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BackTable / VI / Topic / Procedure
Fallopian Tube Recanalization
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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 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 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 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
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 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
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Dr. Renato Abu Hana