Tubal Factor Infertility
Fallopian tubes are reproductive organs that connect ovaries to the uterus. During ovulation, the ovary releases an egg which travels through the tubes towards the uterus. If the sperm are present in the uterus they swim towards the tube to fertilize the egg. Fertilization takes place in the fallopian tube forming an embryo. This embryo then travels towards the uterus and implants itself into the uterine lining where it grows for the next nine months.
In cases when the fallopian tubes are damaged, blocked in some way therefore they prevent the sperm from reaching the egg for fertilisation. This scenario is termed as tubal factor infertility.
In some cases the tube’s damage may allow fertilization of egg but the embryo is unable to travel to the uterus and remains in the tube. This is termed as ectopic or tubal pregnancy.
Blocked fallopian tubes:
Tubal blockages are identified by the location of the blockage. Below are the types of tubal blockages:
- Proximal tubal blockage: This type of blockage is located close to the uterus.
- Mid-segment blockage: In this case the tubes are blocked in the middle segment of the entire organ. Mid-segment blockage can be caused by some form of damage or scarring, which can occur from tubal ligation, ectopic (tubal) pregnancy or an unsuccessful attempt of surgical reversal of sterilization.
- Distal tubal blockage: when the blockage is situated away from the uterus it is known as distal tubal blockage. Fallopian tubes may be partially or completely blocked at their end.
Causes of tubal factor infertility
The most common cause of tubal factor infertility is infection. Additional causes of blocking and scarring are endometriosis (endometrial tissue grows outside the uterus), pelvic inflammatory disease, sexually transmitted infections, ectopic pregnancy (the embryo grows outside of the uterus inside the tube), previous surgery.
Symptoms:
The main symptom of tubal factor infertility is the inability to become pregnant. Many women do not realize that they have fallopian tube damage until they have consulted a doctor for infertility.
Diagnosis:
To confirm whether or not one or both fallopian tubes are blocked, your doctor may perform one of these two procedures:
- Hysterosalpingogram (HSG): this is an X-ray procedure performed by a radiologist. The vagina is opened with a speculum and then a catheter is inserted to inject liquid through the cervix into the uterus. If this liquid comes out from both the ends then the tubes are not blocked. If the liquid does not enter or flow through the tubes, then the affected tube is considered blocked. Through this test one can only ascertain if the tube is open, but it cannot be determined if the tube is functional or not. It is possible that the tube might be open but the inner lining may be severely damaged.
- Laparoscopy: In this minimally-invasive procedure, a surgical instrument called a laparoscope is inserted through a very small incision in the naval area. The surgeon can look through the laparoscope to see if one or both of the tubes are open. The laparoscope can also be used to look for other problems that may affect fertility, such as scar tissue or endometriosis.
Treatment:
Treatment options for blocked or damaged tubes include IVF and surgery.
- In vitro fertilization (IVF): Most of the tubal disorders are rectifiable wit surgery however women who have extreme damage in the tubes have very minimal chances of conceiving naturally. Therefore IVF is the best option available for a successful pregnancy. There are chances that too much damage in the tubes may cause them to fill with fluid and this may result in low IVF success rates. In some cases the doctors recommend removal of damaged tubes before IVF procedure.
- Surgery: Surgery might help in getting pregnant naturally if the tubes are not too damaged. Probability of conceiving after surgery depends on factors like age of the female, minimal amount of scar tissue blocking the tubes and sperm quality of the male partner. There is possibility of ectopic pregnancy after the tubal surgery. Special care is required in cases where the female partner has had a tubal surgery and she is pregnant.
