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Expecting a better alternative

Fallopian tube recanalisation (FTR) is an alternative, cheaper and less invasive solution to blocked tubes, writes GENEVIEVE …

Fallopian tube recanalisation (FTR) is an alternative, cheaper and less invasive solution to blocked tubes, writes GENEVIEVE CARBERY

LAST MONTH Cliona O’Leary became the first woman in Ireland to give birth following the unblocking of her fallopian tubes by an non-surgical radiological procedure.

Fallopian tube recanalisation (FTR) takes less than an hour and could offer some women a cheaper and less invasive solution to the usual options for blocked tubes.

O’Leary says that chance led her to the outpatient procedure, which is relatively new to Ireland but well established in the US and Canada. For this reason she wants to create awareness of the availability of FTR.

About one-third of female fertility problems are caused by blocked fallopian tubes, says Dr Cathy Allen, a consultant gynaecologist at the Merrion Fertility Clinic and at the National Maternity Hospital in Holles Street.

Tubal surgery or in vitro fertilisation (IVF) are the two choices normally available to women, says Allen.

FTR offers an alternative to these, but is not suitable for all women with blocked tubes.

Tubal surgery can be very invasive and hard to get as there is only one tubal surgery centre in the State, while IVF is not publicly funded and is a significant treatment to go through, Allen says.

Cliona O’Leary and Ken O’Shea began trying to conceive a few months after they got married in February 2008.

They are both from Cork originally but they met through their work in RTÉ where O’Leary is assistant commissioning editor in sport and O’Shea is head of current affairs.

O’Leary always had irregular periods, so they did not try for a long time before they sought help. A year after they got married they went to see Allen at the Merrion Fertility Clinic.

O’Leary was shocked when tests revealed that mucus was blocking her fallopian tubes and feared she might never get pregnant.

The couple was advised that their best option was IVF and decided to proceed with it.

“You are so focused on wanting a baby, you don’t care what you have to go through” says O’Leary.

“We knew it was hit and miss, and that it was a really difficult process for any woman to go through – long, hard and expensive,” says O’Shea.

However, Allen said it was “fortuitous timing” that she knew a radiologist who had recently moved back from Canada. Dr Ronan Browne, consultant radiologist at the Adelaide and Meath Hospital in Tallaght, returned from Vancouver five years ago where he learned the procedure and where he was carrying out one or two a week.

O’Leary was a suitable candidate because of the type of blockage and its location close to her uterus.

The technique is more suitable for younger people who want to try to conceive naturally as it causes a little delay in attempts to conceive, says Allen.

But IVF can be the best option for older women rather than waiting to conceive naturally following their procedure, she says.

FTR involves the radiologist passing a small plastic tube and wire through the cervix into the fallopian tube to relieve the obstruction, while using X-rays to visualise the tools.

“It’s not ground-breaking, just not widely available or practised in the country and not everyone is suitable,” says Browne.

Cliona says the procedure was “very straightforward, not in any way painful and took a few minutes”.

The pair was overjoyed when it worked.

“To be told a couple of weeks after we were going to begin IVF that there is nothing to stop you conceiving naturally is remarkable,” says O’Shea.

After trying naturally for a month they decided to use a method of artificial insemination, IUI (Intrauterine Insemination), to speed things up because of O’Leary’s age (36). She became pregnant on the second time using IUI.

“It worked, I didn’t believe it. I tested myself six times before I believed it,” she says.

Their baby girl, Aoileann, was born in June this year at 6lb and 11oz, and O’Leary is enjoying “every scream and cry”.

The couple credit luck with their new arrival. “If we hadn’t met Cathy, we might never have met Ronan and could still be trying,” says O’Leary.

Browne says the uptake of the procedure, which is available to public and private patients, has so far been limited in Ireland. Because maternity and radiology units tend to be in different hospitals, there is the barrier of cross-centre referral and a lack of awareness that it is available in Ireland, he says.

Dr Sam Coulter-Smith, Master of the Rotunda Hospital, says interventional radiology is becoming a breaking frontier in a lot of areas.

“It’s great to see it, if it avoids more complex surgery then it is well worth pursuing,” he says.

Tubal disease can take place anywhere along the tube, so where it has occurred and the extent of it would dictate what approach is necessary, he says.

O’Leary and O’Shea are aware that they were very fortunate, both through the people they met and the length of time it took to get pregnant. “Other people go through a lot more than us,” O’Leary says.

“This time last year I was thinking I was never going to have a baby and it was a sad and lonely place”, says O’Leary, who praises the support of her husband, doctors, RTÉ bosses and people at online forum Rollercoaster.ie.

However, she urges anyone who has been trying to get pregnant for a while to get checked out as tests don’t cost much and they may not necessarily require difficult or expensive procedures.

FALLOPIAN TUBE RECANALISATION (FTR): WHAT IS IT?

FTR is carried out by a radiologist to treat some types of fallopian tube blockage.

A hysterosalpingogram (HSG) is carried out initially to identify the site of the blockage. A dye is injected into the tubes and an X-ray is used to visualise the injected dye and potential blockages.

The FTC procedure involves passing a guidewire and catheter into the tubes to relieve the obstruction. X-rays are used during the procedure to visualise the guidewire and catheter.

What are the causes of tubal obstruction?

It has many causes including infection, endometriosis, polyps, congenital factors and debris. About one-third of women with fertility problems will have blocked fallopian tubes.

Who is most suitable?

People with tubal blockages which are close to the uterus.

What are the outcomes?

Tubal blockage is relieved in 70-90 per cent of procedures.

The pregnancy rate after the procedure is about one-third, most in the first six months after treatment. About one-third will subsequently reblock.

What are the risks?

Small risk of infection, tubal perforation and subsequent ectopic pregnancy.