Despite the fact that there are many causes of infertility, in the western world, a blockage and damage of the fallopian tube is often the reason women are unable to conceive. However, in the GCC countries this cause of infertility is very limited amongst local patients.
Tubal disease resulting in infertility can be the result of an inflammatory process in or around the fallopian tube. Infection of the fallopian tubes is one reason for the alteration in the tubal epithelial lining. In some cases, the infection may be caused by sexually transmitted organisms such as chlamydia or gonorrhea.
Sometimes the damaged tubes swell and fill with fluid. A hydrosalpinx is a particular type of tubal blockage in which the tube is obstructed near the fimbria end (the outside end of the fallopian tube that is in contact with the surface of the ovary), and the tube becomes filled with clear watery fluid. The reason for the obstruction of the tube in the region of the fimbria is in most cases a genital tract infection, e.g. with Chlamydia.
Furthermore, pelvic tuberculosis could still be a cause of infertility in some ethnic groups. Congenital tubal abnormalities do occur but are rare.
Abdominal surgery like tubal ligation removal and complication from lower abdominal surgery such as cesarean section might also cause damage. Moreover, diseases like endometriosis and uterine fibroids possibly may cause scarring between the end of the fallopian tube and ovary.
Depending on the severity of the damage, fallopian tubes may remain patent but will function ineffectively, or may be completely blocked. When the cause of the tubal damage is infectious, the damage is usually bilateral. If the cause is endometriosis or obstruction due to a fibroid, it is possible that only one tube could be affected with the unaffected one is working properly.
Most women with tubal infertility do not experience any symptoms. Often they do not realise that their fallopian tubes are blocked until they consult a doctor for infertility. However, in some cases, women with extensive tubal damage may experience severe pelvic pain.
A medical history and pelvic exam are necessary to make the assumption that there might be a tubal obstruction but to confirm the tubal block other medical examinations are needed to confirm the diagnosis or any abnormalities.
The treatment options for tubes found to be blocked, scarred or damaged depends of course on the findings, but in general they are surgery and in vitro fertilisation (IVF).
Procedures involving the repair or reconstruction of fallopian tubes is known as tuboplasty. A tuboplasty maybe performed via laparoscopy (in exceptional cases via laparotomy), to successfully reopen a fallopian tube.
If the obstruction is present at the proximal (where the fallopian tube inserts into the uterus) portion of the fallopian tube, success in opening the tube may be accomplished by performing a hysteroscopy. However, if the distal (farthest) portion of the fallopian tube is blocked, it may also be opened either through microsurgery or by laparoscopic laser surgery.
However, there is a possibility of scar tissue and adhesion re-growth. The tubes may become blocked again or adhered to the abdominal wall, other parts of the reproductive organs or other organs surrounding the location, for example, bladder. Also, there is a great risk for ectopic pregnancy, particularly tubal pregnancy. A tubal pregnancy is a serious health problem that is more likely to occur after tubal surgery or tubal disease. So in case a woman will get pregnant after tubal surgery, a close follow-up is necessary to exclude any chance of an ectopic pregnancy.
Although some tubal problems are correctable with surgery, women with severely damaged tubes have such poor chances of achieving pregnancy naturally that In Vitro Fertilisation (IVF) offers them the best option for a successful pregnancy.
However, if the tubes show presence of hydrosalpinx and are severely damaged, the success rates of IVF are reduced, and the doctor may recommend removal or closure of damaged tubes prior to IVF or puncture the hydrosalpinx during the IVF. Hence, a removal of the tube will also cause a long-term reduction of the ovarian reserve since the vascularisation of the ovary will decrease after removal of the tube.
At IVI Middle East Fertility Clinic, we understand the difficulties couples experience when they are unable to conceive. All fertility treatments at our clinics are dedicated to helping couples make their dreams come true, by building or growing their families. Take the first step and contact us to learn about our many fertility treatments today.
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