Distal Tubal Disease

Tubal occlusion can affect any segment of the fallopian tubes, but most commonly affects the distal tube and accounts for ~80 % of tubal diseases. Tubal impairment often occurs following pelvic inflammatory disease, pelvic and abdominal surgery and endometriosis. Pathology in the distal portion of the tube may vary from peritubal adhesions, damaged fimbriae, distorted tubal anatomy to tubal blockage leading to the formation of hydrosalpinx. Various tubal and uterine screening modalities such as hysterosalpingography (HSG), Ultrasonography and Sonohysterography (USS), laparoscopy and Hysterosalpingo-Contrast Sonography (HyCoSy) are used in different centres. Laparoscopy is still considered as the “golden standard”. For couple with infertility associated with distal tubal disease, there are two therapeutic options: reconstructive tubal surgery and in vitro fertilization. The decision-making process requires detailed discussion on the effectiveness, adverse effects and cost of the procedures. Tubal surgery is not obsolete. It may be more cost-effective than IVF in selected cases and improves the results of IVF treatment. Endoscopic evaluation of the tubal mucosa (salpingoscopy) is essential to help decide if reconstructive tubal surgery is appropriate. In the case of unsuccessful reconstructive surgery or if a tube is irreparably damaged, a salpingectomy prior to in vitro fertilization ought to be considered. For patients with dense adhesions between the fallopian tube and the bowel or pelvic side wall, other options to improve the outcome of IVF should be considered, including proximal tubal occlusion or hysteroscopic tubal occlusion. Tubal surgery should be performed in women with hydrosalpinx, prior to IVF treatment. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Serafini P, Batzofin J. Diagnosis of female infertility. A comprehensive approach. J Reprod Med. 1989;34:29–40. Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril. 2011;95:2171–9. Papaioannou S, Afnan M, Jafettas J. Tubal assessment tests: still have not found what we are looking for. Reprod Biomed Online. 2007;15:376–82. National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. In: Clinical guideline. London: NICE; 2004. Sokalska A, Timmerman D, Testa AC, Van Holsbeke C, Lissoni AA, Leone FP, et al. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. 2009;34:462–70. Guerriero S, Ajossa S, Lai MP, Mais V, Paoletti AM, Melis GB. Transvaginal ultrasonography associated with colour Doppler energy in the diagnosis of hydrosalpinx. Hum Reprod. 2000;15:1568–72. Strandell A, Waldenstrom U, Nilsson L, Hamberger L. Hydrosalpinx reduced in vitro fertilization/embryo transfer pregnancy rates. Hum Reprod. 1994;9:861–3. Mukherjee T, Copperman AB, McCaffrey C, Cook CA, Bustillo M, Obasaju MF. Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis: a case for prophylactic salpingectomy. Fertil Steril. 1996;66:851–3. Seli E, Kayisli UA, Cakmak H, Bukulmez O, Bildirici I, Guzeloglu-Kayisli O, Aric A. Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window. Hum Reprod. 2005;20(11):3012–7. Zhong YP, Li J, Wu HT, Ying Y, Liu YF, Zhou CQ, Xu YW, Shen XT, Qi Q. Effect of surgical intervention on the expression of leukemia inhibitory factor and L-selectin ligand in the endometrium of hydrosalpinx patients during the implantation window. Exp Ther Med. 2012;4(6):1027–31. Lilford RJ, Watson AJ. Has in-vitro fertilization made salpingostomy obsolete? Br J Obstet Gynaecol. 1990;97(7):557–60. Singhal V, Li TC, Cooke ID. An analysis of factors influencing the outcome of 232 consecutive tubal microsurgery cases. Br J Obstet Gynaecol. 1991;98(7):628–36. Hedon B, et al. Critical evaluation of the fallopian tube. Fertility and Reproductive Medicine, Proceedings of the XVI World Congress on Fertility and Sterility, San Francisco. 1998;4–9:61–70. Muzii L, Angioli R, Tambone V, Zullo MA, Marana R, Panici PB. Salpingoscopy during laparoscopy using a small-caliber hysteroscope introduced through an accessory trocar. J Laparoendosc Adv Surg Tech. 2010;20(7):619–21. Mage G, et al. A preoperative classification to predict the intrauterine and ectopic pregnancy rates after distal tubal microsurgery. Fertil Steril. 1986;46:807–10. Orvieto R, Saar-Ryss B, Morgante G, Gemer O, Anteby EY, Meltcer S. Does salpingectomy affect the ipsilateral ovarian response to gonadotropin during in vitro fertilization-embryo transfer cycles? Fertil Steril. 2011;95(5):1842–4. Mijatovic V, Veersema S, Emanuel MH, Schats R, Hompes PGA. Essure® hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization–embryo transfer in patients with a contraindication for laparoscopy. Fertil Steril. 2010;93:1338–42. Mijatovic V, Dreyer K, Emanuel MH, Schats R, Hompes PGA. Essure® hydrosalpinx occlusion prior to IVF-ET as an alternative to laparoscopic salpingectomy. European J Obstet Gynecol Reprod Biol. 2012;161:42–5. Kerin JF, Cattanach S. Successful pregnancy outcome with the use of in vitro fertilization after Essure® hysteroscopic sterilization. Fertil Steril. 2007;87:1212.e1–12124.e4. Galen DI, Khan N, Richter KS. Essure® multicenter off-label treatment for hydrosalpinx before in vitro fertilization. J Minimally Invasive Gynaecol. 2011;18:338–42. Hitkari JA, Singh SS, Shapiro HM, Leyland N. Essure® treatment of hydrosalpinges. Fertil Steril. 2007;88:1663–6. Arora P, Arora RS, Cahill D. Essure® for management of hydrosalpinx prior to in vitro fertilisation—a systematic review and pooled analysis. Br J Obstet Gynaecol. 2014;121:527–36. Na ED, Cha DH, Cho JH, Kim MK. Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy. Clin Exp Reprod Med. 2012;39(4):182–6. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2015 Springer-Verlag London About this chapter Cite this chapter Chen, Y.Q., Hou, H.Y., Li, TC. (2015). Distal Tubal Disease. In: Metwally, M., Li, TC. (eds) Reproductive Surgery in Assisted Conception. Springer, London. https://doi.org/10.1007/978-1-4471-4953-8_1 Download citation DOI: https://doi.org/10.1007/978-1-4471-4953-8_1 Publisher Name: Springer, London Print ISBN: 978-1-4471-4952-1 Online ISBN: 978-1-4471-4953-8 eBook Packages: MedicineMedicine (R0)