The fallopian tubes are vitally important for female fertility. They are how the eggs get from the ovaries to the uterus. Under normal circumstances, sperm will travel into the fallopian tubes to fertilize an egg released from the ovary, and the resulting embryo is nourished and transported to the uterus where the pregnancy will continue to term. A common cause of female infertility is blockage of the fallopian tubes, usually as the result of debris that has built up. Occasionally, scarring from surgery or serious infection can lead to occlusion.
What is fallopian tube recanalization?
Interventional radiologists are able to diagnose and treat blockages in the fallopian tubes with a nonsurgical procedure known as Fallopian Tube Recanalization (FTR). Recanalization is the technical term for reopening. During the procedure, which does not require any needles or incisions, a speculum is placed into the vagina and a small plastic tube (catheter) is passed through the cervix the into the uterus. A liquid contrast agent (sometimes called "dye", although nothing is being stained), is injected through the catheter. An X-ray camera shows the uterine cavity on a television screen and what is called a "hystero-salpingogram" or "HSG" is obtained. Literally, that means a "uterus-and-fallopian-tube-picture".
If a blockage of one or both of the fallopian tubes is identified, a smaller catheter is then threaded through the first catheter right then into the fallopian tube to open the blockage. Over 90% of the time, at least one blocked fallopian tube can be reopened and normal function restored.
Who should consider fallopian tube recanalization?
Sometimes, women have a hysterosalpingogram in a doctor's office, clinic, or x-ray department that shows a blockage. Sometimes they are found to have a problem with the tubes during laparoscopy, when the doctors inject blue dye into the uterus an examine the tubes using a "scope", and nothing passes through. Sometimes, a blockage is discovered during a sonogram in which sterile saline (water) is injected into the uterus. At this point, an interventional radiologist can evaluate the tubes and will try to unblock them at the same time if possible.
Two days before your procedure, your gynecologist will prescribe an antibiotic called Doxycycline to be taken twice a day, which you will continue up to and after your procedure for two more days. Since FTR is sometimes uncomfortable (though usually much less than a hysterosalpingogram, owing to much more delicate equipment being used), an intravenous line is placed prior to the procedure. Short-acting medications will be given for relaxation and pain relief. For this reason, you will be instructed to not eat anything after midnight the night before. You will also be asked to take Ibuprofen 400 mg (2 pills) the night before and the morning of your procedure.
The FTR Procedure
The procedure is done under sterile conditions to avoid the possibility of introducing infection. The overall time to do the procedure is about a half an hour, most of which is spent in getting you comfortable, readying the equipment, and cleaning the skin. The actual time spent in evaluating and unblocking the tubes is usually only a matter of minutes and you will be able to leave about a half hour after your procedure is completed. You must be accompanied by an adult who can take you home afterward. The doctors will explain to you and your companion the results and a letter will be sent to your doctor as well.
Most women will have a little spotting for a day or two afterward. We will give you a pad in recovery and you may wish to have some pads at home in case of spotting. There should be no lingering pain or other unpleasant sensation. If you experience pain, cramps, fever, or vaginal discharge, please contact your gynecologist immediately. If he or she is unavailable, we will give you contact information to reach us and we will help with your problem.
Usually, both fallopian tubes can be unblocked. Most couples will conceive within a cycle or two. The FTR procedure was timed so that there was no risk of being fertile at the time of your procedure. You may begin trying to get pregnant again once the spotting has stopped, and don't have to wait an extra cycle in between. Douching is not advisable in general, but particularly after the FTR because the cervix may be slightly open for a day or so.
Successful FTR and pregnancy are lower when severe scarring is present from prior surgery or bad infections, such as PID (Pelvic Inflammatory Disease). FTR unclogs the tubes, but does not reverse the process at work that caused them to become blocked in the first place. For that reason, about 1/3 of patients will reocclude their tubes by about 6 months. You may wish to consult your doctor if you have not gotten pregnant after 6 months and he or she is thinking about enhancing your fertility, such as giving you injections to stimulate your ovaries. It is advisable in that case to make sure that your tubes are still open. An interventional radiologist can perform an HSG and safely repeat the FTR if blockage is again found.
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