Effectiveness of Selective Tubal Catheterization in the Management of Female Infertility due to Proximal Tubal Obstruction in Togo

Introduction: The problem of fertility is growing nowadays not only in western countries but also in other areas as even in developing countries the couples postpone childbirth well over the age of 30 in order to focus on their careers and financial stability.

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction.

Methods: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative
-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after failure of spontaneous tubal opacification.

Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified; 62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%.

Conclusion: It is concluded that selective tubal catheterization has an objective and satisfactory therapeutic value. In a context where its indications are only shared with other techniques with subjective results such as hydrotubation, it remains the first-line treatment of infertility by proximal tubal obstruction.