Page 21 - World Association of Laparoscopic Surgeons - Journal
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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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