ABSTRACT
The first hysterosalpingogram may have been peformed only 15 years after Roentgen
discovered medical x-rays. It is a standard test that nonetheless figures prominently
in modern decision making for more than 300,000 infertile couples in the United States
alone. The application of angiographic techniques to this old-fashioned test has revolutionized
the diagnosis and treatment of proximal tubal obstruction. Results from worldwide
centers have shown that nonsurgical recanalization of proximally obstructed tubes
can be accomplished in about 90% of patients using a variety of catheter techniques.
The pregnancy rate in a population that was recommended for tubal microsurgery or
in vitro fertilization because of well-documented, isolated proximal tubal obstruction,
but underwent catheter tubal recanalization instead without any other therapy, was
58% by 1 year and all pregnancies were intrauterine. In a population in which the
cause of infertility is less well defined and additional tubal disease may be present,
one would expect a lower short-term pregnancy rate, about 30 to 40%, and about 10%
ectopic pregnancies. The American Society for Reproductive Medicine (formerly the
American Fertility Society) has recommended that patients who have proximal tubal
obstruction undergo selective salpingography and tubal recanalization prior to the
more invasive and costly treatments that were used in the past.
KEYWORD
Fallopian tubes - catheter - sterilization - fertility
