Fallopian tube recanalization for infertility

Fallopian tube recanalization (FTR) by an interventional radiologist is a minimally invasive procedure designed to treat proximal fallopian tube blockages, which can contribute to infertility. The procedure involves using imaging guidance to navigate a catheter and guidewire through the blocked segment of the fallopian tube, restoring its patency and improving the chances of natural conception.

Indications

This procedure is indicated for:

1. Infertility: Women with infertility due to proximal fallopian tube blockages.
2. Hydrosalpinx: Blockage associated with fluid accumulation in the fallopian tube.
3. Unexplained Infertility: As part of a diagnostic and therapeutic approach.

Procedure

1. Pre-procedure Assessment:
   • Imaging Studies: Hysterosalpingography (HSG) or similar tests to confirm the presence and location of the blockage.
   • Medical History and Physical Examination: Evaluation to ensure the patient is a suitable candidate for the procedure.
2. Preparation:
   • Informed Consent: The patient is informed about the procedure, its risks, and benefits, and consent is obtained.
   • Antibiotics: Prophylactic antibiotics may be administered to prevent infection.
3. Anaesthesia:
   • The procedure is typically performed under local anesthesia with sedation to ensure patient comfort.
4. Procedure:
   • Patient Positioning: The patient is positioned similarly to a gynecological exam, usually in a lithotomy position.
   • Hysterosalpingography (HSG): A catheter is inserted through the cervix into the uterus, and contrast dye is injected to visualize the fallopian tubes under fluoroscopy.
   • Catheter Navigation: A thin catheter is guided through the cervix into the uterine cavity, and a guidewire is advanced into the blocked fallopian tube.
   • Wire Recanalization: The guidewire is gently maneuvered through the blocked segment of the fallopian tube. Once the blockage is passed, the catheter follows to ensure the tube is open.
   • Balloon Dilation (if necessary): In some cases, a small balloon may be inflated within the fallopian tube to further open the blockage.
5. Post-procedure Imaging:
   • After recanalization, additional contrast dye is injected to confirm the patency of the fallopian tube.

Benefits

• Minimally Invasive: Less invasive than surgical alternatives, such as laparoscopy.
• Quick Recovery: Patients can typically return home the same day and resume normal activities shortly thereafter.
• Outpatient Procedure: Usually performed on an outpatient basis.
• Improved Fertility: Successful recanalization can restore natural fertility by reopening the fallopian tubes.

Risks and Considerations

• Infection: There is a risk of infection, though it is rare.
• Tubal Damage: The procedure carries a risk of damaging the fallopian tube, which could lead to scarring or re-blockage.
• Pain or Discomfort: Some pain or discomfort may occur during and after the procedure.
• Ectopic Pregnancy: Increased risk of ectopic pregnancy following the procedure, as the fallopian tube may be partially damaged or not fully functional.
• Failure to Recanalize: In some cases, the blockage may not be successfully cleared, requiring alternative treatments.

Conclusion

Fallopian tube recanalization by an interventional radiologist is a valuable option for women with proximal fallopian tube blockages contributing to infertility. The procedure’s minimally invasive nature, combined with real-time imaging guidance, enhances its accuracy and safety. While there are inherent risks, the potential benefits in terms of restored fertility and reduced recovery time make it an attractive option for many patients. Proper patient selection and thorough pre-procedure evaluation are crucial to ensure the best possible outcomes.