ABSTRACT
The first hysterosalpingogram may have been peformed only 15 years after Roentgen discovered medical x-rays. It is a standard test that nonetheless figures prominently in modern decision making for more than 300,000 infertile couples in the United States alone. The application of angiographic techniques to this old-fashioned test has revolutionized the diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical recanalization of proximally obstructed tubes can be accomplished in about 90% of patients using a variety of catheter techniques. The pregnancy rate in a population that was recommended for tubal microsurgery or in vitro fertilization because of well-documented, isolated proximal tubal obstruction, but underwent catheter tubal recanalization instead without any other therapy, was 58% by 1 year and all pregnancies were intrauterine. In a population in which the cause of infertility is less well defined and additional tubal disease may be present, one would expect a lower short-term pregnancy rate, about 30 to 40%, and about 10% ectopic pregnancies. The American Society for Reproductive Medicine (formerly the American Fertility Society) has recommended that patients who have proximal tubal obstruction undergo selective salpingography and tubal recanalization prior to the more invasive and costly treatments that were used in the past.
KEYWORD
Fallopian tubes - catheter - sterilization - fertility
