Exxcellence pearls: proximal tubal occlusion

Question 0

What is the rate of tubal occlusion at HSG?

What are possible causes?

Answer 0

15%

Acute or chronic salpingitis, salpingitis isthmica nodosa (“diverticulitis of the fallopian tube”), cornual fibroids, pelvic adhesive disease, endometriosis, prior ectopic pregnancy, adenomyosis; functional occlusion

Question 1

What is the simplest way to confirm proximal tubal occlusion?

Answer 1

Repeat HSG in one month

Question 2

What is the rate of tubal patency upon repeat HSG?

Answer 2

60%

Question 3

What factors during HSG increase the risk of tubal spasm and temporary occlusion?

Answer 3

Excessive uterine manipulation, cold contrast, intrauterine trauma

Question 4

How should patients with tubal occlusion be counseled regarding future fertility?

Answer 4

IVF may be the best treatment option. For patients under age 35 live birth rate per cycle is approximately 40%.

Question 6

What does distal fallopian tube occlusion suggest?

How does this affect fertility? How should it be managed?

Answer 6

Hydrosalpinx

Drainage of fluid into the intrauterine cavity may prevent pregnancy. The tube should be removed and repaired via neosalpingostomy or occluded prior to initiating IVF.