Influence of discordant tubal blockage on clinical pregnancy rates: a retrospective cohort study

PURPOSE: To present recent data on discordant tubal blockage (DTB), its influence on pregnancy rates and how women should gage their fertility when screening and diagnostic tests don't always agree.

METHODS: This retrospective cohort study included 78 infertile women, who underwent tubal patency assessment between January 2016 and June 2024 at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna. Tubal patency was assessed twice. Initial assessment of tubal patency had been performed by hysterosalpingo-contrast sonography (HyCoSy) or hysterosalpingography (HSG) and had suggested bilateral occlusion in the DTB group (n = 38) and bilateral patency in controls (n = 38). Bilateral patency was found in all patients during subsequent laparoscopic chromopertubation. The primary outcome parameter was the clinical pregnancy rate within 6 months.

RESULTS: The basic patient characteristics showed no significant differences between the DTB and the control groups. Clinical pregnancy was found in 47.4% (18/38) of control patients (patent tubes) and in 21.1% (8/38) of DTB patients (p = 0.029) over 6 months of follow-ups. In a multivariate model, younger age [odds ratio (OR), 0.856, p = 0.013] and bilateral patency (OR 4.210, p = 0.010) in both examinations (control group) were associated with higher clinical pregnancy rates.

CONCLUSION: DTB reflects lower fecundity even when subsequent patency is demonstrated. Tubal patency following prior occlusion should not be grounds for complete reassurance, and given lower odds of pregnancy, such patients may be warranted a faster transition to ART given the decreased efficacy of other methods.