Tubal factors in infertility.

Proximal, distal, and peritubal damage can be caused by a number of pathologic processes such as inflammation, endometriosis, and surgical trauma. The diagnosis of tubal occlusion relies primarily on hysterosalpingography, hysteroscopy, and laparoscopy. A number of innovative diagnostic procedures such as sonosalpingography, falloposcopy, and selective salpingography improved our ability to accurately diagnose tubal pathology. The long-standing surgical corrective approach to treat tubal occlusion has been replaced by noninvasive methods in selected patients with endoluminal damage. The development of noninvasive transcervical catheter methods to recanalize proximally obstructed fallopian tubes also allows access to the fallopian tubes for deposition of gametes and embryos and improves the diagnosis and treatment of tubal pregnancies. Transcervical tubal cannulation reduces the risks, costs, and morbidity of surgical procedures. The diverse applications of the transcervical tubal approach may also replace surgical invasive procedures in assisted reproductive procedures. Although radical changes have occurred in the treatment of proximal tubal occlusion, the repair of distal and peritubal damage frequently yields disappointing results, and will probably remain the challenge of the 1990s.