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Fertility and Sterility Interventions
Kalie Adler, DO; Brandt C. Wible, MD; Gloria M. Salazar, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        TERMINOLOGY

        • Definitions

          • Hysterosalpingography (HSG): Contrast injection via cervical canal into endometrial cavity with fluoroscopic monitoring/imaging
            • Normally shows filling of uterine cavity and bilateral fallopian tubes (FT)
              • Tubal patency confirmed if contrast spills from tubes into abdominal cavity
            • Sensitivity and specificity in detecting pathology
              • Tubal occlusion defined as bilateral lack of patency: 92% and 87%
              • Tubal occlusion defined as any abnormality (unilateral or bilateral): 78% and 53%
          • Selective salpingography: Direct selective catheterization of fallopian tubal ostium
            • Contrast injection via catheter during imaging
              • Provides direct opacification of fallopian tube
          • Fallopian tubal anatomy
            • 4 tubal segments
              • Interstitial (intramural)
              • Isthmic
              • Ampullary
              • Infundibular
            • Uterotubal junction located at transition of intramural to isthmic segment of fallopian tube
              • Narrowest portion of fallopian tube
            • Average tubal diameter: 0.8-2.0 mm
              • Increases as fallopian tube courses toward ovaries
            • Average tubal length: 11 cm (range: 7-16 cm)
          • Fallopian tube recanalization (FTR): Guidewire &/or catheter passage through occluded fallopian tube to reestablish tubal patency
            • Fallopian tube disease accounts for up to 35% of infertility cases; various causes
              • Infection (Chlamydia)
              • Postsurgical
              • Salpingitis isthmica nodosa
                • Inflammation of isthmic or intramural segments; characterized by nodular thickening causing obstruction
                • Selective fallopian tube catheterization has higher sensitivity due to ability to fill isthmic diverticula beyond proximally occluded tube
              • Peritubal adhesions
            • Proximal tubal occlusion often caused by mucus plug/inflammatory debris; also caused by spasm
              • Involves interstitial segment/uterotubal junction
              • Responds fairly well to recanalization
            • Less favorable outcomes with more distal occlusions
              • More often due to scarring/fibrosis
          • Fallopian tube occlusion (FTO): Placement of mechanical occluding device into FT
            • Type of bilateral tubal sterilization
              • Hysteroscopic transcervical fallopian tube access
              • Placement of Essure device (Conceptus; Mountain View, CA) into FT
                • Combined outer nitinol/inner stainless steel coil elicits tissue growth; occludes FT
                • During first 3 months, device not fully effective
                • Alternate birth control needed during this time
          • Sonohysterography: Injection of sterile saline into endometrial canal during transvaginal ultrasound
            • Enhances detection of endometrial abnormalities not seen on standard ultrasound
            • Increased pelvic free fluid after procedure can indicate at least 1 fallopian tube is patent

        PREPROCEDURE

        • Indications

          • Contraindications

            • Getting Started

              PROCEDURE

              • Patient Position/Location

                • Equipment Preparation

                  • Procedure Steps

                    • Findings and Reporting

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          OUTCOMES

                          • Complications

                            • Expected Outcomes

                              Selected References

                              1. Foroozanfard F et al: Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women. Nurs Midwifery Stud. 2(2):188-92, 2013
                              2. McMartin K: Hysteroscopic tubal sterilization: an evidence-based analysis. Ont Health Technol Assess Ser. 13(21):1-35, 2013
                              3. Yang T et al: Sonohysterography: Principles, technique and role in diagnosis of endometrial pathology. World J Radiol. 5(3):81-7, 2013
                              4. Allahbadia GN et al: Fallopian tube recanalization: lessons learnt and future challenges. Womens Health (Lond Engl). 6(4):531-48, quiz 548-9, 2010
                              5. McSwain H et al: Fallopian tube occlusion, an alternative to tubal ligation. Tech Vasc Interv Radiol. 9(1):24-9, 2006
                              6. Maubon AJ et al: Interventional radiology in female infertility: technique and role. Eur Radiol. 11(5):771-8, 2001
                              7. Thurmond AS et al: A review of selective salpingography and fallopian tube catheterization. Radiographics. 20(6):1759-68, 2000
                              8. Sohaey R et al: Sonohysterography: technique, endometrial findings, and clinical applications. Semin Ultrasound CT MR. 20(4):250-8, 1999
                              9. Thurmond AS et al: Tubal obstruction after ligation reversal surgery: results of catheter recanalization. Radiology. 210(3):747-50, 1999
                              10. Lang EK: The efficacy of transcervical recanalization of obstructed postoperative fallopian tubes. Eur Radiol. 8(3):461-5, 1998
                              11. Alatas C et al: Evaluation of intrauterine abnormalities in infertile patients by sonohysterography. Hum Reprod. 12(3):487-90, 1997
                              12. Lang EK et al: Recanalization of obstructed fallopian tube by selective salpingography and transvaginal bougie dilatation: outcome and cost analysis. Fertil Steril. 66(2):210-5, 1996
                              13. Thompson KA et al: Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction. Fertil Steril. 61(2):243-7, 1994
                              14. Thurmond AS: Pregnancies after selective salpingography and tubal recanalization. Radiology. 190(1):11-3, 1994
                              15. Thurmond AS: Selective salpingography and fallopian tube recanalization. AJR Am J Roentgenol. 156(1):33-8, 1991
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Procedure

                                    TERMINOLOGY

                                    • Definitions

                                      • Hysterosalpingography (HSG): Contrast injection via cervical canal into endometrial cavity with fluoroscopic monitoring/imaging
                                        • Normally shows filling of uterine cavity and bilateral fallopian tubes (FT)
                                          • Tubal patency confirmed if contrast spills from tubes into abdominal cavity
                                        • Sensitivity and specificity in detecting pathology
                                          • Tubal occlusion defined as bilateral lack of patency: 92% and 87%
                                          • Tubal occlusion defined as any abnormality (unilateral or bilateral): 78% and 53%
                                      • Selective salpingography: Direct selective catheterization of fallopian tubal ostium
                                        • Contrast injection via catheter during imaging
                                          • Provides direct opacification of fallopian tube
                                      • Fallopian tubal anatomy
                                        • 4 tubal segments
                                          • Interstitial (intramural)
                                          • Isthmic
                                          • Ampullary
                                          • Infundibular
                                        • Uterotubal junction located at transition of intramural to isthmic segment of fallopian tube
                                          • Narrowest portion of fallopian tube
                                        • Average tubal diameter: 0.8-2.0 mm
                                          • Increases as fallopian tube courses toward ovaries
                                        • Average tubal length: 11 cm (range: 7-16 cm)
                                      • Fallopian tube recanalization (FTR): Guidewire &/or catheter passage through occluded fallopian tube to reestablish tubal patency
                                        • Fallopian tube disease accounts for up to 35% of infertility cases; various causes
                                          • Infection (Chlamydia)
                                          • Postsurgical
                                          • Salpingitis isthmica nodosa
                                            • Inflammation of isthmic or intramural segments; characterized by nodular thickening causing obstruction
                                            • Selective fallopian tube catheterization has higher sensitivity due to ability to fill isthmic diverticula beyond proximally occluded tube
                                          • Peritubal adhesions
                                        • Proximal tubal occlusion often caused by mucus plug/inflammatory debris; also caused by spasm
                                          • Involves interstitial segment/uterotubal junction
                                          • Responds fairly well to recanalization
                                        • Less favorable outcomes with more distal occlusions
                                          • More often due to scarring/fibrosis
                                      • Fallopian tube occlusion (FTO): Placement of mechanical occluding device into FT
                                        • Type of bilateral tubal sterilization
                                          • Hysteroscopic transcervical fallopian tube access
                                          • Placement of Essure device (Conceptus; Mountain View, CA) into FT
                                            • Combined outer nitinol/inner stainless steel coil elicits tissue growth; occludes FT
                                            • During first 3 months, device not fully effective
                                            • Alternate birth control needed during this time
                                      • Sonohysterography: Injection of sterile saline into endometrial canal during transvaginal ultrasound
                                        • Enhances detection of endometrial abnormalities not seen on standard ultrasound
                                        • Increased pelvic free fluid after procedure can indicate at least 1 fallopian tube is patent

                                    PREPROCEDURE

                                    • Indications

                                      • Contraindications

                                        • Getting Started

                                          PROCEDURE

                                          • Patient Position/Location

                                            • Equipment Preparation

                                              • Procedure Steps

                                                • Findings and Reporting

                                                  • Alternative Procedures/Therapies

                                                    POST PROCEDURE

                                                    • Things to Do

                                                      OUTCOMES

                                                      • Complications

                                                        • Expected Outcomes

                                                          Selected References

                                                          1. Foroozanfard F et al: Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women. Nurs Midwifery Stud. 2(2):188-92, 2013
                                                          2. McMartin K: Hysteroscopic tubal sterilization: an evidence-based analysis. Ont Health Technol Assess Ser. 13(21):1-35, 2013
                                                          3. Yang T et al: Sonohysterography: Principles, technique and role in diagnosis of endometrial pathology. World J Radiol. 5(3):81-7, 2013
                                                          4. Allahbadia GN et al: Fallopian tube recanalization: lessons learnt and future challenges. Womens Health (Lond Engl). 6(4):531-48, quiz 548-9, 2010
                                                          5. McSwain H et al: Fallopian tube occlusion, an alternative to tubal ligation. Tech Vasc Interv Radiol. 9(1):24-9, 2006
                                                          6. Maubon AJ et al: Interventional radiology in female infertility: technique and role. Eur Radiol. 11(5):771-8, 2001
                                                          7. Thurmond AS et al: A review of selective salpingography and fallopian tube catheterization. Radiographics. 20(6):1759-68, 2000
                                                          8. Sohaey R et al: Sonohysterography: technique, endometrial findings, and clinical applications. Semin Ultrasound CT MR. 20(4):250-8, 1999
                                                          9. Thurmond AS et al: Tubal obstruction after ligation reversal surgery: results of catheter recanalization. Radiology. 210(3):747-50, 1999
                                                          10. Lang EK: The efficacy of transcervical recanalization of obstructed postoperative fallopian tubes. Eur Radiol. 8(3):461-5, 1998
                                                          11. Alatas C et al: Evaluation of intrauterine abnormalities in infertile patients by sonohysterography. Hum Reprod. 12(3):487-90, 1997
                                                          12. Lang EK et al: Recanalization of obstructed fallopian tube by selective salpingography and transvaginal bougie dilatation: outcome and cost analysis. Fertil Steril. 66(2):210-5, 1996
                                                          13. Thompson KA et al: Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction. Fertil Steril. 61(2):243-7, 1994
                                                          14. Thurmond AS: Pregnancies after selective salpingography and tubal recanalization. Radiology. 190(1):11-3, 1994
                                                          15. Thurmond AS: Selective salpingography and fallopian tube recanalization. AJR Am J Roentgenol. 156(1):33-8, 1991