Hai Yan Hou1, Ya Qiong Chen2, Tin-Chiu Li3, Chun Xiu Hu4, Xiao Chen4, Zhen Hua Yang4. 1. Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China; Jessop Wing, Sheffield Teaching Hospitals, Sheffield, England. 2. Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China. Electronic address: chenyq82@yahoo.com.cn. 3. Jessop Wing, Sheffield Teaching Hospitals, Sheffield, England. 4. Department of Obstetrics and Gynaecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China.
Abstract
STUDY OBJECTIVE: To determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization. DESIGN: Clinical cases series (Canadian Task Force classification II-3). SETTING: Reproductive surgery center. PATIENTS: Patients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included. INTERVENTIONS: Laparoscopy-guided hysteroscopic tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Only the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years). CONCLUSION: Successful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.
STUDY OBJECTIVE: To determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization. DESIGN: Clinical cases series (Canadian Task Force classification II-3). SETTING: Reproductive surgery center. PATIENTS: Patients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included. INTERVENTIONS: Laparoscopy-guided hysteroscopic tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Only the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years). CONCLUSION: Successful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.
Authors: Joseph I Ikechebelu; George U Eleje; Prashant Bhamare; Ngozi N Joe-Ikechebelu; Chidimma D Okafor; Abdulhakeem O Akintobi Journal: Obstet Gynecol Int Date: 2018-06-06