Outcome of laparoscopy-guided hysteroscopic tubal catheterization for infertility due to proximal tubal obstruction.
OBJECTIVE
To determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization.


METHODS
Clinical cases series (Canadian Task Force classification II-3).


METHODS
Reproductive surgery center.


METHODS
Patients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included.


METHODS
Laparoscopy-guided hysteroscopic tubal catheterization.


RESULTS
Only the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years).


CONCLUSIONS
Successful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.
Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China; Jessop Wing, Sheffield Teaching Hospitals, Sheffield, England.
Hai Yan
HY
Hou
Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China. Electronic address: chenyq82@yahoo.com.cn.
Ya Qiong
YQ
Chen
Jessop Wing, Sheffield Teaching Hospitals, Sheffield, England.
Tin-Chiu
TC
Li
Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China.
Chun Xiu
CX
Hu
Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China.
Xiao
X
Chen
Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China.
Zhen Hua
ZH
Yang
D000328:Adult; D002404:Catheterization / Q000379:methods; D002681:China; D016208:Databases, Factual; D005184:Fallopian Tube Diseases / Q000473:pathology / Q000601:surgery*; D005186:Fallopian Tube Patency Tests / Q000379:methods; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D016896:Treatment Outcome
Hysteroscopic tubal catheterization; Infertility; Laparoscopy; Proximal tubal obstruction