March 26, 2021 4:11:40 pm
By Dr Radhika Sheth
Did you know that tubal factor infertility accounts for about 25-30 per cent of all cases of infertility? Tubal factor infertility occurs when there is a blockage in the fallopian tubes. Fallopian tubes are organs of the female reproductive system that connect each ovary to the uterus. Many couples complain that they are not conceiving despite several efforts. Getting the fallopian tubes checked could be one of the options to avoid any fertility related issues. The condition includes cases of completely blocked fallopian tubes and cases where just one blocked tube or scarring narrows the tubes.
How do fallopian tubes work?
Every month, roughly in the middle of a menstrual cycle, an egg is released from the ovary. The egg travels from the ovary, through the tubes, and into the uterus. The sperm also needs to swim from the vagina into the uterus and then through the fallopian tubes to reach the egg. Fertilisation usually takes place in the fallopian tube. The fertilised egg then moves from the tube to the uterus for implantation. If a fallopian tube is blocked, the sperm may not be able to swim up to the egg. The path back to the uterus for the fertilised egg is also blocked. This can occur on one or both sides and is the cause of infertility in up to 30 percent of infertile women. At times, the tube may be blocked only partially. This can increase the risk of a tubal ectopic pregnancy.
Causes of blocked fallopian tubes
A blocked fallopian tube may cause some women to experience symptoms such as pain in the pelvis or belly. This pain might happen regularly, such as around the time of their period, or be constant.
Pelvic inflammatory disease
Sexually transmitted infections (STIs).
Past ectopic pregnancy
Fibroids: These masses can block the fallopian tube, particularly where they attach to the uterus.
Past pelvic surgery: Past surgery, especially on the fallopian tubes themselves, can lead to scarring and pelvic adhesions that block the tubes.
It’s unusual for women with blocked fallopian tubes to experience any symptoms. Many women assume that if they are having regular periods, their fertility is fine. This isn’t always true. Blocked fallopian tubes don’t often cause symptoms. Many women don’t know they have blocked tubes until they try to get pregnant and have trouble. Women with blocked tubes quite often are asymptomatic. The diagnosis is usually made during infertility work-up. In some cases, however, some of the causes of blocked fallopian tubes can have their own symptoms. Sometimes, a blockage in a fallopian tube can cause a fertilised egg to get stuck. This is known as an ectopic pregnancy.
For example, endometriosis and pelvic inflammatory disease (PID) may cause painful periods and painful sexual intercourse.
A hydrosalpinx is a type of tubal blockage that causes the tube to swell up and fill with fluid. The fluid blocks the egg and sperm, preventing fertilization and pregnancy. A hydrosalpinx may cause lower abdominal pain and unusual vaginal discharge.
Diagnosis of blocked fallopian tube
Hysterosalpingography (HSG): Hysterosalpingography is a radiologic procedure to check the shape of the uterine cavity and the shape and patency of the fallopian tubes. It is a special x-ray using a radio-opaque dye to look at the uterus and Fallopian tubes. The test involves placing a dye through the cervix using a small tube. Once the dye is in place, x-rays of the pelvic area are taken. If the tubes are open, the dye will go through the uterus and fallopian tubes and spill out into the pelvic cavity. If the dye does not pass through the tubes, the fallopian tubes could be blocked. Nearly 15-20 percent of women may have false blocks in an HSG. These false blockages appear to be at the cornual region, which is the junction where the fallopian tube and uterus meet. This often happens due to transient ‘cornual spasm’ due to momentary pain as the dye is passing through the uterus. Laparoscopy is often needed to confirm if these blocks are genuine or false.
Laparoscopy: Tubal patency can be confirmed by a laparoscopic surgery. If a blockage is found during the procedure, it may be possible to fix it and open the tubes in certain cases by laparoscopy.
Treatment for blocked fallopian tubes
If one tube is open and healthy, natural conception is possible. Fertility drugs may be advised to increase the chances of ovulation on the side with the open tube. This, however, is not an option if both tubes are blocked.
Laparoscopic surgery: In certain cases, laparoscopic surgery can open blocked tubes. However, this treatment does not always work. The chance of success depends on the exact location, size, and cause of tubal block. The chance of conceiving after surgery if the tubes are otherwise healthy is 20-40 percent.
The couple should be counselled that risk of ectopic pregnancy is higher after surgery to treat tubal blockage. Also, surgical repair may not always be the best option. IVF may be a better option in these cases. These include moderate to severe endometriosis, male factor infertility and advanced age of the female partner.
In-Vitro Fertilisation (IVF): In the pre-IVF era, if repair surgery was not successful, women with blocked tubes had no options to get pregnant. The use of IVF makes conception possible even in these cases. IVF treatment involves taking fertility drugs to stimulate the ovaries. Then, using an ultrasound-guided needle through the vagina under anaesthesia, the eggs are retrieved. In the lab, the eggs mixed with sperm from the male partner. These eggs then can fertilise and result in embryos. One or two healthy embryos are selected and transferred to the uterus. Since IVF completely bypasses the fallopian tubes, tubal blockages do not matter. IVF offers success rates as high as 45-50 % per cycle and is a promising treatment option in women with blocked tubes.
The majority of blocked fallopian tubes are caused by pelvic infections. Most—but not all—of these infections are caused by sexually transmitted infections. It is important to undergo regular screening for STIs and get the symptoms checked out right away. This is an important step in preventing tubal infertility. If the STI or pelvic infection is caught early enough, treating it may help prevent the development of scar tissue.
(The writer is Consultant Fertility Specialist, Cloudnine Group of Hospitals, Mumbai – Malad and Vashi)
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