番茄社区

HOLLYWOOD, Fla. – A relatively fast outpatient procedure helped infertile women become pregnant – without the need for pills or in vitro fertilization, researchers said here.

Using micro-catheters and a 0.018-inch guide-wire, doctors can perform proximal fallopian tube recanalization in less than the time it takes to watch a feature length movie, reported Jeff Wang, BS, a fourth-year medical student at Chicago Medical School.

At the 2019 International Symposium on Endovascular Therapy, Wang said his review of hospital records found that of 66 women for whom complete records were available, 21 pregnancies occurred, and the median time to pregnancy in these women was 4 months.

"The use of micro-catheters and wires that can be maneuvered in a minimally-invasive manner should make it a first-line use for removing fallopian tube proximal occlusions for women having fertility problems," Wang told 番茄社区.

His retrospective review overall included 160 patients over the course of 24 years who were treated by Rush Medicine of Chicago. "We have one of the larger datasets out there and it confirms this is a minimally-invasive procedure that has pretty good outcomes. It also shows how obstetricians and gynecologists can work together with interventionalists," Wang said.

"There is a subset of women – about 30% of the women who report fertility problems -- who have proximal occlusions of their fallopian tubes," he said. "These occlusions can be mucus or debris or a contamination of mucus and debris which build up over time. Which women are at risk for this occurring has not yet been fully explored. It could be they have a history of chronic infection or they could just be unlucky."

He said the women are all referrals from specialists. "Usually, you have a couple who come to the ob/gyn office with problems of getting pregnant," he said. "These patients are then referred to a reproductive endocrinologist/fertility specialist."

In an outpatient procedure, interventionalists employ a micro-catheter to perform hysterosalpingography, and, if necessary, the wire is deployed to remove debris from the tube. "It can take a half hour to 90 minutes, depending on anatomy or whether both tubes need to be opened," Wang said. "We use a high pressure hysterosalpingogram to determine if contrast is getting into the fallopian tubes. Sometimes this itself will unblock the occlusion. If we can't see the contrast, we know there is a blockage. The procedure is all done through the vaginal canal. Some women experience some post-procedural pain that can be managed with medication."

He said that all the women in the study were seeking to get pregnant. "But so far we have only been able to gather follow-up data on 66 of the patients, and 21 of them or 32% have gotten pregnant. Our data only tells us that these patients achieved fertilization. We do not yet have data on live births. Live births are part of a different dataset that we haven't flushed out yet."

In commenting on the study, Francisco Contreras, MD, an interventional radiologist and associate professor of radiology at Florida State University, University of Central Florida, and Florida Hospital, Orlando, told 番茄社区, "We, as interventional radiologists, have been successful in using these techniques to recanalize the fallopian tubes, and I think as more and more physicians and patients learn of these procedures it is likely that this will be done more frequently." He suggested that a 32% pregnancy rate as described in the study would be considered a good result.

Contreras noted that undergoing the minimally-invasive procedure would not preclude other attempts at pregnancy down the line, such as in vitro fertilization.

• Prior to the treatment, Wang said 89 women had no patent tubes, but after the procedure 72 of these women achieved bilateral patency; 14 achieved unilateral patency; three women still had no patent tubes.
• In the 67 women who presented with one blocked fallopian tube, bilateral patency was achieved in 61 women; six women remained with one open tube.
• Four women had patent fallopian tubes but underwent the procedure to remove blockages. All still had bilateral patency following the procedure.

Wang said the interventionalists achieved technical success in 319 of 341 tubes they attempted to recanalize.

"We are now seeking to get long-term data and to increase the sample size, and it is important to get live birth outcomes as well," he said.

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