Tubal Recanalization Success Rate and Complications of Fluoroscopy Guided Transcervical Fallopian Tube Catheterization in Treatment of Proximal Tubal Obstruction

Abstract

Background: Infertility is a relatively common condition with crucial medical and socioeconomic implications, and it affects 10 to 15% of couples worldwide in the reproductive age group. A third of the cases of infertility in women are of tubal origin, with 20% of these attributed to isolated proximal tubal obstruction (PTO). The unique anatomy of the proximal fallopian tube is relevant in preventing vaginal bacteria from gaining access to the peritoneum but also predisposes it to obstruction. Fluoroscopy-guided transcervical selective salpingography and fallopian tube recanalization by use of a coaxial system of guidewires and catheters has been universally accepted as an alternative treatment for this condition. Despite its good technical success rates, confirmed feasibility and safety it has been slow to become adopted since the advent of assisted reproductive techniques (ART) such as in vitro fertilization (IVF). Study Objective: To evaluate the tubal recanalization success rate and complications of fluoroscopic trans-cervical fallopian tube catheterization (FTC) in patients with proximal tubal obstruction. Materials and Methods: A cross-sectional study was carried out at the interventional radiology suites of Kenyatta National Hospital and The Karen Hospital in Nairobi, Kenya from July 2020 to October 2021. Female patients in the reproductive age group with documented tubal infertility referred for FTC who fulfilled the inclusion criteria were enrolled into the study. A structured data collection tool was used to document demographic data, clinical and imaging findings of the study participants. The proportion of patients who had PTO on pre-procedure HSG, subsequently underwent fluoroscopic T-FTC and the tubal recanalization success rate and complications of the procedure determined. Data was analyzed using SPSS version 23 and Microsoft Excel and represented in tables and charts. HSG and FTC findings were presented as proportions with 95% confidence intervals and further association with other patient characteristics will be tested using Fischer’s exact test of associations. Significance was defined as p< 0.05. Results: A total of 37 participants were recruited into the study. Their ages ranged from 24 years and 47 years. The mean age was 34.3years and the median age was 35 years. 7 patients (18.9%) had primary infertility while 30 patients (81.1%) had secondary infertility. We successfully recanalized 46 of the 56 proximal fallopian tube obstructions with guidewire and catheter at a technical success rate of 82%. There was statistically significant association between uterine cavity abnormalities with cannulation success with a p value of 0.021. Conclusion: In our experience, fluoroscopy guided T-FTC is a safe treatment option in appropriately selected patients with infertility from PTO, associated with high technical success rate at relatively low cost and morbidity. We established an association between acquired uterine cavity abnormalities seen on HSG and the success rate of T-FTC, which can be subjected to larger study evaluations. It therefore merits to be recommended for patients with PTO, prior to more invasive and costly treatments.