Introduction:
Infertility and subfertility are two major gynecological disorders. Subfertility is a condition that is characterized by being unable to get pregnant for more than one year after having unprotected sex. All over the world, around 180 million people are suffering from such conditions. Every one out of five couples is suffering from fertility-related issues. Women's fertility disorders cause about 37 percent of these cases. Hormonal causes, infectious diseases, and structural malformations are the major causes of such problems. Around 30 percent of these cases are caused by issues related to the fallopian tube. Fallopian tube recanalization (FTR) is a surgical procedure to cure certain malformations like proximal fallopian tube blockage.
What Is Fallopian Tube?
Fallopian are tube-like structures extended from the uterus to the ovaries. These seromuscular structures are also known as oviducts or uterine tubes. The length of these tubes is 11 to 12 centimeters with a one-millimeter diameter. The fallopian tube comprises four parts: uterine, isthmus, ampulla, and infundibulum. The uterine, isthmus, and ampulla form the proximal part of the tube, while the infundibulum forms the distal part of the tube. The main function of the fallopian tube is it aids the movement of the egg. The egg released from the ovaries goes to the uterus via this duct. The fertilization of the egg with the sperm takes place in the ampulla portion of the fallopian tube. After this, the fertilized egg traveled to the uterus via the fallopian tube.
The movement of the egg and fertilized egg is aided by the ciliary movement of ciliated epithelial cells (thread-like structures projecting out of the front cells) and the contraction of smooth muscles. But blockage or damage of the fallopian tube structure prevents normal movement of the egg. These blockages are of two types: proximal fallopian tube blockage and distal fallopian tube blockage. Proximal fallopian tube blockage prevents the movement of the sperm and disrupts the fertilization process. Distal fallopian tube blockage involves the infundibular part. This part plays a crucial role in the implantation of the fertilized egg and in the movement of the fertilized egg toward the uterus. Blockage of the distal portion is responsible for problems in the implantation. This is also responsible for the repeated failure of assisted reproductive procedures. Proximal blockage of the fallopian tube is seen in 25 percent of the cases of tubal fertility-related complications.
The reasons associated with proximal tubal blockage are:
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Pelvic Inflammatory Disease: Pelvic inflammatory disorders are one of the main causes of the blockage of the tubal structures. These are mainly caused by sexually transmitted disorders like gonorrhea and chlamydia. Besides this infection during the insertion or removal of intrauterine devices (IUD), tuberculosis is also responsible for this kind of condition. Due to infection, fibrosis of the tubal structures and agglutination of intra-luminal folds occur. These are associated with tubal blockage.
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Salpingitis Isthmica Nodosa: This condition is characterized by nodular thickening of the intratubular structures. In this condition, cyst-like glandular structures are present inside the muscular layer. Around 11 percent of women of reproductive age suffer from such conditions. The cause of these conditions are unknown, but these are associated with hormonal imbalance and chronic infections. These are responsible for hypertrophy (overgrowth) of the smooth muscles and blockage of the tubal structures.
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Polypoid Lesions: These are small, well-circumscribed structure structures. These are ectopic endometrial tissue by nature. These are also known as subcorneal or cornual polyps.
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Endometriosis: In this condition, tissue similar to the ovary can be found outside the ovary. Such tissues can often be found in the proximal portion of the fallopian tube. Endometriosis is responsible for hormonal imbalance and altered inflammatory response. As a result, alteration of the fallopian tube structure can be seen. Also, the blockage can be caused by the deposition of intraluminal debris from retrograde menstruation. Moreover, increased tubal perfusion pressures (TPP) associated with endometriosis are responsible for tubal blockage.
What Are the Diagnostic Procedures?
Different diagnostic tests are done to diagnose the presence of a tubal blockage. These are:
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Hysterosalpingography (HSG): This is the most commonly used diagnostic method. In this technique, contrast media is inserted, and radiographic images of the uterine structures are taken.
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Laparoscopy and Chromotubation: This is the most modern and accurate diagnostic test. In this technique, a blue dye is injected into the fallopian tube, and its flow is observed with the help of a laparoscope.
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Selective Salpingography: Laparoscopic procedure is expensive and requires general anesthesia. On the other hand, the hysterosalpingography method is not accurate. As an alternative, this method is used. In this technique, the fallopian tube is directly opacified by a catheter, and radiographs are taken. This method can differentiate between pathological blockage and spasms, as spam can be treated by increased pressure of the dye in the catheter.
What Is Fallopian Tube Recanalization?
This is a therapeutic procedure in which a guided wire and a catheter are used to remove the blockage of the proximal fallopian tube. This process can be done as a continuation of selective salpingography or with the help of the laparoscopic technique also.
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Procedure
A speculum and a small catheter are inserted into the uterine cavity during the procedure. After this, dye is injected, and radiographs are taken to assess the blockage. The guidewire is passed through the guiding catheter, and gentle probing to done to remove the blockage. But in certain cases, a guidewire is not enough to remove the blockage. In those cases, a 45-degree angled hydrophilic coated microwire system is used to remove the blockage. After removing the occlusion, contrast media is passed through it, and radiographs are taken to check the patency.
Conclusion:
Subfertility and infertility are major causes of fertility-related complications. Tubal factors are one of the biggest causes of fertility-related complications. Proximal blockage of the fallopian tube is responsible for fertilization problems. Fallopian tube cannulation is a non-surgical technique to treat such conditions.
