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IVF versus Tubal Recanalization
Discussion in 'All Categories' started by Shrineta Agrawal - Nov 9th, 2011 9:02 pm.
Shrineta Agrawal
Shrineta Agrawal
Dear Sir

I am suffering from secondary infertility for last 7 year because of sterilization done just after one kid. My gynecologists are saying that I have tubal block which need to be re-canalized. Now my question is I should go for IVF or tubal re-canalization. Please help so that I can decide. I will definitely give weight to the premier institute of minimal access surgery that is definitely onle one in the world and it is World Laparoscopy Hospital.

With regards

re: IVF versus Tubal Recanalization by Dr M.K. Gupta - Nov 9th, 2011 9:16 pm
Dr M.K. Gupta
Dr M.K. Gupta
Dear Mrs. Agrawal

In certain infertile women, the fallopian tubes are blocked in the uterine (cornual) end. Recanalization is really a non-invasive procedure used to open the blocked fallopian tubes during these patients. The diagnosis of cornual block or proximal tubal occlusion (PTO) is created usually using a X-ray from the uterus and tubes, called a hysterosalpingogram (HSG) or perhaps a laparoscopy.

In patients with documented tubal disease, choices for management would essentially include expectant management, tubal surgical procedures or IVF. Advances in non-invasive endoscopic cannulation techniques and the soaring acceptance and applications of IVF question the surgical control over patients presenting with tubal damage.

Fallopian tube recanalization is a relatively recent reproductive technique , in which an X-ray of the uterus is conducted, utilizing a dye to visualise the uterine cavity and the site from the block, with the help of an advanced X-ray machine called an image intensifier. In patients who demonstrate a tubal block on X-ray, helpful information wire or a balloon is passed towards the section of tubal blockage & the block is opened up. In women whose tubes are blocked because of a mucus plug or debris, you can open the block successfully. Obviously, when the block is due to fibrosis, the technique won't work. The success rate of fallopian tube recanalisation is all about 50%, depending upon how good the patients are selected. About 20 -30 % of these women will acquire a pregnancy after Six months.

Until the widespread utilization of IVF at first from the 1980s, tubal surgery was the only available option for restoration of fertility in patients with PTO. Although tubal microsurgery and IVF may be complementary options within the control over patients with tubal obstruction following failed FTR, and although microsurgery to fix localized damage has the advantage of long-standing restoration of love and fertility, poor pregnancy rates with tubal microsurgery in patients with severe tubal damage and also the insufficient technical skill required to perform these procedures has resulted in a liberal referral to IVF.

Choice of patients with tubal disease for future therapeutic management is based on tubal lesions, such as the facet of tubal mucosa and tubo-peritoneal environment, and also the harshness of the tubal damage and the health of the mucosa is key in determining the outcome. In which the mucosa is unhealthy, surgical treatment is not justified; early referral for IVF is indicated.

Fallopian tube catheterization is diagnostically useful and technically highly successful for treating occluded tubes; however, patients with distally blocked tubes are not good candidates for this procedure and distal tubal obstruction, brought on by fibrosis and peritubal disease, is usually not amenable to catheter recanalization techniques. While a functional obstruction may be amenable to conservative management, true occlusion may require management by microsurgical techniques or IVF.

Cases of failed fluoroscopically guided tubal canalization happen to be related to severe intrinsic tubal disease and tubal occlusion instead of towards the technique. Significantly higher pregnancy rates happen to be reported in patients without distal disease compared to those with bipolar tubal disease (49 vs 12%, life table-adjusted rate; p = 0.0002) separate from underlying etiology for tubal disease. Dechaud et al. reported no pregnancies in patients with severe endotubal lesions despite a high tubal catheterization rate following falloposcopically guided cannulation. Following nonhysteroscopic falloposcopy under laparoscopic control,

Lee reported that although interstitial tubal obstruction was overcome with the LEC, among the 15 cases with hydrosalpinx or fimbrial obstruction, 67% of the cases with flattened mucosa in the endosalpinx and endotubal adhesions were suitable for IVF and 27% cases with normal mucosa were suitable for tuboplasty. Letterie and Luetkehans reported no pregnancies following Fallopian tube canalization and microsurgery in patients with bipolar tubal occlusion after 12 and 18 months follow-up.

They suggested that instead of the low patency rates and better recurrence rates of PTO in comparison with data of prior studies, IVF, although more costly, could eventually represent probably the most expedient and effective approach to control over coexistent proximal and distal tubal disease (bipolar disease).

Microsurgical repair of bipolar tubal damage yields poor pregnancy rates and also the expertise necessary to perform they isn't necessarily available. Because distally obstructed tubes can't be successfully catheterized, the possibility impact of FTR depends on the percentage of cases in which the occlusion is proximal.

Tubal surgical procedures or IVF treatment is not influenced adversely by prior transcervical tubal recanalization and remains a choice for patients who failed to attain pregnancy.

It is also possible to recanalise a cornual block while carrying out a hysteroscopy. The key is the same, the only difference being the guidewire is passed in to the cornual end under hysteroscopic guidance, rather than fluoroscopic guidance.

Please remember that this method is not a panacea for all tubal blocks. Thus, is can't be employed for women whose tubes are blocked due to tuberculosis (TB ); or those with a mid-tubal or isthmic block or hydrosalpinx. Also, sometimes the tubes could possibly get re-blocked after a couple of months. If a pregnancy is not achieved within 6 months from the FTR, the next step is in vitro fertilization (IVF).
re: IVF versus Tubal Recanalization by ARVIND KUMAR - Dec 22nd, 2011 9:05 am
Dear Madam
As iam father of two childerens 1st one is 7 year old boy & 2nd one was 2month old boy
my second baby boy has expired suddenly in sleep as 4 years earlier . so we are deeply shocked . as my wife had operated family planning operaion at the time of delivery . now we are planning for tubal operation please advice me wheter this operation is benifical or not or wheter any risk factor for my wife or not
Awaiting your early reply
with regards
arvind kumar
re: IVF versus Tubal Recanalization by ginorerve - Jan 16th, 2012 2:30 am
accutane and infertility in males
re: IVF versus Tubal Recanalization by SPESHYPRORP - Jan 20th, 2012 8:56 pm
Happy New Year!
Health, luck and love!
re: IVF versus Tubal Recanalization by turoguasouts - Jan 22nd, 2012 1:23 pm
You are talking about the mental, physical, emotional and spiritual aspects of somebody's health.
Any type of hemorrhoid can cause irritation, pain, and bleeding in the areas of the anus and rectum.
John's Wort, for example, is one of the herbal treatments for depression that works so well that in Germany, it outsells many major prescription antidepressants.
It will not be a "quick fix".
The herb works by increasing the potency and activity of white blood cells, which are the "defenders" of the body.
re: IVF versus Tubal Recanalization by Shama - Jan 26th, 2013 3:55 am
Hi..a month before iam recanalised for my fallopian tubes.but now pain is severe after taking the tablets also..please help

Dear Shama

You should consult the gynecologst who has done your recanalization. Without seeing laparoscopic video and the OT note, we will not be able to tell you the cause of pain.

With regards

Dr J S Chowhan
re: IVF versus Tubal Recanalization by shahzad - Apr 3rd, 2014 12:36 am
my wife tubes blocked in laparoscopy.
suggest what i do for get pregnancy


Dear Shahzad

You can consult the gynaecologist for feasibility of Tubal Recanalisation.If this is not possible then IVF can be considerd.


With Regards

Dr J S Chowhan

World Laparoscopy Hospital
Cyber City, DLF Phase II, Gurgaon, NCR Delhi, 122 002, India
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re: IVF versus Tubal Recanalization by diana - May 1st, 2015 3:58 am
Good evening. I'm 35 years old. Before 8 years was block my tube when i have my 3 babies. Now i going marriage again. And need microsurgery for open. Please tell me how much it will be .and how many days must stay in hospital. And surgery possible if i come tourist visa? Thanks.

Dear Diana,

You can get laparoscopic recanalization done for conceiving. other option is IVF. We can send you the invitation letter and on behalf of that you can get the visa. Tourist visa will be illegal for surgery in India.

with regards
re: IVF versus Tubal Recanalization by Smitha - Dec 17th, 2015 10:50 pm
I did permanent family planning can I reopen my feloppian tube.

Dear Smitha

Nowadays Laparoscopic tubal recanaliozation or davinci tubal recanalization is a very good option to reopen the fallopian tube. You can get this surgery done at World Laparoscopy Hospital.

With regard

Dr Nidhi
re: IVF versus Tubal Recanalization by Kundan Singh Rana - Feb 25th, 2017 3:19 pm
Kundan Singh Rana
Kundan Singh Rana
Dear Sir / Madam
As i am father of two children 1st one is 12 year old girl & 2nd one was 6 year old boy. My second baby boy has expired suddenly high grade fever 106.5 ' we are deeply shocked . before 4 year my wife had operated family planning operation . now we are planning for tubal recanalization operation please advice me whiter this operation is beneficial or not or whiter any risk factor for my wife or not how much cost , how long time. i am leaving in himachal near Chandigarh. please help me.....
Awaiting your early reply.

With regards
Kundan Singh Rana
Mob. 9857455945

Dear Mr Rana

You can get laparoscopic or robotic tubal recanalization surgery. It is safe surgery and it does not have generally any risk involved. Success rate of this surgery is quite high at our surgery. Please bring your wife to WLH and consult Dr R K Mishra.

With regard

Dr Rahul.
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