Falloposcopy

By Gary S. Berger, M.D.

For millions of women with tubal infertility, the recent introduction of falloposcopy in the US is good news. For the first time, internal examination of the fallopian tube allows assessing tubal health and disease to permit optimal treatment.

What is falloposcopy?

Falloposcopy is the visual examination of the inside of the fallopian tube. This procedure involves inserting a tiny flexible catheter through the cervical canal and uterine cavity into the fallopian tube. An even smaller (0.5-millimeter) flexible fiber optic endoscope is threaded through the catheter into the fallopian tube. The inside of the tube can then be thoroughly examined on a TV monitor via a camera attached to the outer end of the falloposcope.

Video of normal fallopian tubes

Video of abnormal fallpian tubes (These are large video files — 9 megs and 6 megs.)

What are the benefits of falloposcopy?

Abnormalities of the tube, including obstruction, scar formation, and damage to the inner lining can be identified. As soon as abnormalities are identified, the doctor can repair the tubes at the same time if that is the best method of treatment. If tubal damage is too severe to repair surgically, then In Vitro fertilization (IVF) will be the recommended treatment. In many cases, the tubes can be repaired through outpatient microsurgical techniques.

How long does the procedure take?

Falloposcopy takes between 30-45 minutes to perform. If followed by tubal reconstructive surgery, the total operating time is 1½ to 2 hours.

What type of anesthesia will be used?

Falloposcopy can be performed with local anesthesia or with intravenous sedation. When combined with reparative tubal surgery, general anesthesia is used.

What are the risks of falloposcopy?

General risks of any invasive diagnostic procedure include the possibility of infection or bleeding. The risk of infection is avoided by first obtaining bacterial cervical cultures and treating any possible infectious microorganisms with appropriate antibiotics before falloposcopy is performed. Perforation of the fallopian tube can occur, although this is uncommon and generally does no harm. In rare cases, bleeding at the perforation side may require laparoscopic treatment.

Will falloposcopy increase my chances of becoming pregnant?

Falloposcopy is approved for use as a diagnostic procedure. However, it has already been shown to effectively treat some causes of proximal tubal obstruction. By allowing accurate diagnosis of intratubal disorders, it permits selection of the best choice of treatment including immediate balloon tuboplasty, outpatient microsurgical repair by laparoscopy or laparotomy, or In Vitro Fertilization. Selecting the optimal method of treatment increases the chances of success in terms of becoming pregnant and subsequent live birth.

If my diagnosis is tubal occlusion, will falloposcopy remove the obstruction?

The forward unfurling balloon at the front of the falloposcope has been shown in clinical trials in Japan to unblock obstructions in the fallopian tube, particularly in the proximal end near the uterus.

When can I resume normal activities after falloposcopy?

Normal activities can be resumed the day following a falloposcopic examination. If reconstructive tubal surgery is performed at the same time, recovery will be longer depending on the nature of the operation.

Does insurance cover this procedure?

As a diagnostic procedure, your insurance carrier may not cover falloposcopic examination. However, falloposcopically directed balloon tuboplasty is covered as a therapeutic procedure by many insurance carriers. Check with your doctor’s office manager for details about the benefits that may be available from your insurance carrier.

How will my doctor decide if falloposcopy is indicated in my situation?

There are a variety of factors that determine whether falloposcopy may be beneficial for you. Your doctor will review your history and test results, including HSG, laparoscopy, or previous laparotomy operative reports, and discuss your findings with you.

See also “Tubal Reversal” fact sheet.

Gary S. Berger, M.D.
http://www.tubal-reversal.net/
Reproductive Surgeon
and Medical Director
Chapel Hill Tubal Reversal Center
109 Conner Drive Suite 2200
Chapel Hill, North Carolina 27514
Tel: (919) 968-4656