A new age in fertility: Remastering fallopian tube recanalisation

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recanalisation
Alberto Alonso-Burgos (L) and Luis Chiva de Agustín (R)

Each woman is unique, and a one-size-fits-all approach is not appropriate for addressing what can be extremely complex reproductive health issues.

Natural Procreative (NaPro) technology, is a groundbreaking medical approach that focuses on understanding and treating the underlying causes of women’s health issues rather than merely addressing symptoms. Developed by Dr Thomas Hilgers in the 1990s, NaPro combines the best aspects of reproductive medicine and natural fertility awareness methods to provide personalised and effective care for women. This involves identifying and treating the root causes of infertility, irregular cycles, and other male and female conditions. NaPro’s effectiveness is supported by extensive research and a growing body of evidence. Studies have shown that NaPro can significantly improve fertility rates, with success rates rivalling or surpassing those of conventional treatments.

Up to 67% of all infertility cases can be attributed to fallopian tube disease. In cases where infertility is caused by blockage of the fallopian tubes, a simple and obvious alternative might seem to be to try unblocking the tubes in question. Fallopian tube recanalisation (FTR) is a procedure that aims to reopen blocked or damaged fallopian tubes, allowing the possibility of restoring natural conception. By reopening the blocked tube, sperm can reach the egg, potentially leading to successful fertilisation and pregnancy. This can be particularly meaningful for couples who desire to conceive without the assistance of assisted reproductive technologies. Moreover, FTR is a less invasive procedure compared to major surgeries like tubal ligation reversal or in vitro fertilisation. This makes it an appealing option for those who would prefer a natural approach to conception. Additionally, FTR is often considered a cost-effective alternative, as other approaches can be costly.

The American Society for Reproductive Medicine recommends that patients who have proximal tubal obstruction undergo selective salpingography and tubal recanalisation before considering more invasive and costly treatments. Since hysterosalpingography followed by FTR could potentially be considered for any woman undergoing infertility investigation, it is unfortunate that numerous infertility clinics remain unaware of this procedure, or they may have knowledge of it but lack access to an interventional radiologist capable of performing it. Consequently, several interventional radiologists may also lack awareness regarding the procedure and the number of potential patients who could benefit from it.

In this context, several controversial questions may arise. Within this straightforward procedure, over 85% of patients are discharged with a satisfactory outcome (successful tubal recanalisation), and more than 30% achieve pregnancy within the first year following the procedure. However, if tubal recanalisation (FTR) is indeed a simple, safe, and cost-effective method, why is it seldom utilised? Why are other more invasive techniques, which are not free of side-effects and considerably more expensive, routinely employed? Why do insurance companies include the tubal recanalisation as any other artificial fertility treatments and fail to provide coverage for this treatment of a straightforward condition such as tubal obstruction? Even when development of new materials and kits for this purpose should be considered, yet the industry appears to be blind to this.

When talking about fertility, a tailored treatment plan to meet the specific needs of each patient should be performed in the fertility unit and an interventional radiologist should play an active part in this.

Alberto Alonso-Burgos is head of the Interventional Radiology Unit and Luis Chiva de Agustín, director of the Department of Obstetrics and Gynaecology at the University of Navarra, Pamplona, Spain. 

Disclosures: The authors declared no relevant disclosures.


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