Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure.

OBJECTIVE

Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG).

DESIGN

Prospective study.

SETTING

Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care.

PATIENTS

One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure.

INTERVENTION

Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube.

MAIN OUTCOME MEASURES

Of 155 tubal ostia, 145 (94.2%) were catheterized.

RESULTS

Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube.

CONCLUSIONS

During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.