Discussion:
In this study, women who underwent technically successful fallopian tube
recanalization procedures, the spontaneous intrauterine pregnancy rate
was 31.4%, with the take-home-baby rate of 25.7%. The spontaneous
pregnancy rates in women with tubal disease without intervention is
7.9% [5]. Earlier studies on FTR demonstrated a spontaneous
pregnancy rate of 58% [8]. These studies were limited, however, as
strict patient selection was performed, which included both documented
negative diagnostic laparoscopy and proximal tubal occlusion by HSG. In
studies that lacked strict patient selection, such as lack of diagnostic
laparoscopy, the spontaneous pregnancy rate decreased to 15-39%, which
is concordant to the results obtained in this study and what is likely
to be seen in clinical practice [8,21].
The ectopic pregnancy rate in this study was 5.7%. Prior studies have
documented ectopic pregnancy rates which have ranged from 0-13%
[8,17,21]. The slightly higher ectopic pregnancy rate found in this
study could conceivably be secondary to lack of strict patient
population selection (i.e. lack of diagnostic laparoscopy). A possible
explanation for ectopic pregnancies after FTR has been thought to be
secondary to peritubal adhesions, which is unable to be seen on FTR,
however, could be readily identifiable on diagnostic laparoscopy
[17]. Peri-procedural complication rate was low, with only one
uncomplicated urinary tract infection identified, which resolved after a
short course of oral antibiotics. An additional 2 women had spontaneous
abortions. These rates do not appear significantly different when
compared to literature [22].
There are some limitations to this study. As this study was conducted at
an academic tertiary medical center in the Midwest of the United States,
our study population may not be applicable universally. Additionally,
the study size is relatively small with only 35 women meeting the
inclusion criteria, however, this procedure is underutilized and not
commonly performed.
Given the safety profile of fallopian tube recanalization and the
improved pregnancy rate, fallopian tube recanalization is a simple,
viable option which can be performed by interventional radiologists in
women who suffer from infertility secondary to tubal occlusion.