FTR - fallopian tubal recanalisation


In some infertile women, the fallopian tubes are blocked at the uterine (cornual) end. Recanalization is a minimally invasive procedure used to open the blocked fallopian tubes in these patients. The diagnosis of cornual block or proximal tubal occlusion (PTO) is made usually by doing a X-ray of the uterus and tubes, called a hysterosalpingogram (HSG) or a laparoscopy.

Fallopian tube recanalization is a relatively new reproductive technique , in which an X-ray of the uterus is performed, using a dye to visualise the uterine cavity and the site of 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, a guide wire or a balloon is passed to the area of tubal blockage & the block is opened up. In women whose tubes are blocked because of a mucus plug or debris, it's possible to open the block successfully. Of course, if the block is because of fibrosis, the technique will not work. The success rate of fallopian tube recanalisation is about 50%, depending upon how well the patients are selected. About 20 -30 % of these women will achieve a pregnancy at the end of 6 months.

It is also possible to recanalise a cornual block while doing a hysteroscopy. The principle is exactly the same, the only difference being that the guidewire is passed into the cornual end under hysteroscopic guidance, rather than fluoroscopic guidance.

Please remember that this technique is not a panacea for all tubal blocks. Thus, is cannot be used for women whose tubes are blocked because of tuberculosis (TB ); or for those with a mid-tubal or isthmic block or hydrosalpinx. Also, sometimes the tubes can get re-blocked after a few months. If a pregnancy is not achieved within 6 months of the FTR, the next step is in vitro fertilization (IVF).

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.