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.