Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Academic Department, Birmingham Women's Hospital NHS Foundation Trust, Metchley Park Road, Edgbaston, Birmingham, UK.
Hum Reprod. 2017 Apr 1;32(4):836-852. doi: 10.1093/humrep/dex022.
What is the chance of clinical pregnancy when fallopian tube catheterization is used for proximal tubal obstruction?
The pooled clinical pregnancy rate of tubal catheterization after proximal tubal obstruction is 27% (95% CI 25-30%).
Restoring fallopian tube patency by performing tubal catheterization has fallen out of favour since the increased availability of IVF. Our study is the first systematic review and meta-analysis to investigate reproductive outcomes following tubal catheterization for proximal tubal obstruction.
STUDY DESIGN, SIZE, DURATION: We undertook a systematic review and meta-analysis of 27 observational studies consisting of 1720 patients undergoing tubal catheterization for proximal tubal obstruction, who attempted to conceive naturally after the procedure.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Systematic literature searches were performed in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. A total of 2195 titles and abstracts were reviewed. Only studies that reported outcomes when tubal catheterization was performed with no other tubal surgery were included. Twenty-seven cohort studies matched the inclusion criteria for the meta-analysis.
The meta-analysis showed a pooled clinical pregnancy rate of 27% (95% CI 25-30%) after the use of tubal catheterization for unilateral or bilateral proximal tubal obstruction (27 studies, 1556 patients). In women with bilateral obstruction (14 studies, 617 patients), the clinical pregnancy rate was 27% (95% CI 23-32%). Our meta-analysis demonstrated that the pooled cumulative clinical pregnancy rates were 22.3% (95% CI 17.8-27.8%) at 6 months, 25.8% (95% CI 21.1-31.5%) at 9 months, 26.4% (95% CI 23.0-30.2%) at 12 months, 26.0% (95% CI 22.8-29.7%) at 18 months, 27.0% (95% CI 24.0-30.5%) at 24 months, 27.9% (95% CI 24.9-31.3%) at 36 months and 28.5% (95% CI 25.5-31.8%) at 48 months. The pooled live birth rate (14 studies, 551 patients) was 22% (95% CI 18-26%). The pooled ectopic pregnancy rate (27 studies, 1556 patients) was 4% (95% CI 3-5%). The included studies scored satisfactorily on the Newcastle-Ottawa quality assessment scale.
LIMITATIONS, REASONS FOR CAUTION: The pooled clinical pregnancy rate after tubal catheterization was found to be almost comparable to that after IVF. However, included studies were small, non-comparative series with significant clinical heterogeneity in population characteristics, follow-up and surgical equipment, technique and experience.
These findings suggest fallopian tube catheterization as an alternative strategy to IVF in patients presenting with proximal tubal obstruction. Further research should focus on comparing different surgical techniques of fallopian tube catheterization with IVF and provide cumulative reproductive outcomes over long-term follow-up.
STUDY FUNDING/COMPETING INTEREST(S): No funding was required and the authors have no competing interests to declare.
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输卵管导管术用于近端输卵管阻塞时，临床妊娠的几率是多少？
近端输卵管阻塞后行输卵管导管术的临床妊娠率为 27%（95%CI 25-30%）。
自 IVF 广泛应用以来，通过输卵管导管术恢复输卵管通畅的做法已不再流行。我们的研究是第一项系统评价和荟萃分析，旨在调查近端输卵管阻塞行输卵管导管术后的生殖结局。
研究设计、规模、持续时间：我们对 27 项观察性研究进行了系统评价和荟萃分析，这些研究包括 1720 名接受近端输卵管阻塞输卵管导管术的患者，这些患者在手术后试图自然受孕。
参与者/材料、设置、方法：在 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库中进行了系统文献检索。共回顾了 2195 篇标题和摘要。仅包括在不进行其他输卵管手术的情况下进行输卵管导管术且报告结果的研究。27 项队列研究符合荟萃分析的纳入标准。
荟萃分析显示，单侧或双侧近端输卵管阻塞行输卵管导管术的临床妊娠率为 27%（95%CI 25-30%）（27 项研究，1556 名患者）。在双侧阻塞的女性中（14 项研究，617 名患者），临床妊娠率为 27%（95%CI 23-32%）。我们的荟萃分析表明，6 个月时累积临床妊娠率为 22.3%（95%CI 17.8-27.8%），9 个月时为 25.8%（95%CI 21.1-31.5%），12 个月时为 26.4%（95%CI 23.0-30.2%），18 个月时为 26.0%（95%CI 22.8-29.7%），24 个月时为 27.0%（95%CI 24.0-30.5%），36 个月时为 27.9%（95%CI 24.9-31.3%），48 个月时为 28.5%（95%CI 25.5-31.8%）。活产率（14 项研究，551 名患者）为 22%（95%CI 18-26%）。异位妊娠率（27 项研究，1556 名患者）为 4%（95%CI 3-5%）。纳入的研究在纽卡斯尔-渥太华质量评估量表上得分令人满意。
局限性、谨慎的原因：输卵管导管术后的临床妊娠率发现与 IVF 几乎相当。然而，纳入的研究规模较小，为非对照系列研究，在人群特征、随访以及手术设备、技术和经验方面存在显著的临床异质性。
这些发现表明，对于有近端输卵管阻塞的患者，输卵管导管术可作为 IVF 的替代策略。进一步的研究应侧重于比较不同的输卵管导管术手术技术与 IVF，并提供长期随访的累积生殖结局。
研究资金/竞争利益：无需资金，作者无竞争利益申报。
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