New Diagnostic Technique for Infertility : Procedure to Reduce Female Surgeries

Every year, thousands of women who are unable to get pregnant undergo a $5,000 operation to find out if their Fallopian tubes are blocked.

About a third to one-half the time, tubes are clear. The exploratory surgery was unnecessary.

“No one wants to undergo surgery when they don’t have to,” said Dr. Amy Thurmond of Oregon Health Sciences University in Portland. “But couples who want children will often try anything.”

Their options may have gotten significantly better. Thurmond and her colleagues in the department of radiology have developed a non-surgical diagnostic technique that not only accurately detects tubal obstructions, but in some cases, may clear minor blockages without the need for surgery.

The procedure also only costs from $200 to $400.

“At the very least, this is going to help us avoid 30% to 50% of unnecessary surgery,” Thurmond said. “It may even replace some surgery, but we’re going to have to wait and see about that.”

With an estimated one in seven couples facing fertility problems, the new technique promises cost savings of millions of dollars, “not to mention the savings in pain and anxiety,” Thurmond said.

About 40% of infertility problems are solely female in origin, and up to half of those are caused by obstructions or scarring in the Fallopian tubes, two thin passageways that conduct the egg from the ovaries to the womb.

Typically, when a couple goes to the doctor with infertility problems, the woman will undergo a hysterosalpingogram, in which a contrast dye is injected into the cervix and X-rays are taken. The resulting image provides a decent picture of the Fallopian tubes, Thurmond said, but often indicates a blockage where none exists.

Surgery, and three days in the hospital, frequently follow.

However, Thurmond and Dr. Josef Rosch, director of interventional radiology at the Oregon school, recently told an international meeting of radiologists about a variation on the hysterosalpingogram that provides far better results, and may even have a therapeutic effect.

Rather than injecting dye into the cervix, the researchers delivered it directly into the Fallopian tubes using a small catheter threaded through the uterus. This provides a “nearly perfect” view of the Fallopian structure and any possible blockage, Thurmond said.

If X-rays show a minor obstruction, a guide wire is gently guided past it and the tube is dilated using the catheter.

In 41 patients suspected of having blockages after conventional hysterosalpingography, 35 did not require surgery following the modified technique, Thurmond says. The procedure does not appear to cause any damage, and the only side effect so far has been mild pain similar to menstrual cramps.

Two women have become pregnant less than a year following the new procedure, and the rest will be monitored to determine the extent of therapeutic benefit.

“The two pregnancies are very exciting, but we want to know they didn’t happen just by chance,” Thurmond said. “We’re very hopeful, though.”