December 14, 2021 9:50:33 pm
By Dr Santosh Gupta
One of the leading causes of infertility in women is tubal disease which could be blockage of tubes, infection or inflammation of fallopian tubes. Salpingitis or tubal infection is an infection that causes inflammation in the fallopian tubes and reproductive organs.
Fallopian tubes play an important part in conception as they are a conduit between the uterus and ovaries. The egg from the ovary after ovulation should reach the fallopian tube and the sperm after sexual activity, swimming the entire distance from vagina, cervix, and uterus. The process of fertilisation i.e., when the sperm meets the egg, takes place in fallopian tubes. After fertilisation, the embryo develops for another five to six days in the fallopian tube to become a blastocyst and then reaches the uterus to get implanted. Therefore, tubes should be open from both ends, and they should be free from adhesions, healthy enough to nurture an embryo and propel it back to the uterus. In short, it is not only a conduit pipe but has several important roles.
Tubal infections are one of the Pelvic Inflammatory Diseases (PIDs) that can cause infertility among women in severe cases. There are two types of Salpingitis:
Acute Salpingitis: Acute salpingitis causes swelling in fallopian tubes, which may start emitting fluid. This can lead to the development of pus in the fallopian tubes.
Chronic Salpingitis: Chronic salpingitis lasts for a longer period but with mild symptoms. In many cases, women cannot notice the symptoms of the infection.
Symptoms of a tubal infection
*Pain in lower abdomen
*Pain in lower back
*Pain during urination
*Foul-smell of vaginal discharge
*Spotting during the menstrual cycle
Causes of tubal infections
*Tubal infections are mainly caused by the presence of hazardous bacteria like Chlamydia trachomatis (responsible for the STD chlamydia) and Neisseria gonorrhoeae (which causes gonorrhoea). Other bacteria that may lead to salpingitis include Mycoplasma, Staphylococcus, and Streptococcus.
*Engaging in unprotected sex is the main way in which these bacteria find their way into a woman’s reproductive system. Other causes are poor hygiene, procedures like abortion, childbirth, etc, which involve disturbance of the barrier of the cervix which could lead to the bacteria entering the body.
*In India, tuberculosis is also a very common cause of tubal infection and damage.
Effect of tubal infections on fertility
A tubal infection results in scarring or blocking of the fallopian tubes, which could lead to permanent damage. Sometimes, they balloon to form Hydrosalpinx (a condition where the fallopian tube gets blocked with a watery fluid). Transportation of the sperm to the egg will be hindered resulting in infertility. Previous surgeries and Endometriosis can cause tubal adhesions and infertility.
An ectopic pregnancy is a situation where the egg is fertilised but won’t be able to enter the uterus due to damaged fallopian tubes. Chances are that the embryo will start growing in the tube. The embryo attaching itself anywhere outside the uterus is extremely risky. If left untreated, it continues to grow and will rupture the tube. Cases of ectopic pregnancy could be life threatening and must be given immediate medical attention.
Diagnosis of tubal infections
If you see any of the above-mentioned signs and symptoms, you must seek medical care to reduce the risk of complications in future. Your doctor may perform the following tests for diagnosis:
*Vaginal or cervical swab
*Blood and urine tests
*Abdominal or Transvaginal ultrasound
*Hysterosalpingogram or HSG test
Treatment of tubal infections
Early diagnosis is important for salpingitis as the treatment will depend on the severity of the infection. Timely treatment will prevent blockage or scarring of fallopian tubes.
The doctor will prescribe oral antibiotics to cure a minor infection. If the infection has become severe causing blockage or scars, the doctor will perform surgery to remove the damaged areas. A laparoscopy surgery can also be done if there is an abscess in the fallopian tubes or ovaries to drain the fluid. The fluid-filled area can also be removed during the surgery.
How IVF can help in severe infections
If the infection is not diagnosed early and damages the tubes which cannot be corrected surgically, women may opt for In-Vitro Fertilization (IVF) for conception. Whatever normally happens in the fallopian tube, in an IVF process that is done in an IVF lab. Through IVF, your egg won’t have to reach your uterus through fallopian tubes as the embryo is prepared in a petri dish and inserted through the cervix. However, success rates of IVF depend on several factors like age and quality of eggs and sperm.
As soon as you see any signs and symptoms of tubal infections, you must go to a doctor for an early diagnosis. In case of infertility, IVF or other assisted reproductive technologies (ART) might help women to conceive.
(The writer is Fertility Consultant, Nova IVF Fertility, Bangalore.)
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