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Tubal Surgery - Tubal Cannulation

This is a procedure devised for the treatment of cornual occlusion or proximal tubal blockage in women with tubal factor infertility. A tiny wire is placed through the cervix and uterus and into the tube either under x-ray guidance or via a hysteroscope (a small telescope).
Hysteroscopic tubal cannulation allows visualisation of the entire uterine cavity, which may be useful in diagnosis and treating other coexisting problems at the same time of cannulation. In 2004 the National Institute for Health and Clinical Excellence (NICE) guideline for the management of infertility has recommended tubal cannulation as a treatment option in cases of proximal tubal occlusion.

Tubal blockage occurs in approximately 11% of women who have had one episode of pelvic inflammatory disease (PID), increasing to 23% after two episodes and 54% after three episodes. Other causes of tubal occlusion include fibrosis and endometriosis (7-14%), salpingitis isthmica nodosa and cornual polyps (10%). Tubal blockage secondary to tubal spasm or intratubal debris may cause a reversible tubal occlusion.

Tubal cannulation gently helps to open the tube and may relieve an obstruction in the cornual area. Laparoscopy can be performed at the same of the hysteroscopy to ensure that the tubes are not perforated with the wire and also to inject some dye through the uterus into the tubes to verify that they are open.

Laparoscopic treatment of tubal adhesions and fimbrial phimosis.
Some patients with an otherwise normal fertility evaluation can have subtle adhesions over the fallopian tubes and ovaries. These adhesions appear like cobwebs (or cling-film) over the surface of these organs and can prevent the release of the egg during ovulation, prevent the tubes from picking-up the eggs and limit the motility of the tubes. Injury to the distal end of the tubes may also result in loss of or damage to the feathery appendages of the tube (fimbria), known as fimbrial phimosis. Patients at high risk for these problems include those who have had intrauterine devices for long time, those with a history of pelvic inflammatory disease (PID), appendicitis or ruptured ovarian cyst. The adhesions and the fimbrial phimosis can be treated laparoscopically (keyhole surgery).

In carefully selected cases, tubal surgery has comparable success rates with IVF with the advantage of avoiding the risks of ovarian hyperstimulation syndrome and multiple pregnancies. Subsequent spontaneous pregnancies after one intervention is also a realistic possibility. IVF may be considered as the first treatment option in older women (>37 years), in the presence of other factors contributing to the couple 's subfertility, and when either there has been no pregnancy or previous ectopic pregnancy following successful tubal surgery.

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