Hysteroscopic tubal cannulation: long-term results

Objective To examine the success rate and long-term results of hysteroscopic cannulation under laparoscopic control for proximal fallopian tube obstruction. Design Retrospective outcome analysis. Setting Referral endoscopic private practice for infertility. Subjects 29 patients referred with proximal tubal cornual obstruction, confirmed by hysterosalpingography or laparoscopys with other tubal factors confounding infertility. All patients underwent hysteroscopic proximal guide wire tubal cannulation under laparoscopic guidance. Main outcome measures Pregnancy outcomes from 2 to 5 years following the procedure. Results Of a total of 29 attempts at tubal cannulation, 16 were unsuccessful at the time of surgery (55%), while 13 patients had successful proximal tubal cannulation, and patency confirmed via intraoperative chromotubation. Of these 13, three were lost to long-term follow up. Among the 10 remaining patients, there were three pregnancies: two term deliveries and one ectopic pregnancy. The remaining seven of the 10 patients with successful cannulations did not achieve pregnancy (70%) and elected for in vitro fertilization or adoption. Conclusion After over a decade of reports of hysteroscopic tubal cannulation, this procedure has been used as the first-line, and often only therapy for proximal tubal obstruction. The results of this ser-ies indicate that pregnancy rates are not as favourable as reported by others. These long-term poor results should be consider-ed when counselling patients with cornual occlusion about this surgery or other assisted reproductive options.