Six medical centers are reporting today that thousands of American women who are infertile because of obstructed Fallopian tubes may now have an effective and less costly path to pregnancy than surgery or "test tube" fertilization.
Doctors, including a team at the University of Maryland Hospital, were able to clear many obstructions by inflating a tiny balloon inside the hair-thin passageways of the Fallopian tubes -- a method similar to one used to unclog arteries of the heart and leg.
The method, described in today's Journal of the American Medical Association, involves sliding a series of telescoping tubes through the uterus and into the Fallopian tubes -- finally inflating the balloon several times to open the area previously clogged with mucous or scar tissue.
Almost 30 percent of the 77 women who underwent the procedure became pregnant within six months after physicians cleared one or two of their tubes. In the remaining cases, the tubes either could not be opened because they were too scarred, or they were opened but nonetheless failed to function properly.
"It's a very revolutionary treatment," said Dr. Eugene Katz of the University of Maryland, although he explained the balloon treatment is appropriate only for women with obstructions near the entrance of the Fallopian tubes -- not those with blockages relatively far into the tubes.
About 1 million American women are infertile because of obstructed Fallopian tubes, said Dr. Edmond Confino, the lead investigator at the Mount Sinai Hospital Medical Center in Chicago. Of these, he said, at least 10 percent -- or 100,000 women -- have blockages close enough to the uterus to be cleared by the new method known as "transcervical balloon tuboplasty."
The Fallopian tubes are the two narrow passageways, each less than a millimeter in diameter, where sperm travel to fertilize the ovum. They extend in a curved-under fashion from the uterus to the ovaries.
Obstructions in the near-end of the Fallopian tubes often result from scar tissue left by infections, said Dr. Confino. Less often, the tubes can become obstructed with displaced tissue fragments -- the result of incomplete menstruation in women suffering from endometriosis.
Many women with this type of obstruction have opted for in vitro fertilization, a method in which the egg is fertilized in a test tube and implanted into the woman's uterus. That method costs between $5,000 and $8,000 per attempt and often must be repeated several times before a successful pregnancy results.
Dr. Katz estimated that balloon tuboplasty, pending federal Food and Drug Administration approval, will probably be offered for less than $2,000. It is done under local anesthesia and may be offered as an outpatient procedure.
The conventional method for unclogging Fallopian tubes is a major operation in which surgeons cut into the abdomen, remove the obstructed tube, cut out the clogged section and reinsert the remaining tube. The operation, done under general anesthesia, costs more than $6,000, he said.