Since initial reports of transvaginal cannulation for proximally occluded tubes about 1985, there has been significant increase in reports of tubal cannulation for cornual occlusion.  However, this is more commonly discussed as a therapeutic rather than a diagnostic procedure.  Some of these procedures are being performed without cervical culture or preoperative medication.  It would appear that some of the patients being reported as successful therapeutic cannulation might have been more properly reported as successful diagnostic cannulation or alternately may represent overuse of the equipment.

All patients had chlamydia cultures and standard cultures prior to surgery.  These were treated until the cultures were negative.  Danocrine and GnRH analogs were used to suppress hormonal production on the basis of statements by Brian Cohen regarding the association of endometriosis with cornual occlusion.  Doxycycline was used in all patients due to a high incidence of positive Chlamydia IGG titers and the inability to perform cornual Chlamydia cultures.  These had been used together since 1980 and were analyzed in 1985.

Ovarian suppression and antibiotics were used for eight weeks prior to hysterosalpingogram and/or hysteroscopy for 26 patients.

In this study, 62% of patients with cornual occlusions responded to a combination of hormonal suppression, antibiotics and repeat tubal studies.  Radiologic tubal cannulation as a diagnostic or therapeutic procedure may be successful in certain patients but may not demonstrate coexistent salpingitis isthmica nodosa and is ineffective against hydrosalpinges and endometriosis.

Combined hysterosalpingogram, laparoscopy with hysteroscopic cannulation following a combination of Danazol or GnRH analogs in association with Doxycycline or other antibiotic therapy appears to be the most comprehensive approach in the evaluation and therapy of these patients.

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