Falloposcopy: Antegrade Imaging in the Management of Oviductal Disease

Salpingoscopy provides excellent views of the outer oviductal lumen, provided the fimbrial end is accessible laparoscopically. Falloposcopy is a less invasive approach through the uterine cavity. The technique is demanding and requires small flexible endoscopes with a reduced field of view and image quality. A recent technologic advance is a cage device that keeps the lumen wall away from the falloposcope lens for continuous antegrade viewing and reduction of white-out. Using a microendoscope designed for falloposcopy and a coaxial delivery system, 150 oviducts were evaluated in 87 women with suspected tubal factor infertility of at least 2 years' duration. Of the 150 oviducts, 40 (27%) were patent and normal, 57 (38%) were patent with mild disease, 17 (11%) were patent with moderate to severe disease, and 36 (24%) were occluded with severe disease. During 15-month follow-up the spontaneous pregnancy rate in women with at least one normal or mildly diseased tube was 23%, and in those with moderate to severe disease was only 6%. After falloposcopy, clinical management was modified based on oviductal findings in 55% of women and confirmed as appropriate in the remainder. The wire cage catheter-delivery system is currently under evaluation and is investigational in the United States. It permits continuous imaging in an antegrade fashion from the uterotubal ostium to the fimbriae or a point of obstruction. This instrument should simplify the technique and improve the diagnostic capabilities of falloposcopy.