研究開発・学会発表

【Objective】
Falloposcopic Tuboplasty (FT) is recognized because it allows not only observation with the falloposcope but also is a useful as a treatment for tubal occlusion and stenosis. This FT has been established as a highly useful, less invasive, and novel treatment for women with tubal infertility.  We have used FT for many patients with tubal infertility before performing ART treatments for several years. The present study was conducted to evaluate how long to continue conventional treatment after FT and what is the age limit for this treatment .

【Design】
Retrospective study.

【Materials and Methods】
FT was performed for the 1468 patients with confirmed bilateral or unilateral occulusion and stenosis from January, 2005 to December, 2010. These patients had been diagnosed by hysterosalpingogram、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 cannulation. So far, 852 patients, who were able to follow up, have been pregnant so far 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 abortion was 7.5%. This pregnancy rate shows the age decline. 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 an abortion. 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 advanced to ART and at present about 82.4% have became pregnant.

【Conclusion】
Although ART has been used for women with tubal damage 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 after FT.