The fallopian tubes may be blocked distally (near the ovary) or proximally (at the insertion into the uterus). Distal occlusion is much more common than proximal occlusion. Women who have proximal occlusion may be candidates for tubal catheterization to relieve the obstruction. Tubal catheterization may be performed under x-ray guidance with the patient awake or in the operating room using a hysteroscope with the patient asleep. Our preference is to perform this procedure under x-ray guidance as this avoids the need for surgery and a general anesthetic.
Women who have documented proximal tubal occlusion on a previous hysterosalpingogram (HSG) are brought back to the radiology suite for tubal catheterization. An oral sedative and pain medication are given prior to this procedure. A standard HSG is performed first. Many women who had proximal tubal occlusion on a previous HSG will be found to have bilateral tubal patency on repeat HSG and no further therapy is required. However, if the repeat HSG confirms proximal occlusion, tubal catheterization is performed immediately. Small wires are threaded into the proximal tube at its insertion into the uterine cavity. This is performed under x-ray guidance. Most of the time the obstruction can be overcome and tubal patency established. For those women in whom the tubes cannot be opened with this technique, either surgical correction or IVF will be required.
Proximal tubal occlusion can also be treated in the operating room using the hysteroscope. This procedure is usually reserved for those patients who are going to be having a laparoscopy for other reasons. A hysteroscope is inserted into the uterus and under direct visualization a small catheter is inserted into the opening of the fallopian tube. Dye is injected through this catheter and tubal patency is evaluated by an assistant who is looking at the tubes from above with a laparoscope.