Using Tubal Cannulation to Clear Fallopian Tube Blockage
Fallopian tube blockage occurs in more than 10 percent of women who have one episode of pelvic inflammatory disease (PID), and the rate goes up with more incidents of PID. Tubal blockage is a common cause of female infertility. Approximately one in four women who cannot conceive has this condition. Tubal cannulation is a procedure done to clear a blockage in the fallopian tubes, so the sperm can fertilize the egg, and the fertilized egg can move into the uterus. Tubal cannulation is often performed immediately following a selective salpingography. This procedure is done to identify and locate the fallopian tube blockage. The doctor unblocks the tube by using a catheter covered wire guided with ultrasound or real-time X-ray. The blocked region is opened up using a balloon device that is on the end of the catheter. This outpatient procedure is often done without anesthesia, but you may receive a sedative to help you relax.
Overview of Tubal Cannulation
Tubal blockage occurs in around 11 percent of women who have one incident of PID, 23 percent who have two episodes, and 54 percent who have three or more episodes. Other common causes of fallopian tube occlusion include endometriosis and fibrosis (10 percent) and salpingitis isthmica nodosa (10 percent). Tubal cannulation should only be done if the salpingography test clearly shows a blockage in one or both or the fallopian tubes. This procedure is more successful when the portion of the tube closest to the womb is blocked (called a proximal tubal obstruction). Some doctors require that the woman has tubal cannulation before undergoing expensive fertility measures, such as in vitro fertilization with embryo transplant.
When tubal adhesions or fibrosis affect fertility, they appear like cobwebs inside the fallopian tube or cling over the surface of the reproductive organs to prevent the release of the egg during ovulation. When the tube cannot move the egg into the uterus to implant, pregnancy does not occur. Patients at risk for damaged fallopian tubes include those with a history of PID, a history of a ruptured ovarian cyst, damage to the tube (fimbria), and a history of intrauterine device (IUD). Laparoscopic treatment of tubal adhesions and fibrosis is an alternative to tubal cannulation. The procedure is minimally invasive, relatively painless, and associated with few risks.
Proximal tubal blockage can be treated with a pregnancy rate of 50 percent following the procedure. The highest success rates occur with selective salpingography and tubal cannulation. Removal of the avascular adhesions increases the success rate to 70 percent with an ectopic pregnancy rate of 20 percent.
Contraindications to Tubal Cannulation
The tubal cannulation procedure is not right for everyone. It is not recommended if you have:
- Genital tuberculosis or other infections.
- Extensive scarring of the fallopian tubes (obliterative fibrosis).
- Severe damage to the fallopian tubes.
- Previous fallopian tube surgery.
- Severe blockage of the fallopian tubes.
- Certain blockages near the isthmus (narrowest part of the fallopian tube).
- Severe fallopian tube disease with scarring.
- A blockage in the fallopian tube that is farther from the uterus (distal tubal obstruction).
Risks of Tubal Cannulation
As with other surgical and minimally invasive procedures, there are a few risks associated with tubal cannulation. It should only be done by a doctor who is specially trained and qualified. The risks include:
- Tearing of the fallopian tube wall (perforation).
- Failure to restore fallopian tube function.
- Life-threatening infection of the abdominal organ tissues (peritonitis).
During the Procedure
Tubal cannulation is often performed immediately following a selective salpingography, and is often done without anesthesia. The doctor unblocks the tube by using a catheter covered wire guided with ultrasound or real-time X-ray. The blocked region is opened up using a balloon device that is on the end of the catheter. You may receive a sedative to help you relax or a form of anesthesia.
After the Procedure
The tubal cannulation procedure can help restore fertility in some (but not all) women. It is important that you follow the doctor's instructions after the procedure for best results. In carefully selected cases, tubal cannulation has comparable success rates to IVF, but it avoids the risk of ovarian hyperstimulation and multiple pregnancies. It is also possible that the woman will have subsequent spontaneous pregnancies following the procedure. Pregnancy rates depend on the:
- Location of the blockage.
- Specific procedure performed.
- Cause of the blockage.
- WebMD (2013). Tubal cannulation procedure. Retrieved from:http://www.webmd.com/infertility-and-reproduction/guide/what-is-tubal-cannulation
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