Interventional Radiology in New York City

Fallopian tube blockage

Fallopian tube abnormalities are common causes of infertility, affecting almost 30% of couples presenting for a fertility evaluation. A proximal tubal blockage is estimated to comprise approximately 10–25% of women with tubal disease. The initial screening test for determining fallopian tube patency is a hysterosalpingogram (HSG).

Selective Salpingography

Selective Salpingography is a minimally invasive, non-surgical procedure used to reopen blockages in one or both of the fallopian tubes. This low-risk procedure is recommended as the first intervention for patients with an obstruction of the proximal fallopian tube – where the uterus meets the fallopian tube.

Causes of proximal fallopian tube blockage

Although the specificity of HSG is high, there is a significant false positive rate, with many patients who genuinely have patent tubes being misdiagnosed with tubal disease. This is especially true in patients diagnosed with proximal tubal disease because there are other common treatable entities (tubal spasm, mucous plugs, mild adhesions or cellular debris) that can masquerade as tubal blockage.

Technique

During the selective salpingography procedure, the fallopian tubes are opacified by a catheter placed in the tubal ostia, where the uterus meets the fallopian tube, and radiographic contrast is then injected. Often, reversible tubal blockage, which otherwise would have been documented as proximal tubal obstruction on routine diagnostic HSG, can be cured by this technique. Fallopian tube recanalization (FTR) is another option in patients who display tubal blockage despite selective salpingography.

Results

Recent evidence suggests that the addition of selective salpingography may improve diagnostic evaluation of the fallopian tubes and even improve pregnancy rates in treatment cycles. Fallopian tube recanalization is also useful in demonstrating tubal patency, reducing the diagnosis of tubal disease, and potentially minimizing surgery in infertile patients.

The American Society for Reproductive Medicine (ASRM) recommends selective salpingography as the next step following the diagnosis of proximal tubal obstruction on HSG. Reports have shown a technical success rate of up to 92%, with post- procedure clinical pregnancy rates of up to 30%.

Selective salpingography allows many patients who would be diagnosed with tubal factor infertility following conventional HSG to establish the actual status of their tubes and give them a chance at conceiving with little or no infertility treatment.

References

• Hysterosalpingography with selective salpingography. Vardhana PA, Silberzweig JE, Guarnaccia M, Sauer MV. J Reprod Med. 2009;54:126-32.
• Fallopian tube catheterization. Thurmond AS. Semin Intervent Radiol. 2008 Dec;25(4):425-31.
• A review of selective salpingography and fallopian tube catheterization. Thurmond AS, Machan LS, Maubon AJ, Rouanet JP, Hovsepian DM, Moore A, Zagoria RJ, Dickey KW, Bass JC. Radiographics. 2000 Nov-Dec;20(6):1759-68.