Beyond recanalizing proximal tubal occlusion: the argument for further diagnosis and classification

摘要: Proximal tubal occlusion (PTO) accounts for 20% of factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that already diagnosed by laparoscopy hysterosalpingography (HSG) can be confirmed bypassed (false PTO) ; patients with false were placed on a temporary waiting period. Nodular pre-treated gonadotrophin-releasing hormone analogue (GnRH-a) at least 6 weeks to shrink the underlying pathology, after which re-catheterization was performed. In prospective study starting in July 1993, 53 prediagnosed as having examined falloposcopy. Three these had directed microsurgical repair (conservative treatment not possible). A total 19 cases revealed patent tubes healthy mucosa no pathology PTO). Of remaining 31 patients, 18 classified 13 occlusion. all one tube GnRH-a treatment. After month period, 37% achieved spontaneous pregnancy (6% per cycle). rate true group significantly lower (10% patient, 1.6% P < 0.05). assisted reproduction techniques, particular gamete intra-Fallopian transfer (GIFT), subsequent group, 50% cycle achieved. retrospective analysis our entire population (n = 109) showed achieving patency (using falloposcopy GnRH-a) dramatically low (1.8%), difference between groups. chance enhanced (P 0.001) using techniques (GIFT) following