研究開発・学会発表

【Introduction】
Falloposcopic tuboplasty (FT) has been recognized as a highly useful instrument of both an assessment of tubal luminal lesion and a surgical technique of recanalization of tubal occlusion and stenosis. We have used FT as a diagnosis and a treatment for about 1500 over tubal infertility patients since 2003 at our clinic. The aim of this study was to evaluate the pregnancy outcome without ART after FT and the effectiveness and safety of FT.

【Materials and Methods 】
FT was performed for the 1468 patients with bilateral or unilateral occlusion and stenosis from January 2005 through December 2010. These patients had been diagnosed by hysterosalpingography、hysteroscope and hydrotubiation. All FT was performed with the procedure of transcervical balloon tuboplasty by intaravenous anesthesia in outpatient base. Lesions in the tubal lumen were observed falloposcopically during retrograde imaging after complete recannulation. 852 patients were able to follow up, and 253 of them have been pregnant by natural intercourse or artificial insemination. Patients with hydrosalpings, severe male factor and ART followed FT were excluded from this study.

【Results】
Mean age of the patients was 33.5 years old (ranged from 22 to 49 years old) .Clinical pregnancies occurred in 253/852 patients (29%). All pregnancies were singletons and the miscarriage was 7.5%. The pregnancy rate decreased with the age. The highest, 50% (3/6), pregnancy rate was seen for the 25 year old cases. Under 38 years old, the pregnancy rate was over 22 %. The oldest case of conception was 41 years old, but she had a miscarriage. The mean pregnancy period after FT was 3.5 months.  The pregnancy cases occurred within the first month after FT. Within 6 months after FT 85.7% (216/252) of the women became pregnant. Ectopic pregnancy was 1.6% (4/253). The 250 out of 599 cases that had not conceived were conducted to ART and at present about 82.4% have become pregnant.
Conclusion
Although ART has been used for women with tubal lesion as a standard treatment, we apply FT as an initial treatment before ART. Our results show that this FT technique is useful for the patients with tubal infertility and does not cause an increase of ectopic pregnancy. FT might be recommended to the selected patients with tubal infertility under 40 years old before conducting IVF. And it is also recommended to reconsider the therapeutic plan for these patients about 6 months over after FT.