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PubMed1987

Observations on the mode of action of an intratubal device, the P-block.

A hydrogelic intratubal device, called P-block, Mark 9, was inserted hysteroscopically with local anesthesia in the intramural part of the fallopian tube of 25 women referred for the procedure as an alternative to abdominal sterilization. Hysterosalpingography revealing bilateral oviductal patency was followed by hysteroscopic checkup verifying bilateral presence of P-blocks, except in three patients who had expulsion of the P-blocks on one side. All of the 22 patients had retention of the P-blocks 6 to 7 months after insertion. None became pregnant. Thus it is suggested that an intratubal device in the isthmic part of the human fallopian tube acts as an intrauterine contraceptive device, preventing intratubal and intrauterine pregnancies. Endeavors to explain the contraceptive effect of a nonocclusive intratubal device are discussed on the basis of our present knowledge of tubal physiology. Distension of part of the human isthmus is likely to disturb normal gamete transport through the isthmus.

Adult↗
PubMed1988

An experimental study of tubo-ovarian function following restoration of patency in hydrosalpinges.

The recovery of tubal function after restoration of patency in mechanically induced hydrosalpinges was studied in twenty sexually mature rabbits by correlating the morphological lesions of tubal damage and adhesion formation with the ovulatory function, pregnancy rate and nidation index at 2 and 4-8 weeks postoperative intervals. Two weeks after hydrosalpinx correction no implantations occurred although the oviducts had a patency rate of 63% and no or slight adhesions were present. From four weeks after hydrosalpinx correction implantations occurred. Morphological studies showed a partial or complete recovery of mucosal lesions in this group of rabbits. The number of ovulations correlated with the presence or absence of a moderate degree of postoperative adhesion formation.

Animals↗
PubMed1991

Treatment of tubal pregnancy by local injection of prostaglandin: selection of patients and evaluation of subsequent tubal patency.

Thirty women who had a small unruptured tubal pregnancy were treated by laparoscopically guided injection of prostaglandin F2 alpha into the oviduct and into the corpus luteum. They had no side effects. The serum human chorionic gonadotropin (S-HCG) concentration decreased in 25 women to less than 20 IU/l in a median time of 8 days (range 1-45). Five women were operated on because of increasing S-HCG concentration. The median diameter of the oviduct at the site of the gestation, the tubal localisation and the gestational age was similar in the women treated by prostaglandin and those, who were operated on after failure of the procedure. Four of the 6 women, with S-HCG concentrations of more than 2000 IU/l, needed subsequent operative treatment, compared to only one of 24 with a lower concentration. The median duration of the hospital stay after treatment was 2 days for the group of women with a S-HCG concentration of less than 2000 IU/l. Hysterosalpingography 3 months after treatment showed patency on the side of the pregnancy in 12 of 14 women. Prostaglandin injection seems to be an appealing option for the treatment of selected ectopic pregnancies.

Animals↗
PubMed2004

An ultrasound-based approach to the assessment of infertility, including the evaluation of tubal patency.

An optimal initial infertility investigation protocol would be a process that is diagnostically accurate, expeditious, cost-effective, reliable and as minimally invasive as possible. In addition, the investigation should provide the clinician with useful prognostic information regarding possible future treatment. At present, extensive use of invasive procedures such as diagnostic hysteroscopy and laparoscopy is the standard at many fertility centres. Recent advances in gynaecological ultrasonography have shown that ultrasound can replace routine invasive investigative procedures. An ultrasound-based approach would make the basic infertility investigation less time-consuming and less expensive, but at the same time more acceptable to the majority of patients. This chapter describes an ultrasound-based approach to the assessment of infertility. In addition, the role of ultrasonography for assessment of the pelvic organs as a basic part of the initial investigation of an infertile couple is discussed and compared to more traditional invasive methods.

Fallopian Tube Patency Tests↗
PubMed2004

Predictive value of impaired uterine transport function assessed by negative hysterosalpingoscintigraphy (HSSG).

BACKGROUND: Hysterosalpingoscintigraphy (HSSG) has given insight into the dynamics of rapid sperm transport inside the female genital tract. RESULTS: While there is an increase of an ipsilateral transport on the side bearing the dominant follicle in 70% of the subjects in the periovulatory phase, 15% of the patients do not demonstrate transport to the fallopian tubes (negative HSSG). In these patients the pregnancy rate achieved spontaneously or by intrauterine insemination is significantly reduced compared to the patients who showed an intact transport mechanism confirmed by positive HSSG. On the other hand, by means of assisted reproductive techniques (ART), pregnancy rates were higher in the group of patients showing negative HSSG (P < 0.0005). CONCLUSIONS: Our data clearly indicate that HSSG is a helpful method to evaluate the integrity of the utero-tubal transport mechanism. As pregnancy rates remain low in patients with negative HSSG, this result should be considered as an indication for IVF-treatment even in patients with patent fallopian tubes and normozoospermia of the partner.

Fallopian Tube Patency Tests↗
PubMed2006

The validity of air and saline hysterosalpingo-contrast sonography in tubal patency investigation before insemination treatment.

OBJECTIVE: To compare the prognostic significance of tubal patency investigation by means of laparoscopy, hysterosalpingo-contrast sonography (HyCoSy) with air and saline as a contrast medium, and hysterosalpingography (HSG) in relation to the outcome of intrauterine insemination (IUI) treatment. STUDY DESIGN: A retrospective study of 559 consecutive women attending the university hospital infertility clinic for infertility treatment in 1996-2003. Tubal patency was evaluated by laparoscopy in 261 women, by HyCoSy in 217 and by HSG in 81 women before insemination treatment. Altogether, 1240 insemination cycles were evaluated and the results were compared in the three study groups. RESULTS: The clinical pregnancy rates per cycle were 14%, 18% and 18% in the laparoscopic, HyCoSy and HSG groups, with no statistically significant difference between the groups. The cumulative pregnancy rates (mean 2.3 cycles) were 30%, 41% and 38%, respectively, with a significant difference between the study groups. In cases of unilateral patency, cumulative pregnancy rates after two cycles were 18% (laparoscopy), 29% (HyCoSy) and 29% (HSG). The numbers of tubal pregnancies were similar in the subgroups. CONCLUSIONS: Hysterosalpingo-contrast sonography with air and saline as a contrast medium is a very cost-effective tubal investigation method as regards selection of subjects for insemination.

Adult↗
PubMed2005

Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes.

BACKGROUND: Hysterosonosalpingography as a contrast ultrasound method is safer, cheaper and easier to perform than hysterosalpingography in the assessment of the uterine cavity and fallopian tubes. Is it feasible for all patients? Which is the main problem in the evaluation of target structures by ultrasound? METHODS: In a prospective study, 68 patients in the initial stage of the infertility treatment were examined by hysterosonosalpingography using saline NaCl infundibile and Echovist as contrast media. Subsequently, further status of the tubes and uterine cavity was assessed by the "gold standards", laparoscopy and hysteroscopy. RESULTS: Sensitivity and specificity of hysterosonosalpingography using NaCl infundibile for evaluation of the uterine cavity was 100 and 88.8%, respectively. Negative predictive value was 100% and positive predictive value 97%. Sensitivity and specificity of the method for the assessment of the tubal status was 100 and 66%, respectively, negative predictive value was 100% and positive predictive value was 61%. For the assessment of tubal patency using positive contrast Echovist the method has shown 100% sensibility and negative predictive value again but it reached a specificity of 77% and a positive predictive value of 70%. There were no evident complications during or after the procedure. CONCLUSION: Hysterosonosalpingography is useful in making decisions regarding further procedures for the diagnosis and treatment of infertility. Uterine cavity evaluation using saline is the method of choice. Tubal patency can be assessed only under ideal sonographic conditions. The method is feasible for early assessment of the reproductive status of uterine cavity and fallopian tubes as a simple, safe and cheap outpatient method prior to any following invasive procedure or even histerosalpingography.

Adult↗
PubMed2005

Effects of cornual catheterization on uterotubal histology and function.

OBJECTIVE: To assess histologic damage and functional impairment following coaxial tubal catheterization. DESIGN: Prospective randomized controlled study. SETTING: Research laboratory. PATIENT(S): Ninety-two female New Zealand rabbits. INTERVENTION(S): Tubal cannulation and mating. MAIN OUTCOME MEASURE(S): Rabbits randomized for placement of unilateral catheter and guide wire (group 1), unilateral catheter and guide wire plus falloposcope (group 2), and catheterization as in group 1 or 2 but using a cage catheter (groups 3 and 4, respectively). A fifth group consisted of rabbits with tubal perforations. Rabbits were killed at 2 or 4 weeks after catheterization or after mating. The sixth group consisted of only control rabbits. RESULT(S): Only one catheterized tube in groups 1 and 3 showed inflammation, fibrosis, or edema. None of the tubes manifested ciliary loss. Serosal tubal adhesions were identified in two tubes in group 1, in one in group 3, in three tubes in group 5, and one in the control group. The nidation index in control and nonperforated catheterized tubes ranged from 72%-95% (not significant). Nidation index in tubes unintentionally perforated was 81%. CONCLUSION(S): Catheterization of the uterotubal junction and fallopian tube in rabbits does not cause long-term tubal damage or impair tubal function.

Animals↗
PubMedDate not supplied

Reproductive performance after selective tubal catheterization.

STUDY OBJECTIVE: To evaluate the reproductive performance of women after selective tubal catheterization. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION: Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION: One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.

Adult↗
PubMed1992

The use of carbon dioxide laser laparoscopy in the treatment of tubal ectopic pregnancies.

OBJECTIVE: The purpose of this study was to assess the efficacy of the treatment of unruptured tubal ectopic pregnancies by the use of carbon dioxide laser laparoscopy. STUDY DESIGN: A series of 125 consecutive ectopic pregnancies were treated laparoscopically; the tubal pregnancy was removed by a laparoscopic laser technique. Preoperative assessment included monitoring beta-human chorionic gonadotropin levels, use of vaginal ultrasonography, and preoperative and postoperative hematocrit levels. RESULTS: Laparoscopic laser surgery was successful for removal of tubal ectopic pregnancies in all but four patients, in whom a laparotomy was required. Hematocrit levels before and after surgery were similar. The time necessary for beta-human chorionic gonadotropin to fall to nondetectable levels averaged between 3 and 4 weeks. There were five patients who had complications requiring additional surgery and/or medical treatment. CONCLUSION: The techniques are easy to learn, and the use of laparoscopic laser surgery in the treatment of tubal ectopic pregnancies appears to be a safe procedure with definite advantages for both the patient and the physician. There are decreased operating times, shorter hospital stays, and lower medical costs compared with those for major surgery. Subsequent successful intrauterine pregnancy rates are comparable to those of conservative methods previously reported.

Adult↗
PubMed1977

A two-year experience with the Falope ring sterilization procedure.

The use of cautery laparoscopic sterilization procedures has two major disadvantages: (1) occasional inadvertent thermal injury to organ structures other than the Fallopian tube and (2) the inability to limit the injury to the Fallopian tube in a manner that might allow subsequent reconstructive surgery. In an effort to avoid the use of thermal energy to effect female sterilization, the Falope ring laparoscope was developed. From October, 1973, through September, 1975, 4,390 sterilization procedures were completed employing this approach; 902 cases have been completed at the Woman's Clinic of the Johns Hopkins Hospital, 1,741 cases were completed by gynecologists in various cities in the United States, and 1,747 procedures were completed by physicians in various locations throughout the world sponsored by the International Fertility Research Program.

Cautery↗
PubMed1985

Sterilization failures and their causes.

To say that a sterilization failure rate is expected does not answer why. Forty-seven cases of repeat sterilization have undergone such surgical and pathologic scrutiny. Resection methods failed most frequently because of spontaneous reanastomosis or fistula formation. Fimbriectomy was particularly vulnerable to reanastomosis because the fimbria ovarica was not removed. Mechanical devices failed when the device was defective, placed improperly, or placed in an improper location. Tissue damage was evident but incomplete when the bipolar electrocoagulation method failures were reviewed, and the endosalpinx remained viable. Unipolar method injuries, in contrast, were complete; they failed by fistula formation. Thus bipolar method failures may occur because of the limited range of electrical power available when using bipolar generators. Some sterilization failures are preventable, but many are not. When medicolegal questions arise, these findings may help answer the question, Why?

Contraceptive Devices, Female↗
PubMed1987

Conservative surgical management of isthmic ectopic pregnancies.

During the 12-month study interval ending March 30, 1986, there were 203 ectopic pregnancies at Grady Memorial Hospital, a ratio of one ectopic gestation per 34 deliveries. Twenty patients with isthmic ectopic pregnancies were selected for treatment by one of three operative modalities. Seven patients with ruptured isthmic ectopic pregnancies underwent segmental tubal resection without reanastomosis. All four patients who underwent segmental tubal resection with primary microsurgical reanastomosis had postoperative hysterosalpingograms demonstrating bilateral tubal patency. One pregnancy has occurred in this group. Nine patients underwent linear salpingostomy. In five of the six patients who had postoperative hysterosalpingography, patency of the involved fallopian tube was demonstrated. Four of these nine patients, including one patient with contralateral tubal occlusion, have conceived. We conclude that linear salpingostomy for isthmic ectopic pregnancies is as effective as segmental tubal resection with primary microsurgical reanastomosis in achieving tubal patency.

Adult↗
PubMed1987

Hysterosalpingographic evaluation of tubal patency after ectopic pregnancy.

In the period 1983 to 1985, hysterosalpingography was performed in 76 women after laparotomy to manage ectopic gestations. Clinical characteristics of these women, including their operative findings, were then correlated with the follow-up hysterosalpingography. Study participants were classified into five groups according to surgical management of the ectopic gestation. In each of the five groups, a substantial percentage of those women with a nonpatent fallopian tube (contralateral to the tube bearing the ectopic gestation) on hysterosalpingography had a normal-appearing fallopian tube at laparotomy. Approximately 50% of women with a history of previous pelvic inflammatory disease were found to have nonpatent contralateral fallopian tubes on follow-up hysterosalpingography.

Adolescent↗
PubMed1988

Sterilization reversal: results of 101 attempts.

One hundred one patients underwent reversal of sterilization. Among the 79 patients with a known outcome, the successful pregnancy rate was 35%. In contrast, the tubal patency rate was 91%. An analysis of standard preoperative fertility factors failed to reveal their predictive value. Total motile sperm counts of greater than 60 x 10(6) resulted in more successful pregnancies than counts below this number (p less than or equal to 0.005). The operating microscope did not have any advantage over loupes. Patients with one tube greater than 7 cm in length had a delivery rate of 75%, compared with 16% for those with shorter tubes (p less than or equal to 0.001). Eighty percent of patients with a distal segment of the anastomosis that included part of the isthmic tube had deliveries (p less than or equal to 0.029). In contrast, all ectopic pregnancies were associated with a distal segment consisting only of ampulla; the risk of ectopic pregnancy after patent ampullary anastomosis was 23% (p less than or equal to 0.05).

Fallopian Tube Patency Tests↗
PubMed2000

Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study.

OBJECTIVE: To assess the feasibility and reproducibility of laparoscopic microsurgical tubal anastomosis using a remote-controlled robot. DESIGN: Descriptive case study. SETTING: Academic medical center. PATIENT(S): Eight patients with previous laparoscopic tubal sterilization who requested tubal reanastomosis. INTERVENTION(S): Systematization of the operative steps for laparoscopic tubal reanastomosis using a remote-controlled robot. MAIN OUTCOME MEASURE(S): Primary outcome measures were feasibility and reproducibility; secondary measures were tubal patency, operative time, complications, and ergonomic qualities. RESULT(S): The 16 tubes were successfully reanastomosed and patency was confirmed. The mean time that the robotic system was in use was 140 minutes, and mean surgical time was 52 minutes per tube. CONCLUSION(S): Laparoscopic microsurgical tubal reanastomosis after tubal sterilization can be performed using a remote-controlled robotic system. The robot, which has three-dimensional vision, allows the surgeon to perform ultraprecise manipulations with intraabdominal articulated instruments while providing the necessary degrees of freedom. Systematization of the operative steps allowed performance of the operation at a speed that compares favorably with the time needed for open microsurgical techniques. Larger series are needed to assess postoperative pregnancy rates.

Adult↗