What should I do if my fallopian tubes are blocked? What is fallopian tube dilation and recanalization?

Author: Miao Jie, deputy chief physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Reviewer: Liang Yuting, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Hysterosalpingography is the most commonly used method to check whether the fallopian tubes are unobstructed. If the angiography finds that the fallopian tubes are obstructed or proximal to the fallopian tubes, fallopian tube dilation and recanalization can be performed under DSA for treatment.

The fallopian tube dilatation and recanalization procedure is a procedure in which a special fallopian tube catheter is inserted into the uterine cornu through the uterine cavity. An ultra-smooth micro-guidewire is introduced through the fallopian tube catheter to clear the fallopian tube. Because the guidewire is ultra-smooth and has moderate hardness and softness, it generally does not damage the fallopian tube. However, when the fallopian tube adhesions are severe, clearing failure may occur.

After using the guide wire to clear the fallopian tube, selective salpingography is performed through the fallopian tube catheter to observe the appearance of the fallopian tube. If the clearing effect is not satisfactory, continue to clear it until it is satisfactory. After the clearing is successful, the treatment drug is injected under pressure through the fallopian tube catheter, which not only flushes the fallopian tube, but also has a therapeutic effect. The drug enters the pelvic cavity through the fallopian tube and also has an effect on improving the pelvic environment, thereby achieving a therapeutic effect.

For example, patients with proximal fallopian tube obstruction can achieve the purpose of clearing the fallopian tube through this method. After clearing the tube, they can prepare for pregnancy in the next menstrual cycle.

Figure 1 Original copyright image, no permission to reprint

It is important to understand that after the fallopian tubes are unblocked, if there are some personal factors, such as persistent pelvic inflammation or accompanied by diseases such as endometriosis, the fallopian tubes may be blocked again.

Because fallopian tube dilatation and recanalization is only a physical clearing, if the cause is not completely eliminated, the fallopian tube may be blocked and adhered again after a period of time.

Therefore, it is recommended that patients should start preparing for pregnancy as soon as possible from next month after either salpingography or dilation and recanalization surgery. If the time is longer than one year, the fallopian tubes are likely to become blocked again.

Of course, some fallopian tube blockages are very serious. For example, if there has been a history of female reproductive system tuberculosis, the tubal lumen is severely damaged, and the adhesions are also very serious. It is difficult to clear them with this method. In this case, the patient will be advised to undergo in vitro fertilization, that is, to implant the fertilized egg into the uterine cavity through artificial insemination.

Figure 2 Original copyright image, no permission to reprint

For patients with severe fallopian tube adhesions, if they are unwilling to undergo assisted reproductive technology, they can also consult a reproductive surgeon and try a combined hysteroscopy and laparoscopy to clear and repair the fallopian tubes. If the operation is successful, natural conception is expected.

Relatively speaking, tubal dilatation and recanalization is relatively simple, with less damage, low risk and low cost. For patients with mild tubal obstruction, it can be the first choice for treatment. If tubal dilatation and recanalization is not effective, other treatment options can be adopted. The doctor will inform the patient of several treatment methods, follow the patient's opinions, and also help the patient analyze which treatment is more suitable according to the specific situation.