Hysteroscopic Tubal Occlusion Using Iso-AMYL-2-Cyanoacrylate A Pilot Study

Abstract

Background: Several retrospective and prospective studies have long demonstrated a negative effect of hydrosalpinx on the success rates in patients undergoing in vitro fertilization (Anderson et al, 1994 and Vandromme et al, 1995). Two reports, with promising results, were published to evaluate the pregnancy and perinatal outcomes of ultrasound sclerotherapy with 98% ethanol and tetracycline (Eun Duc Na et al, 2012) or with ethanol only (Zhang et al, 2014) on women with hydrosalpinx before in vitro fertilization and embryo transfer. In 2007 an animal experiment was conducted in Brazil to test the effectiveness and safety of the use of a cyanoacrylate derivative for hysteroscopic occlusion of rabbit uterine tubes. The authors concluded that this approach offers a safe and feasible method of uterine tube obstruction (Rivoire et al, 2007). Aim of the work: The present study was conducted to assess the safety and efficacy of hysteroscopic tubal occlusion using Isoamyl-2-cyanoacrylate (Amcrylate®; Concord Drugs Ltd., Hyderabad, India). Study design: This is a pilot study conducted in the Early Cancer Detection Unit of the Ain Shams University Maternity and Women’s Hospital, Abbassia – Cairo, Egypt. Patients and methods: This is a pilot study conducted in the Early Cancer Detection Unit of the Ain Shams University Maternity and Women’s Hospital, Abbassia – Cairo, Egypt in the period from November 2015 to June 2016. It included twenty patients who were scheduled for abdominal hysterectomy and bilateral salpingo-oophorectomy for a benign gynecological indication. Results: Overall 5 cases were histopathologically considered as not occluded (25%), 9 cases (45%) were partially occluded and 6 cases were completely occluded (30%). A perisalpingitis reaction was noted in one case and a stromal reaction was noted in all cases. A methylene blue test was performed on the hysterectomy specimen after the end of the intervention. A negative methylene blue test was indicative of successful tubal occlusion. Four cases out of 20 had a positive methylene blue test representing a 20% failure rate. Conclusion: The present study clearly demonstrates that the use of Isoamyl 2 cyanoacrylate to effect hysteroscopic tubal occlusion is a rather safe procedure. It can be conducted as an office procedure with little discomfort. As to the effectiveness of the procedure we had an 80% negative methylene blue testing. Key words: Isoamyl 2 cyanoacrylate, Hysteroscopy & tubal block