Simple Procedure Enables Pregnancy in Infertile Women: Study

Blocked fallopian tubes can be opened using a brief and “ridiculously simple” outpatient procedure, often enabling natural conception and avoiding costly infertility treatments, researchers have found.  

For the technique, clinicians use x-rays to determine where a fallopian tube is blocked — if indeed it is — then use a fine wire to clear any obstructions so that patients can conceive naturally. However, in roughly one fourth of cases, the researchers found, what appear to be blockages on an initial x-ray are not problems on a repeat scan, meaning patients don’t require more invasive therapies to conceive.  

“A 40-year-old woman who had never been pregnant became pregnant 1 month after this procedure,” said Lindsay Machan, MD, associate professor of radiology at the University of British Columbia, Canada, who led the study. “When patients send us pictures of their babies it’s incredibly gratifying.”

Machan is scheduled to present the findings on Monday at the 2022 annual meeting of the Society of Interventional Radiology. He called the study the largest of its kind to date.

As many as 26% of women in North America live with infertility, which is the inability to conceive after 1 year of unprotected sex in those up to age 35, or 6 months in those age 35 and older.

Machan and colleagues examined the records of 956 women with infertility referred to their hospital over a 6-year period. Patients were generally in their mid-30s and had been told that one or both of their fallopian tubes were blocked.  

Using the new diagnosis and treatment technique, 80% of women who received the treatment had fully functioning fallopian tubes by the time they left Machan’s clinic.

Providers usually make a diagnosis of blocked fallopian tubes based on a standard diagnostic tool known as a hysterosalpingogram (HSG), which uses an x-ray and contrast dye to examine the fallopian tube for blockage. The dye eventually fills a fallopian tube, unless it is blocked.

However, sometimes tubal spasms or mucus pieces show up on the HSG as a blockage, and many providers don’t conduct the test a second time, according to Machan, leading to referrals for in vitro fertilization. Machan recommends providers simply repeat the HSG.

When Machan and colleagues repeated the HSG, with patients under light sedation to prevent tubal spasms, they discovered that almost 25% of women with supposedly blocked fallopian tubes had no obstructions.

In another group of patients with one or two blocked fallopian tubes, the researchers completed a second diagnostic assessment known as selective salpingography. In this procedure, a catheter is inserted and an x-ray provides detailed pictures of where blockages are located. The final step entails inserting a fine wire through the catheter to remove tubal blockages when possible.

“The patient can’t feel the wire going out into the tube,” Machan told Medscape Medical News. “It’s a ridiculously simple procedure” compared to other interventional radiology techniques.

The process generally takes 20-30 minutes under light sedation, Machan reported.

 “Very Attractive Option”

“If you find an easy solution for infertility, such as opening a blocked tube, that’s a very attractive option,” said Gloria Salazar, MD, chair of the vascular-interventional radiology division at the University of North Carolina School of Medicine, Chapel Hill.

The approach won’t work for all women depending on the severity of the tubal blockage, Salazar noted, but could be appealing for many women facing infertility. The study’s large number of patients, as well as its description of a combined diagnostic and therapeutic technique, makes it a valuable contribution, she said.

Women interested in the new procedure could face challenges in accessing appropriate specialists, depending on where they live and insurance coverage. Salazar encouraged women who are told that their fallopian tubes are blocked to explore all their options, and to coordinate care among healthcare providers.

Nearly 20% of women in the study had significant tubal blockages that could not be cleared easily. In one patient, the blockage was so severe that in vitro fertilization was unlikely to work, either. However, the patient obtained valuable information to guide her treatment decisions, Machan said.

Machan and Salazar reported no relevant financial relationships.  

Society of Interventional Radiology 2022 annual meeting: Abstract 135. To be presented June 13, 2022.

Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

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