Hormonal treatment of bilateral proximal tubal obstruction

To see whether medical suppressive treatment might be considered in the treatment of a subgroup of patients. with proximal tubal obstruction (PTO), one of the major causes for infertility, often due to endometriosis of the tubouterine junction and therefore primarily treated by operative procedures.

23 infertile patients with bilateral PTO were treated with hormonal suppression therapy with GnRH agonists, norethindrone acetate, or danazol for at least 3 months. The average age of the patients and duration of infertility were (mean + SD) 32.4 +/- 4.8 and 3.9 +/- 2.2, respectively. Bilateral PTO was diagnosed by both hysterosalpingography and laparoscopy.

Fifteen of the 23 patients (65%) were diagnosed as having pelvic endometriosis prior to treatment. Following the treatment, 16 of the 23 patients (69.6%) were shown to have have at least one patent fallopian tube, and 9 patients conceived (39.1%). No patient became pregnant in the absence of one patent tube after treatment.

Hormonal suppressive therapy can be an alternative treatment in patients with bilateral PTO for a period as short as 3 months before any invasive procedure.