Pathophysiology and management of proximal tubal blockage.
OBJECTIVE
To review the physiology, pathology, and treatment of proximal tubal disease.


METHODS
Relevant reports on the pathophysiology of proximal tubal disease were reviewed. All studies in English of microsurgery and macrosurgery, and of radiographic and hysteroscopic cannulation in women with proximal tubal blockage were identified through MEDLINE searches.


METHODS
All studies of therapy for proximal blockage that included pregnancy rates were considered. Series of sterilization reversals, series of unilateral or combined procedures, and series in which the location of tubal blockage was not given were excluded from the data analyses.


METHODS
Raw data were assessed for homogeneity, then standardized and pooled. Total and ongoing pregnancy rates after microsurgery and macrosurgery, as well as radiographic and hysteroscopic transcervical cannulation, were compared by the chi2 test. Relative risks for total and ongoing pregnancies were calculated for all treatment methods.


RESULTS
This meta-analysis suggests that, overall, microsurgical anastomosis results in higher total and ongoing pregnancy rates than macrosurgery or radiographic tubal cannulation. However, pregnancy rates in selected series of transcervical tubal cannulation are similar to those reported for microsurgery.


CONCLUSIONS
Ongoing intrauterine pregnancy rates near 50% can be achieved in patients with proximal blockage of the fallopian tube. Selective salpingography and transcervical cannulation under fluoroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives.
Honoré
G M
GM
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 78284-7836, USA. honore@uthscsa.edu
Holden
A E
AE
Schenken
R S
RS
D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000503:physiopathology / Q000601:surgery; D005184:Fallopian Tube Diseases / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005187:Fallopian Tubes / Q000473:pathology / Q000601:surgery; D005260:Female; D049673:History, 20th Century; D006801:Humans; D007047:Hysterosalpingography / Q000266:history; D015907:Hysteroscopy / Q000266:history; D007247:Infertility, Female / Q000209:etiology; D015201:Meta-Analysis as Topic; D008866:Microsurgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D014599:Uterus / Q000601:surgery