The uterine tube (fallopian tube) carries an egg from the ovary to the uterus. Unless a biological abnormality, surgery, or ectopic pregnancy caused the loss of one tube, women should have two uterine tubes in their bodies.
How does it cause infertility?
While there are many causes of infertility, a blockage of the fallopian tubes is often the reason why many women are unable to conceive. The fallopian tubes are the pathways in which the ova travel from the ovaries down into the uterus, and if there is a blockage in these tubes it can prevent this from occurring.
The fallopian tubes can sometimes become blocked or even damaged due to certain conditions that a woman may suffer from. In rare cases, the blockage to the fallopian tubes may have been present since birth as a birth defect, but has gone undetected until the woman reached adulthood and tried to conceive
What are the reasonsProximal tubal occlusion?
This can occur after infection such as complications from abortion, missed miscarriage, cesarean section or PID. Permanent birth control procedures like Essure block the isthmus.
What is Midsegment tubal obstruction?
It is most often due to tubal ligation damage. Tubal ligation removal comes with its own risk for development of more scar tissue on top of scar tissue already present from the initial tubal ligation procedure.
What isDistal tubal occlusion ?
It is the type of blockage that affects the part of the fallopian tube end towards the ovary. This type of blockage is typically associated with hydrosalpinx. . caused by Chlamydia trachomatis infection, which is a sexually transmitted disease.
What are the Common conditions that may cause blocked fallopian tubes ?
Pelvic Inflammatory Disease (PID)
Tubal Ligation Removal
Complications from lower abdominal surgery such as Cesarean section
Genital Tuberculosis (still common in developing countries, especially India)
What is tubal cannulation?
Tubal cannulation is a procedure used to help clear blockages in a woman's fallopian tubes.
Blockage is a common cause of female infertility because the fallopian tubes are vulnerable to infection and surgical damage. Between 12 - 33% of infertile couples experience a blockage, which affects the woman's ability to get pregnant
What is hysteroscopic tubal cannulation ?
A relatively new method for treating proximal tubal obstruction is that of hysteroscopic tubal cannulation.. . this kind of block is often because of mucus plugs or debris which plug the tubal lining at the uterotubal junction which is as thin as a hair. It is now possible to pass a fine guidewire through the hysteroscope into the tubes, and thus remove the plug or debris and open the tubes - thus restoring normal tubal patency with "minimally invasive surgery"!
What is falloposcopy?
Falloposcopy - in which a very fine flexible telescope is passed into the tube through the hysteroscope, so as to visualize the interior of the entire tube.
How long is the recovery period?
After a hysteroscopy, patients often have cramping similar to that experienced during a menstrual period; and some vaginal staining for several days. Regular activities can be resumed within one or two days after surgery. Sexual intercourse should be avoided for a few days or for as long as bleeding occurs.
What are the benefits of cannulation?
Tubal cannulation is a procedure that can help open the fallopian tubes. It is successful in 80 - 90% of cases. The procedure is less invasive than fallopian tube surgery and because of its simplicity, it's considered a first line treatment for fallopian tube blockage.
Which part of the tube can be reached with this procedure?
The cannulation procedure is most successful when the blockage affects the part of the tube closest to the womb (uterus). This is known as a proximal tubal obstruction.
Who should not have tubal cannulation?
Tubal cannulation may not be recommended if you have:
Extensive scarring in the fallopian tubes
Genital tuberculosis and certain other infections
Previous fallopian tube surgery
Severe blockage that makes it difficult for a tube to pass through
Severe damage to the fallopian tubes
When it can be unsuccessful?
Tubal cannulation may be unsuccessful, or may not work as well if you have:
A blockage in a part of the fallopian tube far away from the uterus
Certain blockages in the narrowest part of the fallopian tube
Inflammatory condition of the fallopian tubes -
Severe tubal disease or scarring
What to expect after tubal cannulation?
Tubal cannulation is successful in restoring fertility for many, but not all, women. It is important to remember that unblocking the fallopian tubes does not always help a woman become pregnant.
What are the factors considered for the success of the procedure?
Type of procedure performed
Location of the blockage
Cause of the blockage
What to be considered for women with severe tubal disease?
Women with severe fallopian tube disease who are not good candidates for tubal cannulation may consider IVF and embryo transfer as an alternative.
Why opting for this?
Laparoscopic-hysteroscopic cannulation for proximal obstruction is a procedure with minimal morbidity and a reasonable successful recanalisation rate. It should be considered as an alternative to in vitro fertilisation.
What are the other options for proximal block?
Tubotubal anastomosis and tubal implantation onto uterus. But these are tedious,prolonged,postoperative longer recovery period and hospitalization and adhesion formation.
Whereas hysteroscopic cannulation doesnot require incision,reduced hospital stay,faster recovery,no blood loss,achieves higher pregnancy rates about 80-90%.
What is a hysterosalpingogram?-HSG
A hysterosalpingogram, or HSG is an important test of female fertility potential. The HSG test is a radiology procedure usually done in the radiology department of a hospital or outpatient radiology facility.
Radiographic contrast (dye) is injected into the uterine cavity through the vagina and cervix.
The uterine cavity fills with dye and if the fallopian tubes are open, dye fills the tubes and spills into the abdominal cavity.
This shows whether the fallopian tubes are open or blocked and whether a blockage is at the junction of the tube and uterus (proximal) or at the other end of the tube (distal).
What is SSG?
Sonosalpingography (SSG), also known as Sion test, is a diagnostic procedure primarily used for evaluating patency of fallopian tubes.[
HOW IS SSG DONE?
Under ultrasound scanning, a slow and deliberate injection of about 200 ml physiologic saline into the uterine cavity is accomplished via Foley catheter. An inflated bulb of the catheter prevents leakage of fluid outside uterine cavity. By visualizing the flow of saline along the tube and observing it as a shower at fimbrial end, tubal patency can be tested. Presence of free fluid in pouch of Douglas also confirms tubal patency.
Hysteroscopic tubal cannulation; is it a novel approach?
Tubal cannulation has emerged as an excellent alternative to treat patients with cornual obstruction. Only those patients in whom cannulation fails should be subjected to microsurgical reconstruction .. With laparoscopy assistance the hysteroscopic approach enables tubal cannulation and evaluation of the entire pelvis. Treatment of additional problems affecting the fallopian tubes, particularly adhesions and endometriosis,ovarian cysts is possible. Laparoscopy helps in monitoring the procedure and visual assessment of tubal patency. The ability to observe the uterotubal junctions directly by hysteroscopy provides an excellent approach for tubal cannulation.
tubal cannulation . will help confirm tubal occlusion, create tubal patency, and avoid either major surgery for tubal repair, or in vitro fertilization if successful.
What are the added advantages of this?
Advantages of tubal catheterization include it being an effective triage for patients with tubal disease, the avoidance of contrast allergies, and the avoidance of radiation, as well as the avoidance of laparoscopy in selected patients. This approach is superior to proximal tubal micro-reanastomosis when successful and superior to IVF when successful. There are low complication rates for this procedure.
Hysteroscopic cannulation should be first choice in the management of proximal tubal obstructions in selected patients. It may be a treatment option for delayed occlusion after successful cannulation or resection anastomosis