Proximal tubal disease

Abstract

Proximal tubal disease accounts for 10˜25 % of tubal infertility. The underlying causes of tubal damage include pelvic inflammatory disease (PID), pelvic and abdominal surgery or endometriosis. Hysteroscopy and laparoscopy with chromopertubation (HLC) is considered as the “gold standard” for evaluating the integrity of the uterine cavity and for establishing tubal status. There are two treatment options for proximal tubal disease, namely, tubal surgery and in-vitro fertilisation (IVF). The success of surgical treatment depends on careful selection of cases. Tubal cannulation should be attempted prior to tubal anastomosis. Laparoscopy guided hysteroscopic tubal cannulation (LHTC) in women with proximal tubal block produces encouraging results regardless of whether one or both tubes are blocked. The overall pregnancy rate of LHTC is around 38 %. In women with proximal tubal block, LHTC and IVF are both effective treatment options.