Proximal tubal obstruction is a common verdict of the Hysterosalpingogram (HSG), found in nearly 15 percent of the studies. The occlusion entails the intersection of the uterus and the Fallopian tube. The tube’s diameter is quite small inside the uterine wall. The occlusion comes to notice at the utero-tubal intersection, when radiographic contrast dye does not succeed in entering the isthmic Fallopian tube.
In a majority of cases, the proximal occlusion is found to be serviceable. Obstruction is an important revelation as involuntary tubal contractions and relaxations are necessary for transporting a gamete. The interstitial segment of the Fallopian tube is anatomically composite area, where the uterus myometrium changes into the three muscle layers that create fallopian tube. The uterus instrumentations while performing the HSG examination, often results in tubal spasm bilaterally and unfilling of the tubes.
Nonetheless, the tubal obstruction may happen because of a number of medical reasons, like:
- Chronic or acute salpingitis
- Salpingitis isthmica nodosa
- Pelvic adhesive disease
- Cornual fibroids
- Endometritis (Often because of Pelvic Inflammatory Disease, Gonorrhea, Chlamydia infections or tuberculosis)
- Previous ectopic pregnancy
Several techniques have been explained for overcoming tubal obstruction. These may include:
- Transcervical tubal cannulation through fluoroscopy
- Concurrent hysteroscopy and laparoscopy
- Transcervical balloon tuboplasty,
- SIS – Saline infusion sonohysterography
All these procedures have some usefulness, but most of them require ample experience of the surgeon and anesthesia. With SIS procedure, the doctors identify the fluid accumulation in the pelvic area through ultrasound to ascertain the tubal patency, but the false indications for the tubal obstruction are found to be higher than the HSG procedure.
The uncomplicated method of confirming the presence of proximal tubal obstruction medically is to replicate the HSG procedure after a month. In a study involving 40 patients having proximal tubal obstruction found in the preliminary examination, the repeated HSG procedure revealed patency of the tubes in 60 percent of the cases.
Anesthesia is not necessary during the HSG procedure. Also, with quickly healing procedure, it is considered the best method for evaluating the tubal patency. The procedure does not require certain operating skills, as several factors like intrauterine trauma, cold contrast and uterine manipulation excessively may accelerate the tubal spasm and cause fleeting obstruction of the isthmic area of the Fallopian tubes.
Hysteroscopy, performed in the office settings, is not very useful clinically. 3-faceted ultrasound may only help the doctor in indentifying the fibroids presence, but the procedure does not review the patency of the Fallopian tubes.
In case it is established that the Fallopian tubes are obstructed, IVF (In vitro Fertilization) is believably the best treatment choice. Although the pregnancy rates after the IVF procedure because of tubal occlusion are related to age, but the nationwide live birth reportedly in each cycle for women below the age of 35 is about 40 percent.