Tubal catheterization is simple and cheap than other surgical treatment. What is more, it reaches a recanalization rate of 90% and pregnant rate higher than 50%. Therefore, it is the initial choice within its therapeutic range.

Procedures:

Tubal catheterization may be performed under x-ray guidance or in the operating room using a hysteroscope. 

1. A catheter is put through the cervix into the uterus.

2. Contrast medium is injected through the catheter. It flows up into the fallopian tubes. The contrast medium helps your tubes show up on the x-ray that is then taken. This test is called a HSG (hysterosalpingogram). It will show the blockage in the fallopian tube and help guide the rest of the procedure.

3. Move the catheter to the opening of the fallopian tubes.

4. Inject fluid through the catheter into the tube to open the blocked tubes. 

5. If the tube remains blocked, a guided wire is next inserted through the catheter into the tubal opening to further open the blocked fallopian tubes.

Indication:

1. If the cervix is too loose to adopt a regular HSG, tubal catheterization is feasible. 

2. If the fallopian tube is partially obstructed or distorted, doctors can give medicine through the catheter after catheterization. In this way, drugs can directly arrive at the lesions, reducing the degree of obstruction.

3. If the patient has tubal pregnancy. Doctors can insert the catheter into one side of the tubal pregnancy and inject corresponding drugs, terminating the pregnancy and treating ectopic pregnancy.

4. If the patients have proximal tubal occlusion, namely the blockage at the uterine end, a tubal catheterization is feasible.

Contraindication:

1. Acute genital inflammation and acute or subacute onset of chronic genital inflammation

2. Severe systemic disease that makes the patient unable to tolerate surgery

3. Pregnancy or menstrual period

4. Within six weeks after delivery, abortion and curettage

5. Fallopian tube blockage at the umbrella end 

Preoperative preparation:

1. The operative time had better be selected within 3 to 5 days after menstruation.

2. Before the surgery, it is necessary to do blood routine examination.

3. Do a leucorrhea regular inspection to detect whether the patient has mold or trichomonad mycoplasma and chlamydia infection.

4. Receive a gynecological examination to detect acute or subacute inflammation.

Postoperative management:

1. Take antibiotics for 3 to 5 days to prevent infection. 

2. Avoid sex for two weeks.

3. Within one week after the surgery, slight lower abdominal pain and small vaginal bleeding is normal.

4. Take a shower instead of the bath.

5. Pregnancy is recommended 3 months after the surgery to prevent the effect of X-rays on the eggs.

6. If there is postoperative menstrual delay, women should do some pregnancy inspections. And if confirmed pregnant, women should ask a doctor for help to diagnose whether it is normal intrauterine pregnancy.

7. Without contraception, if the patients still don't get pregnant for half a year. It is necessary to get another HSG to check the tubal patency after the surgery.

Possible complications of tubal catheterization:

1. Allergic reactions. This mainly refers to the allergic reactions to the contrast medium and fluid. Patients can be cured by giving allergy treatment.

2. Perforation of the fallopian tubes.

3. Uterine infection. This is mainly caused by long surgical time. To avoid this complication, the surgery should be limited within 20 minutes, and antibacterial treatment is also necessary after the treatment.

4. Abdominal pain and small vaginal bleeding.