2 The procedure
2.1.1 Fallopian tube recanalisation by guidewire is a treatment for infertility caused by blocked fallopian tubes, especially if the blockage is close to the entrance to the uterus (proximal).
2.1.2 Alternative radiological methods of clearing tubal obstruction include balloon tuboplasty, which involves inflating a small balloon within the fallopian tube. Tubal obstruction may also be treated surgically.
2.2.1 Fallopian tube recanalisation by guidewire is carried out during the same treatment session as diagnostic salpingography and involves inserting a catheter into the fallopian tube. This, or the subsequent injection of radio-opaque dye, may clear the obstruction. If these strategies fail, a guidewire may be passed up into the fallopian tube through the catheter, and manipulated to clear the obstruction.
2.3.1 No controlled studies were identified. In one study, successful recanalisation was reported in 77% (321/417) of the tubes of 302 patients. Thirty (10%) of these 302 patients became pregnant without further infertility treatment within 12 months of undergoing the procedure. In another study, successful recanalisation was reported in 75% (176/234) of patients. Of these, 22% (39/176) had subsequent live births. For more details, refer to the Sources of evidence section.
2.3.2 One Specialist Advisor noted that the degree of efficacy may depend on patient selection.
2.4.1 In the studies identified, the rate of tubal perforation ranged from 1% (4/417) to 11% (4/38), and the rate of tubal pregnancy from 0.4% (1/234) to 8% (3/38). Other reported complications were sepsis in 0.9% (2/234) of patients, and pain requiring medication in 3% (7/234 and 4/150) of patients. For more details, refer to the Sources of evidence section.
2.4.2 The Specialist Advisors listed the main potential complications as fallopian tube perforation, intra-abdominal bleeding and infection.
2.5.1 There is a distinction between efficacy in terms of opening the fallopian tubes and in terms of achieving pregnancy.
2.5.2 The procedure is often used as an adjunct to other fertility treatments.
2.5.3 There is a potential risk of tubal perforation that may then reduce the chance of pregnancy.
2.5.4 Although the evidence showed an increased risk of tubal pregnancy, it was noted that there was generally a greater risk of tubal pregnancy in patients with tubal disease, even without this procedure.