Tubal surgery in the era of IVF

Tubal surgery should be attempted, at least in some selected cases, to restore normal tubal function before recommending IVF. Diagnostic tests to estimate the impact of tubal factor infertility are recommended before considering carefully the available options.

Nowadays when dealing with hydrosalpinges (fluid in the tube), salpingectomy (removal of the tube) is routinely performed prior to IVF, thus offering women no more hope to achieve a pregnancy spontaneously. The issue raised by some reproductive surgeons like Mr Nardo is "why not salpingostomy (opening the tube and draining the fluid)?", which is more conservative and may leave the woman with a chance to conceive without undergoing IVF treatment in the future. Proximal tubal cannulation under hysteroscopy guidance is a proven successful and satisfactory treatment approach to overcome problems that cause a block at the cornual end (i.e., where the tubes join the uterus) of the Fallopian tube.

Another example where mini-laparotomy or laparoscopy (keyhole) are as high as 80% in good prognosis young women with satisfactory ovarian reserve. Appropriate patient selection, surgical skills and equipment are crucial to the success of the surgery and future pregnancy potential.

Mr Nardo runs specialist theoretical and hands-on workshops for gynaecologists that wish to acquire skills to diagnose tubal patency in the office-setting and perform hysteroscopic tubal cannulation. The next workshop will be held on Monday 26th September 2011 at the Spire Manchester Hospital, Whalley Range, Manchester. For any queries regarding availability of places please contact education@gyne-health.co.uk or 0845 600 9997.