Pregnancy outcomes following fluoroscopy-guided tubal recanalization: a comparison of spontaneous conception and intrauterine insemination—a retrospective cohort study

To evaluate and compare pregnancy outcomes following successful fluoroscopy-guided tubal recanalization (FGTR), focusing on spontaneous conception versus intrauterine insemination (IUI). This retrospective cohort study included 139 women aged 21-40 years who underwent FGTR for tubal occlusion between January 2021 and May 2024. After exclusions, 80 women attempted natural conception, and 59 underwent IUI with ovarian stimulation. Groups were compared in terms of clinical pregnancy rates, time to conception, and post-procedure tubal patency. Clinical pregnancy rates were similar between spontaneous conception (51.2%) and IUI (57.6%) groups (p = 0.976). Mean time to conception did not differ significantly (6.4 ± 2.8 vs. 5.9 ± 2 months, p = 0.360). No pregnancies occurred in women with bilateral distal obstruction, whereas proximal occlusions (unilateral or bilateral) were associated with higher pregnancy rates. Six-month follow up HSG demonstrated that bilateral tubal patency correlated with greater conception likelihood. In women with tubal factor infertility who achieve patency after FGTR, spontaneous conception and IUI yield comparable pregnancy outcomes and similar time to conception. Expectant management may be a cost-effective first-line approach, reserving IUI or IVF for cases without conception within a reasonable timeframe. The site of tubal obstruction and patency status should guide individualized post-FGTR fertility planning.