Page 21 - World Association of Laparoscopic Surgeons - Journal
P. 21
10.5005/jp-journals-10007-1142
Bello L Zainab
REVIEW ARTICLE
Role of Falloposcopy in the Management of Subfertility
Bello L Zainab
ABSTRACT be emphasizing in a moment. Fallopian tube is lined with
epithelial cells which aid in oocyte transport to the fimbria
Aim: To review the technique and results of falloposcopy and
compare it with the conventional methods used in the evaluation end. Fallopian tube alone accounts for more than 30% of
3,4
of tubal subfertility. female subfertility. In the evaluation of tubal infertility;
Data source: Electronic library, SpringerLink, PubMed, Google, the aim should be to ascertain the functional status of the
HighWire, eMedicine and materials from World Laparoscopy tube not just the patency which more often than not is the
Hospital.
case because the tube may be patent but not functional due
5
Study selection: Studies involving the use of falloposcopy in to damaged cilia and mucosa. Conventional methods such
assessing tubal status were reviewed and compared with as hysterosalpingograph or laparoscopic chromotubation
conventional methods.
provide only an indirect assessment of the tubal patency
Data synthesis: Falloposcopy gives an excellent assessment without the status of the tubal mucosa. 5 Salpingoscopy
of tubal functional status accurately and provides treatment for
minor tubal disease and sorts out patients who need IVF for visualizes only the fimbrial end, the intramural and isthmic
early referral. part are not reached, this is very vital as the pathology could
be in that region. False-negative results are common since,
Conclusion: There is no doubt, falloposcopy is a gold standard
in assessing functional status of the fallopian tube accurately, tubes that appear normal and patent by hysterosalpingograph
provides treatment in selected cases and detects patients that could have nonobstructive lesions, such as abnormal
needs IVF and refers them in good time but expertize and further endotubal vasculature or epithelial atrophy. Falloposcopy
5,6
training is required to make the procedure routine in the
evaluation of subfertility. can be used as both diagnostic and therapeutic in the
management of tubal infertility.
Keywords: Falloposcopy, Tubal disease, Classification,
Subfertility.
FALLOPOSCOPY
How to cite this article: Zainab BL. Role of Falloposcopy
in the Management of Subfertility. World J Lap Surg 2012;5(1): This is sometimes called falloscopy; it is the visual
16-20. examination of the inside of the fallopian tubes. This
procedure involves inserting a tiny flexible catheter through
Source of support: Nil
the cervical canal and uterine cavity into the fallopian tube,
Conflict of interest: None declared 0.5 mm flexible fiberoptic endoscope is threaded through
the catheter into the fallopian tube. The inside of the tube
INTRODUCTION
can then be thoroughly examined on a television monitor
Infertility is an absolute term so for the purpose of this via a camera attached to the outer end of the falloposcope.
discussion subfertility will be used. This is defined as
INSTRUMENT
inability of a couple to get pregnant despite adequate coital
exposure (adequate coital exposure is 2 to 3 times per week) The falloposcope is a flexible high resolution microendos-
for a period of 1 year. However, this definition varies with cope of 0.5 mm diameter and 1.73 mm length that contains
age of the woman—for a woman that is 35 years and above, a bundle of 2000 optical fibers and 8 to 12 illuminating
subfertility is regarded as inability to conceive despite fibers. It is capable of magnifying an object up to 50 times
adequate coital exposure for a period of 4 to 6 months. 1,2 of its actual size.
The prevalence of subfertility ranges between 9 and 35% There are two types of falloposcopes—coaxial system
in the developing countries as compared with 4 to 14% in which was manufactured by Kerin in 1970 and linear
the developed countries. 2 everting catheter (LEC) (Figs 1A and B), this consists as of
Causes of subfertility include: unfurling balloon catheter with an internal endoscope that
Male factors—35% is used transcervically without a hysteroscope, this confers
Female factors—35% an advantage of coaxial catheter (Figs 2A and B).
Both male and female factors combined—20%
PROCEDURE
Unexplained—10%.
Female factors have several categories such as cervical, Falloposcopy is done during the midfollicular phase of the
uterine, ovarian and tubal factors for which this article will menstrual cycle (from 5-9 days) after menstruation, so that
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