DIFFERENTIAL IMPACT ON PREGNANCY RATE OF SELECTIVE SALPINGOGRAPHY TUBAL CATHETERIZATION AND WIRE-GUIDE RECANALIZATION IN THE TREATMENT OF PROXIMAL FALLOPIAN-TUBE OBSTRUCTION

A total of 66 patients with proximal Fallopian tube (113 tubes) obstru ction, as diagnosed by both laparoscopy and hysterosalpingogram, were each subjected to a transcervical recanalization procedure sequentiall y using selective salpingography followed, if necessary, by tubal cath eterization with a soft Teflon 2-French catheter and finally, if neede d, wire-guide cannulation, Each procedure was terminated once patency had been achieved without recourse to the next technique, Bilateral ob struction was present in 47 patients and unilateral in 19 patients, Pa tency was achieved in 39 (34.5%) Fallopian tubes by selective salpingo graphy alone, in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wire guide, with 12 (10.6%) tubes remaining obstructed, Pregnancy o ccurred in 24 (36.4%) patients without recourse to other treatment (me an follow-up, 17 months), Where patency was achieved (59 patients), 19 out of 43 (44.1%) of those treated for bilateral obstruction and five out of 16 (31.3%) of those treated for unilateral obstruction achieve d a pregnancy, Pregnancy occurred in six out of 22 patients (27.3%) wh ere selective salpingography was used to produce tubal patency, in 17 out of 30 patients (56.7%) where tubal catheterization was used and in one out of seven (14.3%) where a wire guide was used, which was an ec topic pregnancy, The difference between the ongoing pregnancy rates fo llowing tubal catheterization (50.0%) and wire-guide cannulation (0.0% ) was significant (P = 0.033), While wire-guide cannulation is the mos t effective method used to achieve tubal patency, these results indica te that when it is truly necessary, as opposed to electively used by c linicians, the prognosis with regard to pregnancy is poor and alternat ive therapy such as microsurgery or in-vitro fertilization should be c onsidered early.