Assesment of tubal infertility with radionuclide-labelled particles and falloscopy

Abstract: The fallopian tubes are of central importance for human reproduction in vivo. Damage to the tubal internal mucosa can result in disturbance of sperm and ovum transport. About 40% of infertile women have tubal disease as their main cause of infertility. Our knowledge of the tubal active transport mechanisms necessary for the establishment of an intrauterine pregnancy in vivo is limited. Available methods for assessment of the fallopian tube are incomplete as they inform about patency but not about tubal transport capacity. Two methods have been suggested as valuable clinical tools for assessing active tubal function; radionuclide hysterosalpingography (RN-HSG) which is based on the ability of the fallopian tube to transport particulate matter and falloposcopy which allows inspection of the entire inside of the oviducts. The aims of the present thesis were (i) to further develop the RN-HSG technique for routine clinical use, (ii) to study whether there was a difference in RN-HSG results between fertile women and infertile women, (iii) to investigate whether RN-HSG could predict the subsequent achievement of pregnancy, (iv) to evaluate the performance of falloposcopy in conjunction with diagnostic laparoscopy in the investigation of female infertility and (v) to investigate whether radionuclide-labelled albumin particles deposited in the pouch of Douglas can be demonstrated on the intraluminal surface of fallopian tubes. A new deposition technique was used to verify where the particles were deposited, to avoid the particles being forced by pressure up into the oviducts and to decrease net administered radioactivity. Tubal transport on RN-HSG was comparably distributed in fertile and infertile women and there was no association between patency test results and RN-HSG in the two groups. Data analysed with likelihood ratios strongly indicated that a single RN-HSG investigation could not predict fertility. Falloposcopy may have a place in the investigation and treatment of tubal disease if technical problems are solved. Particles deposited in the pouch of Douglas were confirmed for the first time on the intraluminal surface of the tubes. In conclusion, neither RN-HSG nor falloposcopy can be recommended in infertility investigations on their present performance. Further studies are required of tubal and peritoneal particle migration to develop a model for assessment of tubal infertility. A modified falloposcopy system could be a much-needed instrument for exploring tubal physiology in vivo, which still remains an enigma.