Proximal Tubal Disease

In: Reproductive Surgery in Assisted Conception · 2015 · pp. 15–25 · doi:10.1007/978-1-4471-4953-8_2 · W970702012
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Laparoscopy-guided hysteroscopic tubal cannulation for proximal tubal block shows a 38% pregnancy rate and is an effective treatment option alongside IVF.

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This chapter reviews proximal tubal disease as a cause of tubal infertility (estimated 10–25%) and discusses evaluation and treatment options, focusing on high-level approaches such as hysteroscopy and laparoscopy with chromopertubation (HLC) to assess uterine cavity integrity and tubal status. It describes tubal surgery and in-vitro fertilisation (IVF) as two treatment options, noting that success of surgical treatment depends on careful case selection and that tubal cannulation should be attempted before tubal anastomosis. It reports that laparoscopic guided hysteroscopic tubal cannulation (LHTC) for proximal tubal block has an overall pregnancy rate around 38%, and states that LHTC and IVF are both effective in women with proximal tubal block. This paper is centrally about endometriosis only as a cited underlying cause of proximal tubal damage alongside PID and pelvic/abdominal surgery, and it therefore has relevance to endometriosis via that etiologic connection.

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Abstract

Proximal tubal disease accounts for 10 ~ 25 % of tubal infertility. The underlying causes of tubal damage include pelvic inflammatory disease (PID), pelvic and abdominal surgery or endometriosis. Hysteroscopy and laparoscopy with chromopertubation (HLC) is considered as the “gold standard” for evaluating the integrity of the uterine cavity and for establishing tubal status. There are two treatment options for proximal tubal disease, namely, tubal surgery and in-vitro fertilisation (IVF). The success of surgical treatment depends on careful selection of cases. Tubal cannulation should be attempted prior to tubal anastomosis. Laparoscopy guided hysteroscopic tubal cannulation (LHTC) in women with proximal tubal block produces encouraging results regardless of whether one or both tubes are blocked. The overall pregnancy rate of LHTC is around 38 %. In women with proximal tubal block, LHTC and IVF are both effective treatment options. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

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