There are a number of reasons a woman can be infertile and a common reason is blocked fallopian tubes. It’s important for patients to understand why tubes get blocked;, how this causes infertility; and what potential treatments are.
What Are They?
The fallopian tubes are 2 thin tubes that are positioned, one on either side of the uterus; these help lead mature eggs from the ovaries into the uterus. Whenever an obstruction prevents the eggs from traveling down the tube, it’s referred to as a blocked fallopian tube and can occur on one or on both sides. The other term for this condition is tubal factor infertility and almost 40% of infertility cases are caused by it. The block could be at the cornual ( uterine) end; the ovarian end; or in the mid-segment of the tube.
How Does this Occur?
Every month, when ovulation takes place, an egg gets released from either one of the ovaries. This egg then travels from the ovary, right through the tubes, and moves to the uterus. The man’s sperm also need to swim through the fallopian tubes and get the egg. Generally, the egg gets fertilized while it’s traveling through the tube.
If both the tubes are blocked, the egg is unable to reach the uterus; and of course the sperm is unable to reach the egg. In effect, this prevents fertilization as well as pregnancy. In some cases, the tube only has a partial blockage. This may increase the risk of ectopic ( tubal) pregnancy.
Blocked Fallopian Tubes- The Symptoms
Unlike anovulation, in which irregular menstrual cycles might indicate a problem, blockages in fallopian tubes rarely ever cause symptoms. In women with a hydrosalpinx ( also called a hydro on many IVF bulletin boards) , the blockage is at the ovarian ( terminal) end of the tube and this causes the fallopian tube to dilate and it fills up with fluid. A hydrosalpinx may cause lower abdominal pain in a few women. Sometimes the cause of these blocked fallopian tubes ( such as pelvic inflammatory disease and endometriosis ) can cause painful sexual intercourse and painful menstruation. However, these symptoms don't always indicate that there are blockages in the tubes.
• Current/history of an STD infection, such as Chlamydia or Gonorrhea
• History of a uterine infection caused by a miscarriage/abortion
• History of abdominal surgery
• History of a ruptured appendix
• Previous ectopic pregnancy
• Surgery involving the tubes
• Generally, blocked fallopian tubes are diagnosed with a hysterosalpingogram (HSG). This is a specialized X-ray in which a tiny tube is used to place a dye in the cervix. X-rays will then be taken of the pelvic area. This helps in ascertaining whether there is a blockage in the tubes
• A vaginal ultrasound can help the doctor to diagnose a hydrosalpinx. However, a vaginal scan cannot visualize normal fallopian tubes; and a normal scan does not mean that the tubes are not blocked
• Blood-work to check for presence of Chlamydia antibodies (this may imply previous/current infection)
• Many doctors still do a laparoscopy to check the tubal status, but this is too invasive and expensive in my opinion
• If one of your tubes is open and you are healthy in all other respects, it may be possible for you to get pregnant without any help, especially if you are young and your husband’s sperm count is normal. One normal tube is enough for normal fertility.
• Laparoscopic surgery may be useful rarely to remove scar tissue ( peritubal adhesions). The chances of success in this procedure is dependent on your age (the younger, the better), and if the inner lining of your tubes is normal. Damaged fallopian tubes ( those where the block is at the ovarian end) cannot be repaired , as they cannot function normally even after surgery, since their inner lining ( the cilia) has been damaged. You can read more about this at www.drmalpani.com/blockedtubes.htm
Based on your individual condition and also on whether there are any male infertility issues with your partner, and your age, your doctor may suggest that you skip surgery. In cases such as these, IVF becomes your best bet. It’s also important to note that post tubal blockage surgery, the risk of an ectopic pregnancy is much higher. If you get pregnant, your doctor will have to monitor you carefully when you do get pregnant.
Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!