An innovative application of the holmium laser: a case report of hysteroscopic holmium laser proximal fallopian tubal occlusion

Hysteroscopic proximal tubal occlusion is a treatment option prior to in vitro fertilization and embryo transfer (IVF-ET) in patients with a hydrosalpinx or salpingitis. The Holmium:YAG laser is well-suited for hysteroscopic procedures; however, its use in the treatment of salpingitis has not been previously reported. Here, we report a case of a 30-year-old female who presented to our hospital in 2018 after multiple failed embryo transfers. Her medical history included an induced abortion and a laparoscopic left salpingectomy performed at 12 weeks of gestation on May 4, 2010, due to bilateral tubal abscess. She was discharged following postoperative anti-inflammatory treatment. However, on May 22, 2010, she developed recurrent lower abdominal pain. Pelvic ultrasonography suggested a possible pelvic abscess. Empiric treatment with meropenem and vancomycin was ineffective, and on June 4, 2010, the patient underwent right salpingectomy and pelvic adhesiolysis. Despite multiple IVF attempts in 2017 and 2018, all transfers failed, which was considered to be due to persistent inflammation of the left tubal stump. In 2018, she underwent hysteroscopic proximal fallopian tubal occlusion using a holmium:YAG laser at the left tubal ostium, an innovative application of holmium laser. Following the procedure, she underwent successful embryo transfer and subsequently delivered a healthy infant.