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BackTable / VI / Topic / Procedure
Fallopian Tube Recanalization Procedure
Fallopian tube recanalization is a minimally invasive procedure performed to treat blocked fallopian tubes, a common cause of infertility in women. Using advanced imaging guidance, interventional radiologists can safely and effectively reopen blocked tubes, improving the chances of natural conception. This procedure offers a low-risk alternative to surgical options and is often recommended for women experiencing infertility due to tubal blockages. It involves minimal recovery time and has been shown to deliver favorable outcomes for many patients. Fallopian tube recanalization is an innovative solution that provides hope for women seeking to restore their fertility and achieve their family-building goals.
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Fallopian Tube Recanalization Pre-Procedure Prep
Indications
• Female infertility secondary to isolated proximal tubular obstruction
• Infertility: unable to conceive after 12 months of unprotected intercourse
Contraindications
• H&P
• Confirm negative Pap smears
• Confirm negative gonorrhea and chlamydia cultures
• Negative pregnancy test
• Will need hysterosalpingogram before the fallopian tube recanalization procedure to evaluate for patency of fallopian tubes
• Bilateral vs unilateral occlusion
• Critical to identify site of occlusion - proximal vs distal
Anatomy
• 4 sections of fallopian tube: intramural, isthmic, ampullary and infundibular
• Debris and mucous prone tend to clog the intramural and proximal isthmic segment
• Tube diameter is ~1 mm
Preparation
• Recanalization during days 1-10 of menstrual cycle: after menses and before ovulation
• Doxycycline 100 mg BID x 5 days. Begin antibiotics 2 days prior to procedure
• NSAIDs
• Can have patient take ibuprofen prior to procedure
• Ketorolac (Toradol) 30 mg IV immediate prior to the fallopian tube recanalization procedure
• Moderate sedation
Fallopian Tube Recanalization Podcasts
Listen to leading physicians discuss fallopian tube recanalization on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Fallopian Tube Recanalization Procedure
Antibiotic
• Doxycycline 100 mg BID x 5 days. Begin antibiotics 2 days prior to the fallopian tube recanalization procedure
• Not covered in 2018 SIR antibiotic prophylaxis guidelines
Positioning
• Need patient in the lithotomy position
• Wedge under pelvis may help access cervix
Equipment
• Plastic speculum
• Tenaculum often helpful to anchor cervix
Cervical access devices such as:
• Intrauterine Access Balloon Catheter (Cook)
• 9.0 Fr or Thurmond-Rosch Hysterocath (Cook)
Catheter to access the Fallopian tubes - many options
• 5 Fr Kumpe or MPA
Fallopian Tube Catheterization Set (Cook)
• Can get the 9 Fr Intrauterine Access Balloon Catheter
• Comes with 5 Fr and 3 Fr catheters
Fallopian Tube Recanalization Procedure Steps
• Place trans-cervical sheath
• Perform HSG with dilute contrast
• Dilute Omnipaque 300 by 50% with normal saline
• Slow injection of contrast to reduce spasm
Engage ostium of fallopian tube then clear blockage by:
• Gentle contrast injection
• Pass glidewire through obstruction
• Pass microcatheter and microwire
• Reinject contrast to document patent tubes with spillage of contrast into peritoneum
Fallopian Tube Recanalization Post-Procedure
Post-Operative Care
• Fallopian tube recanalization recovery time: 1 hour
• Counsel patient and partner
• Spotting and cramping is expected up to 3 days following fallopian tube recanalization procedure
• Ok to resume intercourse
Results
• Technical success rates: up to 90%
• Pregnancy: ~30%
Complications
• Tubal perforation 2% - may not be clinically significant
• Infection <1%
• Ectopic pregnancy ~3% if tubes are abnormal following recanalization
Fallopian Tube Recanalization Demos
Watch video walkthroughs of fallopian tube recanalization on the BackTable VI expanded content network.
References
[1] Thurmond AS. Fallopian tube catheterization. Semin Intervent Radiol. 2013;30(4):381‐387. doi:10.1055/s-0033-1359732
[2] Allahbadia GN, Merchant R. Fallopian tube recanalization: lessons learnt and future challenges. Womens Health (Lond). 2010;6(4):531‐549. doi:10.2217/whe.10.34
[3] Thurmond AS, Machan LS, Maubon AJ, et al. A review of selective salpingography and fallopian tube catheterization. Radiographics. 2000;20(6):1759‐1768. doi:10.1148/radiographics.20.6.g00nv211759
Disclaimer: The Materials available on https://www.BackTable.com/ are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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Dr. Renato Abu Hana