Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure

Abstract

Objective: Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG).

Design: Prospective study.

Setting: Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care.

Patients: One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure.

Intervention: Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube.

Main outcome measures: Of 155 tubal ostia, 145 (94.2%) were catheterized.

Results: Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube.

Conclusions: During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.