Laparoscopy Guided Hysteroscopic Tubal Cannulation: A Study on Fertility Outcome

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Journal Name : Bangladesh Journal of Fertility & Sterility

Publisher : Fertility & Sterility Society of Bangladesh

Publication Date : 01/08/2021

Online Publication Date : 10/08/2021

Authors : Maruf Siddiqui, Nusrat Ghafoor, Rusmila Shamim Abdullah, Fahmida Naznine, Chowdhury Ayesha Siddiqua, Vinayak Mahajan, T A Chowdhury

Authors : Maruf Siddiqui, Nusrat Ghafoor, Rusmila Shamim Abdullah, Fahmida Naznine, Chowdhury Ayesha Siddiqua, Vinayak Mahajan, T A Chowdhury

ISSN : 2710-0553


Study Objective: Purpose of the study was to determine the fertility outcome with laparoscopy guided hysteroscopic cannulation in infertile patients having proximal tubal obstruction.

Study Design And Setting: This prospective interventional crossover trial was carried out in the Department of Infertility and Reproductive Medicine, Anwer Khan Modern Medical College Hospital in between November 2017 to September 2019.

Materials And Methods: A total of 126 infertile patients were recruited initially with unilateral or bilateral proximal tubal obstruction on hysterosalpingography (HSG). At first, laparoscopy was performed under G/A and methylene blue dye was used to access the tubal patency. Tubes were found patent in a total of 68 patients in laparoscopy only and they were excluded from the study. The remaining 58 patients were then finally recruited for laparoscopy guided hysteroscopic cannulation in unilateral or bilateral proximal tubal blocks found on laparoscopy. Following cannulation, methylene blue dye was reapplied on patients to assess the successful recanalization rate. Finally, all the patients with successful recanalization were followed up for at least 1 year for assessment of fertility outcome. Successful recanalization rate, any complications, ectopic and pregnancy rates were documented in all cases.

Results: 126 patients were initially recruited, but finally 58 patients made the inclusion criteria. 39 patients had bilateral and 19 patients had unilateral proximal tubal obstruction following laparoscopy. We could not complete the cannulation procedure in 4 patients due to dense adhesions and poor visualization and identification of ostium. Of the remaining 54 patients, successful recanalization rate was 85% per tube and 88% per patient. We did not experience any intraoperative complication in the whole study. A total of 16 successful pregnancies (29.62%) were reported. Unfortunately, 3 of them were ectopic and the remaining 13 pregnancies were intrauterine.

Conclusion: Laparoscopy assisted hysteroscopic tubal cannulation for proximal tubal obstruction can be a suitable alternative
for infertile couples with tubal factor infertility who cannot afford or do not wish to proceed for In-vitro fertilization (IVF).

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