‘-‘,‘:‘,--:‘.
RadloGraphics index terms: Genitourinary imaging GENITAL TRACT, FEMALE Interventlonal radiology GENITOURINARY CumulatIve Index Fallopian tubes, Interventlonal SterIlIty
Fluoroscopic transcervical fallopian tube catheterization for diagnosis and treatment of female infertility caused by tubal obstruction
terms: procedure
Amy
THIS EXHIBIT WAS DISPLAYED AT THE 73RD SCIENTIFIC ASSEMBLY AND ANNUAL MEETING OF THE RADIOLOGICAL SOCIETY OF NORTH AMERICA, NOVEMBER 29-DECEM-
S. Thurmond,
Josef
R#{243}sch,M.D.
Phillip
F. Patton,
Kenneth Miles
MD.’
M.D.
A. Burry, Novy,
M.D.
M.D.
BER 4. 1987. CHICAGO. ILLINOIS. IT WAS RECOMMENDED BY THE GENITOURINARY RADIOLOGY PANEL AND WAS ACCEPTED FOR PUBLI-
CATION
AFTER PEEP REVIEW AND
REVISION
ON MAY
3, 1988.
From the Departments Diagnostic
Radiology
of
and
Ob-
The described technique simplifies the diagnosis of fallopian tube disease and has promising potential for nonsurgical treatment of female infertility caused by fallopian tube obstruction.
stetrics and Gynecology. and the Charles 1. Dotter Memorial Research Laboratory for Interventional
Health Portland,
Radiology,
Sciences
Oregon
University,
Introduction
Oregon.
Fellow of the Padiological Society of North America Research and Education Fund. *
Supported in part by the Radiological Society of North America Research and Edu-
cation Fund, and in part. by the George Alfred Cook Memorial
Fund
through
the
Medi-
cal Research Foundation of Oregon. Address reprint requests to A. S. Thurmond. M.D., L-342, Oregon Health Sciences University, 3181 SW. Sam Jackson Park Road, Portland, OR 97201.
In the United States, 3.5 million infertility (1). Fallopian tube disease
couples suffer from undesired is the single most common
cause
of infertility and, therefore, an examination of the woman’s fallopian tubes is an early step in the evaluation of the infertile couple (13). Hysterosalpingography (HSG) has been used since the 1920s to evaluate the fallopian tubes. A major limitation of HSG, however, is a finding of proximal obstruction up to 25% of HSG examinations technical underfilling or spasm intraluminal debris, endometriosis.
of the
fallopian
(10). Its etiologies
tubes,
which
range
of the tube to occlusion adhesions, or fibrosis
occurs
from by
(3,10). HSG has not been able to determine the cause of obstruction or to differentiate spasm from anatomic occlusion, despite the use of various antispasmodics or repeat examinations (12). Surgery is, therefore, performed to define the nature of the obstruction and to correct it, particularly if obstruction is bilateral (6).
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in
Fallopian
Thurmond
tube Catheterization
Current
Surgical
Evaluation
and
Treatment
Surgical evaluation starts with transcervical instillation of indigocarmine dye in the uterus and direct visualization of the fallopian tubes by laparoscopy. If proximal obstruction is confirmed, the patient will then have laparotomy with transection of the fallopian tube distal to the obstruction, probing and sometimes re-
section
of the occluded
reanastomosis
have not
suggested be the
that
most
and treatment. of surgical
segment,
(6). Recent
surgical
efficient
and tubal
studies,
however,
techniques
mode
Gross and microscopic
specimens
revealed
Fallopian
may
of evaluation
analysis
no evidence
Tube
of Proximal
#{149}t al.
Obstruction
anatomic occlusion in 50% of tubes resected for proximal obstruction; I 7% of tubes were
completely normal and 33% of resected tubes showed a plug of amorphous debris in the proximal tube (10). The surgical procedure requires 3-5 days of hospitalization and a few weeks’ recuperation. The two-year fertility rates following proximal tubal surgery range from 30%, when the obstruction is in the interstitial portion of the tube, to 50-70%, when the obstruction is at the interstitial isthmic junction (5).
of
Catheterization
for Proximal
Tube
Obstruction
In an attempt to diagnose more accurately, and possibly to treat proximal fallopian tube obstruction without surgery, we developed a method of fluoroscopically guided, transcervi-
cal fallopian
tube
catheterization
(8,11,13)
(Figure 1). It is an outpatient procedure lasting approximately 45 minutes, requiring mild sedation only. The patient goes home shortly after the procedure and continues her normal activities.
Figure 1 Schematic drawing of transcervlcal fallopian tube catheterization Procedure Fallopian tube catheterization is performed in the follicular phase of the cycle, lowing the cessation of bleeding. Patients
lected
for the procedure
doxycycline1 days before
receive
during
prophylactic
antibiotic for five days, starting the procedure. Sterile technique
used,
and intravenous
tanyl3
are
given
midazolam2
as needed
vice
folSe2 is
and fen-
for the
patient’s
discomfort, usually mild cramping (8,11). A hysterosalpingography device (Figures 2 and 3) is applied to the external cervix via a vacuum cup4. This allows traction on the uterus
622
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#{149} Volume
the
procedure,
permits
and
the introduction
the
shaft
of the
de-
of guidewires
and catheters without contamination by the vagina or cervix (Figures 2 and 3). A conventional HSG is performed first with the injection of Conray 60g. If obstruction is confirmed, the 9F sheath is introduced in the lower portion of the uterine cavity, and the 5SF catheter is advanced into the uterine cornu with the help of an 0.035” (0.089 cm) diameter guidewire with a small J-tip (8). Contrast agent is then injected directly into the tubal ostium in an attempt
8, Number
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Fallopian
tube Catheterization .
0
to visualize the fallopian (0.038 cm) platinum
the tube (Figure 4). If obstruction tube is again seen, the 0.0 15” diameter guidewire with a soft tip
is advanced
into
the
of
Fluoroscopy
are made to recanalize back and forth movements of the guidewire (8) (Figure 5). When this is accomplished, the 3F catheter is advanced over the guidewire to dilate the recanalized proxisegment.
The
guidewire
is then
removed,
and contrast agent is injected to visualize the entire fallopian tube and to confirm tubal recanalization (Figure 5). When probing of the midisthmic
portion
of the
tube
is needed,
which
easi-
tube
minutes
dose
per
to the
ings
time side,
ovaries,
of dosimeters
the
anterior
and
mately ization,
one the
diation
dose
and
rad. time are
is approximately the
calculated in the
posterior
pelvis,
With experience of the procedure decreased.
radiation
from
placed
readand
on
is approxiin catheterand the ra-
Patients
to resume normal activities, course, the day following
the
vagina
including the procedure.
are
able
inter-
it is done
.- .
I 3
2 2
3
1
4
5 2A 2B Figures 2A&B Vacuum cup hysterograph with inserted coaxial catheter set for selective, transcervical catheterization of the fallopian tubes (A) Upper end (B) Lower end catheter;
1 = hysterograph; 2 9 French Teflon 3 = 5.5 French polyethylene catheter; 4
3 French
Teflon
diameter
Cope mandril
catheter;
5
0.01 5” (0.038
guidewire
Figure 3 Hand vacuum pump for sealing hysterograph’s cup to the cervix (Mityvac; Neward Enterprises, Cucamonga,
CA)
cm)
with a soft plati-
num tip4
2
Warner Chilcott. Hoffman-LaRoche.
I
3
Elkins-Sinn.
4
Cook OB/GYN.
5
Mallinckrodt.
Morris Plains, NJ Nutley. NJ
Inc.,
Cherry Hill, NJ Spencer, IN St. Louis, MO
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a. 0
3-6
absorbed
0 0
C
(Fig-
ure#{243}).
fallopian
tube and attempts the tube with short,
mal
with an ultra soft tipped guidewire, ly follows the curves of the fallopian
623
Fallopian
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Thurmond
a) V a) U 0
4B Figure 4 Successful recanalization of the proximal right fallopian tube obstruction by ostial injection in a 33 year old woman with one year of infertility The patient conceived ongoing shows the left results normal
624
in the same cycle as the procedure and has an intrauterine pregnancy. (A) Conventional HSG proximal obstruction of the right fallopian tube; tube is patent. (B) Mild pressure ostial injection in opening the obstruction and visualization of tube.
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tube
Catheterization V 0 0 0
a. C
0
5C
5D Figure 5 Successful bilateral recanalization of proximal falloplan tube obstruction in a 34 year old woman with a history of Dalkon shield use, pelvic inflammatory disease and 13 years of infertility Previous HSG and laparoscopy showed bilateral proximal fallopian tube obstructions and tuboovarian adhesions. Recanalization was achieved on the right side with a small guidewire and catheter; on the left side by a mild pressure ostial injection. The patient had surgical lysis of adhesions and is attempting to get pregnant. (A) Right ostial injection confirms proximal fallopian tube obstruction. (B) Recanalization of the obstruction
with a soft platinum-tipped
guidewire.
(C) Dilation of the recanalized obstruction Teflon catheter.
(D) Injection
with a 3F
via the 3F catheter
re-
veals patent tube. (E) A moderate pressure, ostial
5E
injection on the left side results obstruction and the visualization
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in the opening of the of a patent tube.
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Fallopian
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a)
V a) U
0
a.
Figures 6A-D Successful bilateral recanalizatlon of occluded fallopian tubes in a 31 year old woman with 3 years of Infertility Previous HSG and laparoscopy showed bilateral proximal obstructions. On the left side, recanalization was achieved with a soft platinum-tipped guidewire and 3F catheter. On the right side, proximal obstruction was recanalized with a soft platinum-tipped
guidewire
and distal obstruction
with an ul-
trasoft platinum-tipped guidewire. The patient is one month post-procedure and attempting to get pregnant. (A) Left ostial injection confirms proximal fallopian tube obstruction. (B) Recanalization of the obstruction with a soft platinum-tipped guidewire. (C) Injection via the 3F catheter reveals normal patent tube. (D) Injection of the right tube via the 3F catheter after recanalization of the proximal obstruction reveals another obstruction at the proximal isthmic portion (arrowhead).
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0 0
0 .
a.
.
C
.
FIgures 6E-H (E) The obstruction is recanalized with an ultrasoft platinum-tipped guidewire. (F) Injection via the 3F catheter reveals another obstruction at the distal isthmic portion (arrowhead). (G) The obstruction is recanalized with an ultrasoft platinum-tipped guidewire. (H) Injection via the 3F catheter
reveals
normal
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patent tube.
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Fallopian
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Materials Fifty
lopian
consecutive
tube
women
obstruction,
conventional
with
HSG, gave
informed
and underwent fallopian tube The mean age of the patients the mean duration of infertility 15 patients
had
secondary six months.
infertility.
The procedure
proximal
demonstrated
primary
and
fal-
by consent
catheterization. was 31 years; was 4.6 years; 35 patients
The average
resulted
and
had
followup
is
tube
vi-
in fallopian
Results
sualization and significantly improved diagnosis in 44 (88%) women. In 3#{243} of these women who had patent tubes following the procedure, 10 intrauterine pregnancies and one ectopic pregnancy occurred in from I to 10 months, with a mean of 3.5 months after the study. In patients who did not conceive by 6 months, followup studies revealed continued patency in 19 of the 23 tubes studied (83%) (Figure 7).
Figure 7 Successful bilateral recanalization of proximal falloplan tube occlusions in a 24 year old woman with 7 years of Infertility Recanalization was achieved with soft platinum-tipped guidewire and 3F catheter. The patient’s
husband
had recently
undergone
rever-
sal of a previous vasectomy, and she did not get pregnant in 5 months. Followup HSG study showed widely
patent fallopian
tubes
bilaterally.
(A) HSG
shows bilateral interstitial fallopian tube obstruction. (B) Injection of the right tube after recanalization of the obstruction shows a normal patent tube. (C) Injection of the left tube after recanalization of the obstruction shows a normal patent tube. (D) Followup
HSG 5 months after recanalization demonstrates continued patency of both fallopian tubes. 7A
7c
7B
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tube catheterization
a a)
a a a. a) C
Improved Improved diagnosis obstructed tube(s) was
Diagnosis with the guidewire and small catheter (Figures 5-7). In these patients, obstruction may have
by visualization of the achieved in 44 worn-
en. Injection into the tubal ostiurn alone visualized the tubes in 13 women (Figure 4). The tubal obstruction
in these
diagnosed
women
underfilling which was
by conventional
was probably
of the flushed
of the contrast agent. quired recanalization
HSG
secondary
tubes or to minor out with selective
been
to
need
to severe
spasm,
for laparoscopy
ation and treatment tion in all 44 women.
debris injection
The other 31 women reof the obstructed tube NORMAL
due
intraluminal
endornetriosis, or mild fibrosis. Catheterization techniques
pended on the findings tubes (Table I).
FALLOPIAN
debris,
eliminated
or laparotorny
the
for evalu-
of proximal tubal obstrucFurther management dein the
distal
fallopian
TUBES
Following fallopian tube catheterization, the appearance of the tube(s) was normal or showed mild disease in 26 women. For these patients, tubal catheterization was the final procedure (Figures 4, 6
and 7). Table I Tubal Appearance Following Fallopian Tube CatheterIzatIon In 44 Women who had ProxImal Obstruction by Conventional HSG Tubes normal
14
Peritubal adhesions
12
Small dilation at site of recanalization Hydrosalpinx Severe salpingifis isfhmica nodosa Mild salpingitis isthmica nodosa
-
4 4 2 1
Dense infratubal adhesions
1
Stenosis at tubal ligation reversal site
3
(postoperative study) Tubal ligation site (preoperative
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Fallopian
Thurmond
tube catheterization
PATENT In ten
FALLOPIAN women,
recanalization either surgical proximal tubal
distal
TUBES
WITH
tubal
disease
SUGGESTION was
demonstrated
and 3F catheter.
After recanaliza-
tion, both tubes showed evidence of salpingitis isthmica nodosa and severe peritubal adhesions. (A) HSG demonstrates bilateral interstitial fallopian tube obstruction. (B) Injection of the left tube via the 3F catheter advanced after recanalization of the obstruction in the mid isthmic portion reveals salpingitis isthmica nodosa (arrow) and a dilated, distally obstructed tube. (C) Injection of the right tube after recanalization of the obstruction shows a patent tube with mild salpingitis isthmica nodosa (arrow). The appearance of the peritoneal spill suggests peritubal adhesions with retraction of the distal tube into the cul-de-sac.
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ADHESIONS following
of the proximal obstruction. These patients underwent lysis of adhesions or distal tubal reconstruction; reconstruction was avoided (Figures 5 and 8).
Figure 8 Bilateral recanalizatlon of proximal tubal obstruction in a 21 year old woman with one year of infertility and a history of pelvic Inflammatory disease Recanalization was achieved with the soft platinum-tipped guidewire
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SEVERELY DISEASED
tube catheterization
TUBES
Recanalization of the proximal tube revealed severe, inoperable distal tubal disease in five patients. These patients were advised to have in vitro fertilization, or to adopt a child and thereby avoid unnecessary exploratory surgery (Figure 9).
Figure 9 Bilateral recanalization of proximal tubal obstruction In a 35 year old woman who had been infertile for 10 years Recanalization was achieved with a soft platinum-tipped guidewire and 3F catheter. Both tubes showed severe salpingitis isthmica nodosa and distal obstruction. The patient was advised to have in vitro fertilization and avoided exploratory surgery. (A) HSG shows bilateral proximal obstruction. (B) Injection of the left tube via the 3F catheter after recanalization of the obstruction reveals severe salpingitis isthmica nodosa and distal tubal obstrucfion. (C) Injection of the right tube via the 3F catheter after recanalization of the obstruction demonstrafes severe salpingitis nodosa and mid isthmic tubal obstruction. There is persistent filling of the diseased left tube.
L
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Fallopian
Thurmond
tube catheterization
PREVIOUSLY Three women who desired surgical reversal of previous tubal ligations had obstruction of
the tube demonstrated in the interstitial portion by HSG. Because such an obstruction makes surgical repair difficult and gives a poor prognosis (7), fallopian tube catheterization
LIGATED
et al.
TUBES
was performed. It was successful in all cases (Figure 10). By demonstrating obstruction in the more distal and surgically favorable isthmic portion of the tube, the catheterization procedure helped in planning surgery.
IOA
Figure 10 Successful visualization of the proximal fallopian tubes In a 31 year old woman prior to reversal of previous surgical tubal ligation The visualization helped in planning the operation, and the patient subsequently underwent successful surgical reanastomosis of ligated tubes. (A) HSG does not visual-
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ize the tubes despite painful injection of the uterus. Radiopaque rings indicate the sites of isthmic ligations (arrows). (B) Injection at the right ostium demonstrates a normal-appearing tube proximal to the ligation site (arrow). (C) Injection at the left Ostium demonstrates
a normal-appearing
mal to the ligation site (arrow).
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Thurmond
Fallopian
et al.
Treatment Ten
women
conceived
out
Potential abortions in the first trimester. One woman who had had previous surgical reversal of tubal Iigation had an ectopic pregnancy distal to the recanalization site at the site of the narrowed surgical anastomosis (Figure 1 1). The remaining eight pregnancies are intrauterine and ongoing (Table II).
of thirty-six
women who had patent fallopian tubes after catheterization (9 out of 26 women who had catheterization
only
conceived;
I out
of 10
women who had additional distal tubal surgery conceived). One woman conceived twice and both pregnancies ended in spontaneous
hA
tube catheterization
fIB Figure 1 1 Successful recanalizatlon of the obstructed right fallopian tube in a 37 year old woman with infertility of 2 years’ duration, following surgical reversal of tubal ligation Recanalization was achieved by moderately forceful injection into the ostium, The patient conceived in the same cycle as the procedure; but had an ectopic pregnancy just distal to the surgical anastomosis, and the tube was removed. (A) HSG shows right proximal obstruction and a short, patent left tube. (B) Moderately
forceful
ostial injection
right tube with an isthmic-ampullary
Volume
results
in visualization
anastomosis
8, Number
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of the short
(arrowhead).
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Fallopian
tube catheterization
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PREGNANCY
AFTER UNILATERAL
Eight women conceived after unilateral catheterization: two after moderate pressure injection into the tubal ostium (Figures 4 and I 1) and
six after
recanalization
with
the
small
guidewire and catheter (Figure 12). Five of them conceived in the first month and the 0ther three conceived three to eight months following catheterization The contralateral tube appeared normal in three women (Figure 4) .
CATHETERIZATION
and exhibited postsurgical changes in five women (Figures 1 1 and 12). These women had suffered from infertility from one to seven years. The catheterization procedure appeared to benefit these patients, even though its causative relation to the pregnancies cannot be definitely proved because of the patent
contralateral
I
tube.
i:i’
,
..
. .
.
,...
.,
,.
#{149}1
\\
.
.
12A Figure 12 Successful recanalization of a proximal obstruction of the right fallopian tube in a 38 year old woman with Infertility of 5 months duration, following surgery to reverse previous tubal ligation HSG showed right proximal obstruction and a short patent left tube. Recanalization was achieved with a soft platinum-tipped guidewire. The patient conceived 8 months following recanalization and has delivered a healthy term baby. (A) Injection into the right cornu confirms proximal tubal obstrucfion. (B) Injection via the 3F catheter advanced after recanalization of the proximal obstruction to the anastomotic site (arrow) reveals a patent tube. (C) HSG (oblique projection) after recanalization demonstrates a patent right tube with narrowing at the site of anastomosis (arrow).
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I 2B
12C
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PREGNANCY
AFTER BILATERAL
A causative relation of the catheterization procedure to the subsequent pregnancy is apparent in the two patients who had bilateral recanalization of proximal tubal obstruction. One woman was scheduled for Iaparotomy with proximal tubal reconstruction following one year of infertility, two HSGs and one laparoscopy, which showed bilateral obstructions (Figure 13). She conceived in the same month as bilateral catheter recanalization was per-
tube
catheterization
RECANALIZATION
formed and has an ongoing intrauterine pregnancy. The second woman with three years of infertility and bilateral proximal obstruction by two HSGs underwent bilateral catheter recanalization (Figure 14). Followup HSG four months later showed reocclusion on the right side more peripheral in the tube; the left tube was patent. The patient conceived six months later and has an ongoing intrauterine pregnancy.
Figure 13 Successful recanalizatlon of proximal obstructions of both fallopian tubes In a 30 year old woman with Infertility for one year Bilateral obstructions were documented by two previous HSGs and diagnostic laparoscopy.
Recanalization
was achieved
with soft
platinum-tipped guidewire and 3F catheter. The patient conceived in the same cycle as the recanalization and has an ongoing intrauterine pregnancy. (A) HSG shows bilateral proximal fallopian tube obstructions. (B) Right ostial injection after recanalization demonstrates a normal, patent tube. (C) Left ostial injection after recanalization reveals a normal, patent tube.
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Fallopian
Thurmond
tube catheterization
C
0
a N
a C a U
a)
a a)
a
14A
14B
14C Figure 14 Successful bilateral recanalizatlon of proximal fallopian tube obstructions In a 32 year old woman with infertility of one year’s duration Recanalization was achieved with a soft platinum-tipped guidewire and 3F catheter. The patient had a four month followup HSG that revealed persistent patency of the left tube and recurrence of occlusion of the right tube. She became pregnant six months later and has an ongoing, intrauterme pregnancy. (A) HSG shows bilateral proximal
636
tubal obstruction.
RadloGraphlcs
(B) Injection
July. 1988
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into the right tube via the 3F catheter after recanalization of the obstruction shows a normal, patent right tube. (C) Injection into the left tube via the 3F catheter after recanalization of the obstruction shows a normal, patent left tube. (D) Right fallopian tube catheterization at the 4 month followup study demonstrates mid isthmic obstruction that could not be recanalized. (E) Injection in the left ostium at the 4 month followup study demonstrates continued patency of the tube.
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Fallopian
et al.
tube
catheterization
a a)
a a)
0
a a N
a 0
Failures In six women (12%), fallopian tube catheterization did not contribute to the diagnosis of fallopian tube disease Selective catheterization of the tubal ostium could not be performed in one woman who had a large cornual polyp and in another woman with a small .
deformed
uterine
cavity
secondary
to Dalkon
shield use (Figure 15). In the remaining four women, the tubal ostia were catheterized, but the proximal obstructions could not be recanalized.
These
mal isthmic
patients
disease
had
had
or previous
severe
isthmic
proxi-
surgery.
Figure 15 Unsuccessful catheterization of fallopian tubes In a 37 year old woman who had used a Dalkon shield over an extended period and subsequently had been infertile for a period of 1 0 years Twice she had had surgical lysis of intrauterine adhesions. HSG shows a small deformed uterine cavity with multiple diverticula. The cornua and tubal ostia could not be defined for catheterization.
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Fallopian
Thurmond
tube catheterization
et al.
Complications Tubal perforation with the small guidewire occurred in three patients. In two patients, it resulted in a contained collection of contrast agent at the site of perforation (Figure 16),
and in one patient, in free peritoneal extravasation. These patients were managed the same as were those without perforation and did not suffer any apparent clinical sequelae.
Figure 16 Unsuccessful attempt at recanalization of obstructed fallopian tubes bilaterally in a 28 year old woman with Infertility after surgery to reverse tubal ligation Recanalization attempts resulted in tubal perforations which did not cause any clinical sequelae. (A) HSG shows bilateral proximal isthmic obstructions (arrowheads). (B) HSG after unsuccessful recanalization affempts, reveals bilateral contamed perforations at the sites of obstructions (arrows).
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Table II Summary of Pregnancies Occurring after Fallopian Tube CatheterIzation
Patient
Infertility Type Duration
Age
Proximal Obstruction Documentation Type HSG(s) Laparoscopy
1
30
1
1 year
bilateral
3
2
34
2
3 years
unilateral
2
3
37
2
2 years
unilateral
4
2
2
1 year
5
33
1
6
37
7 8 9
normal’
normal’
1 month
1
normal’
tuboplasty
1 month
2
0
ligation reversal’
ligation reversal
1 month (1)
unilateral
1
0
normal
normal’
1 month
1 year
unilateral
2
0
normal’
normal
1 month
2
3 years
unilateral
1
1
normal
normal’
1 month
29
2
1 year
unilateral
2
0
ligation reversal’
ligation reversal
3 months (2) 8 months (2)
24
2
7 years
unilateral
2
1
isthmic
isthmic
6 months
resection
resection’
38
10
Foliowing Catheterization Anatomy Time to Right Tube Left Tube Conception
2
33
2
3 mos. 3 years
unilateral
2
bilateral
0
2
0
ligation
ligation
reversal’
reversal
small
normal’
8 months 10 months
dilatation’ ‘
catheterized
tube
( 1 ) tubal pregnancy (2) first trimester spontaneous abortion
Summary I Fallopian tube catheterization is a simpIe extension of conventional hysterosalpin-
(28%) women with patent tubes after the procedure became pregnant. For a final evaluation of the therapeutic effectiveness of the
.
gography
using
angiographic
technique.
2. The procedure substantially improves the diagnosis of fallopian tube disease and helped
44 of 50 (88%)
for diagnosis
patients
and treatment
avoid
4. Fallopian
fallopi-
also has treatment
of infertility caused by fallopian tube obstruction. In a mean followup of six months, 10 of 36
Volume
however,
more
experience
is
needed.
surgery
of proximal
an tube obstruction. 3. The catheterization technique promising potential for nonsurgical
procedure,
tube
catheterization
also
has
potential to improve other procedures that are currently performed surgically, such as fallopian tube endoscopy (2), intratubal placement of sperm and ova for treatment of infertility (4), and tubal sterilization (9).
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4
July, 1988
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#{149}
639
Fallopian
tube catheterization
Thurmond
et al.
Addendum Since acceptance patients
have
conceived,
of this paper, for a total
two
more
of 12
intrauterine
pregnancies
pregnancy
in 36 patients.
and one ectopic
References 1. American Fertility Foundation. What you should know about infertility. Contemp Obstet Gynecol 1980; 15:10 1-105. 2. Brosens I, Boeckx W, Delattin P. Puttemans P. Vasquez G. Salpingoscopy: A new pre-operative diagnostic tool in tubal infertility. Br J Obstet Gynaecol 1987;
94:768-773. 3, Fortier KJ. Haney
AF. The pathologic spectrum of uterotubal junction obstruction. Obstet Gynecol 1985; 65:93-98. 4. Jansen PP. Anderson JC. Catheterisation of the fallopian tubes from the vagina. Lancet 1987; 8:309-310. 5. McComb P. Gomel V. Cornual occlusion and its microsurgical reconstruction. Clin Obstet Gynecol 1980; 23:1229-1241. 6. Musich JR. Behrman SJ. Surgical management of tubal obstruction at the uterotubal junction. Fertil Steril 1983; 40:423-441.
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Volume
#{149}
Rock JA. Guzick D5, Katz E, zacur HA, King TM. Tubal anastomosis: Pregnancy success following reversal of Falope ring or monopolar cautery sterilization. Fertil Steril 1987; 48:13-17. 8. R#{244}sch J, Thurmond AS. Uchida BT. Fallopian tube catheterization: Technique update. Radiology (in press). 9. Seigler AM. The fallopian tube. Mount Kisco. NY: Futura, 1986; 27 1-346. 10. Sulak PJ, Letterie GS. Coddington CC. Hayslip CC, Woodward JE, Klein TA. Histology of proximal tubal occlusion. Fertil Steril 1987; 48:437-440. I I . Thurmond AS, Novy M, Uchida BT, R#{243}sch J. Fallopian tube obstruction: Selective salpingography and recanalization. Radiology 1987; 163:511-514. 12. Thurmond AS. Novy M. R#{224}sch J. Terbutaline in diagnosis of interstitial fallopian tube obstruction. Invest Radiol 1988; 23:209-2 10. 13. Winfield AC. Wentz AC. Diagnostic imaging of infertility. Baltimore: Williams & Wilkins, 1987. 7.
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