Midtubal occlusion: etiology, management, and outcome

OBJECTIVE: To assess the significance of pathological midtubal occlusion in infertility. DESIGN: Retrospective descriptive case review. SETTING: Tertiary referral center. PATIENTS: Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. INTERVENTIONS: Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. MAIN OUTCOME MEASURES: Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. RESULTS: Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. CONCLUSION: Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.