Instruments and techniques Reproductive performance after selective tubal catheterization Dania Al-Jaroudi, MD, Milton J. Herba, MD, and Togas Tulandi, MD From the Department of Obstetrics and Gynecology (Drs. Al-Jaroudi and Tulandi), and Department of Radiology (Dr. Herba), McGill University, Montreal, Quebec, Canada. STUDY OBJECTIVE: To evaluate the reproductive performance of women after selective tubal cath- eterization. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION: Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of con- ception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION: One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hys- terosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%. © 2005 AAGL. All rights reserved. KEYWORDS: Proximal tubal occlusion; Cornual blockage; Selective tubal catheterization; Transcervical tubal cannulation The findings of proximal tubal occlusion (PTO) or cor- nual occlusion on hysterosalpingogram can be due to sev- eral reasons including tubal spasm, mucus plugs, debris, or true cornual blockage. 1 In order to distinguish between true cornual obstruction and other lesions, several methods in- cluding laparoscopy have been advocated. During laparos- copy, tubal patency can be assessed, and some surgeons also can perform tubal reconstruction. A less-invasive technique than tubal surgery is selective tubal catheterization (STC) or transcervical tubal cannulation. 2 Selective tubal catheteriza- tion can be done using balloon angiographic catheters or guidewires under fluoroscopic, hysteroscopic, or ultrasound guidance. The reported successful cannulation of at least one fallopian tube is 79% with a pregnancy rate of 34%. 3 Materials and methods We examined the medical records of all women with hys- terosalpingographic findings of bilateral PTO who subse- quently underwent STC at McGill University Health Cen- ter, Montreal, from January 1994 through January 2001. All procedures were done by one operator (MJH). Corresponding author: Togas Tulandi, MD, Department of Obstetrics and Gynecology, McGill University, 687 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A1. E-mail: togas.tulandi@mcgill.ca. 1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.01.013 Journal of Minimally Invasive Gynecology (2005) 12, 150-152