Introduction of a New Coaxial Falloposcopy System

Coaxial falloposcopy is a transcervical approach to visualizing the entire fallopian tubal lumen from the uterotubal ostium (UTO). To eliminate bulky camera attachments and poor image quality, a new falloposcopy system was developed with a small articulating-tip hysteroscope, stabilizing device to maintain UTO alignment, flexible coaxial catheter and guidewire, and 0.4-mm outer diameter falloposcope with enhanced fiberoptics. We used the instrument in 23 women with a diagnosis of proximal (PTO) or distal (DTO) tubal obstruction (group 1, 16 patients, 30 tubes) or unexplained infertility (group 2, 4 patients, 7 tubes) after previous hysterosalpingogram or laparoscopy. Successful cannulation was achieved in 31 (83.3%) of 37 tubes. Fibrosis of the UTO prevented access to two tubes. In group 1, 14 of 23 tubes with presumed PTO were patent and normal at falloposcopy. In group 2, pathology was present in two of seven tubes. A false positive diagnosis was made in 61% of tubes with presumed PTO and false negative diagnosis in 29% of presumably normal tubes. Coaxial falloposcopy is an effective means of assessing the tubal lumen and should become a more routine part of infertility evaluations.