Evaluating Lipiodol Efficacy in Proximal Tubal Occlusion Treatment: Single-Center Experience and Literature Review

Abstract

BACKGROUND Tubal infertility caused by proximal occlusion of fallopian tubes is a common cause of female infertility. Lipiodol (ethiodized oil) is an oil-based iodinated contrast medium, previously used in hysterosalpingography, and is now used as a therapeutic agent. This single-center study aimed to evaluate the experience of outcomes from the use of Lipiodol in 96 women with infertility due to fallopian tube occlusion. MATERIAL AND METHODS In total, 96 women with infertility caused by tubal obstruction, confirmed in hysterosalpingography and/or laparoscopy, who underwent tubal recanalization followed by Lipiodol injection were enrolled. Information regarding the reproductive outcome at a minimum of 6 months following the treatment was collected by a telephone survey or direct contact. Pregnancy rate was calculated. RESULTS Average age on admission was 33±4.1 years. In most cases (79%, 76/96), infertility was primary. Average duration of infertility was 2.8 years. Comorbidities included endocrinopathies and endometriosis. Complete patency was achieved in 96% of cases (92/96 patients). In 4 cases (4%), distal occlusion of 1 ovary was observed, resulting in partial procedural success. Tubal catheterization was needed in 29 patients (30%). No procedural complications were noted. Thirty-four patients conceived, resulting in a 35.8% pregnancy rate. Miscarriage was noted in 5 patients, and tubal ectopic pregnancy in 1 patient. No long-term complications were reported. CONCLUSIONS Our results show that use of oil-based contrast for tubal recanalization is safe and effective treatment for proximal tubal occlusion, with a relatively high pregnancy rate (36%). Further studies are required to fully discover its potential benefits.

Figure 1

Tubal recanalization in a 32-year-old patient with proximal tubal occlusion. Procedure was selective salpingography and tubal catheterization. Initial contrast injection disclosed the uterine cavity, with no contrast flow through fallopian tubes, suggesting bilateral proximal occlusion. (A) Thin white arrow shows tenaculum forceps. Selective tubal catheterization was performed with a 0.035” guidewire (thick white arrow) inserted via 5 Fr diagnostic catheter (white triangle). (B) Tubal patency was confirmed with contrast injection. (C) Afterward, 5 mL of Lipiodol was instilled until visible spill into the peritoneal cavity. (D) The procedure was performed bilaterally. (E) Bilateral spill of Lipiodol into the peritoneal cavity confirmed fallopian tubes patency. (F) White stars show spill of Lipiodol.