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Tubal catheterization: a low-cost IVF alternative?(Gynecology)
MIAMI BEACH -- A simple tubal catheterization procedure, done at the time of diagnosis of proximal tubal occlusion during hysterosalpingography, can restore tubal patency and enable natural conception in a large percentage of women, according to one expert.
Transcervical tubal catheterization (TTC) should be offered first to infertile patients with unilateral or bilateral proximal tubal occlusion, but these patients are often sent instead to laparoscopic tubal repair or in vitro fertilization (IVF), said Ilan Tur-Kaspa, M.D., director of the Institute for Human Reproduction, and director of the clinical IVF program at the Reproductive Genetics Institute in Chicago.
"It could be used more often. It depends on the experience and expertise of the physician, as well as the patient's wishes," he said in an interview.
Speaking at a congress on laparoscopy and minimally invasive surgery, Dr. Tur-Kaspa outlined his experience with TTC in 625 infertile women who together had 1,010 blocked fallopian tubes. Almost half of the women (45%) already had been treated or referred for IVF because of proximal tubal occlusion.
After TTC, 84% of occluded tubes were recanalized, and 87% of these patients were advised to attempt natural conception. A total of 81% of patients followed this advice, and 41% achieved a natural pregnancy.
The pregnancy rate was considerably higher in women who had no other causes of infertility identified (52%), but was still significant in women with other diagnosed causes of infertility (32%). The highest pregnancy rate was 71%, in women under age 30, and the rate in women over age 40 was 19%, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons.
"With a diagnosis of proximal tubal occlusion, often the next steps would be either laparoscopy or IVF. But in most of these cases you could either avoid or postpone those procedures [by performing TTC], and for many women this would result in a natural conception," he said.
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Source: HighBeam Research, Tubal catheterization: a low-cost IVF alternative?(Gynecology)