BLOCKED FALLOPIAN TUBES AND INFERTILITY

WHAT ARE FALLOPIAN TUBES

Fallopian tubes are the female reproductive organs that connect the ovaries and the uterus. Every month at the time of ovulation, which occurs roughly in the middle of a menstrual cycle, the fallopian tubes pick an egg and carry it from the ovary to the uterus.

Conception also occurs in fallopian tube. If an egg is fertilized by the sperm, it moves through the tube towards the uterus for implantation.

If a fallopian tube is blocked, sperms cannot reach eggs and fertilised egg cannot reach uterus. Common reasons for blocked fallopian tubes include infection, pelvic adhesions and scar tissue.

SYMPTOMS OF BLOCKED FALLOPIAN TUBES

Most often, there are no symptoms of blocked fallopian tubes. Many women don’t come to know that they have blocked fallopian tubes until they try to get pregnant and have trouble conceiving.

In few cases, blocked tubes can lead to mild, regular pain on one side of the abdomen. This usually occurs in a type of blockage called hydrosalpinx. This is the type of blockage when fluid fills and enlarges a blocked fallopian tube.

Conditions leading to a blocked fallopian tube can cause their own symptoms. For example, endometriosis causes very painful periods and pelvic pain. It can increase your risk for Blocked Fallopian Tubes due to adhesions and scarring.

EFFECTS OF BLOCKED TUBES ON FERTILITY

Blocked tubes are common causes of infertility. Sperm and an egg meet in the fallopian tube for the fertilization. A blocked tube can prevent them from uniting and thus inhibits resulting fertilisation.

If both tubes are completely blocked, pregnancy without treatment will be impossible. If the fallopian tubes are partially blocked, you can potentially get the pregnant. However, the risk of an ectopic pregnancy i.e. pregnancy in the tube, increases.

This is because it’s more difficult for a fertilized egg to move through a blocked tube to the uterus. In these cases, your fertility specialist might recommend IVF (in vitro fertilisation).

If only one tube is blocked, the effect on fertility is less marked because an egg can still travel through the normal fallopian tube. Fertility medications can help increase your chance of ovulating on the normal side.

WHAT ARE THE CAUSES OF BLOCKED FALLOPIAN TUBES

Fallopian tubes are usually blocked by pelvic adhesions or scar tissue. These can be caused by many factors, including the following:

  • Pelvic inflammatory disease. This diseases can cause scarring or hydrosalpinx.
  • Some sexually transmitted infections (STIs). Chlamydia and gonorrhoea can cause scarring and lead to pelvic inflammatory disease resulting in blocked fallopian tubes
  • Endometriosis. Endometrial tissue on the outside of other organs can also cause the adhesions that block the fallopian tubes. Endometrial tissue can build up in the fallopian tubes and causes a blockage.
  • Past ectopic pregnancy. This can result in scarring of the fallopian tubes.
  • Fibroids. These benign tumours can block the tubes, particularly where they are attached to uterus.
  • Past abdominal surgery. Past surgery, especially on the fallopian tubes themselves, can lead to the pelvic adhesions that block the tubes.

You can’t prevent many causes of the blocked fallopian tubes. However, you can decrease your risk of sexually transmitted infections by using a condom during sex.

DIAGNOSING A BLOCKED FALLOPIAN TUBE

Hysterosalpingography or HSG is a type of X-ray technique used to examine the inside of fallopian tubes to help diagnose blockages. During HSG, your physician introduces a dye into your uterus and fallopian tubes.

The dye helps your physician or fertility specialist to see the inside of your fallopian tubes on the X-ray. An HSG can be done in your doctor’s office. It should take place within the first half of the menstrual cycle. Side effects are rare, but false positive results are possible where the test shows a blockage but tubes are open.

If the HSG doesn’t help your fertility specialist to make a definitive diagnosis, they can use laparoscopy for further evaluation of pelvis and fallopian tubes. If the fertility specialist finds a blockage during the procedure, they might remove it, if possible.

TREATMENT FOR BLOCKED FALLOPIAN TUBES

If you have one open fallopian tube and you are otherwise healthy, you might be able to get pregnant with simpler procedures. Your doctor may give you fertility medications to increase your chances of ovulation on the side with the open tube. This is not an option if the both tubes are blocked.

LAOAROSCOPIC SURGERY

In some cases, laparoscopic surgery can open blocked fallopian tubes or remove the scar tissue. Unfortunately, this treatment doesn’t always work in all cases. The chance of success depends on how old you are (the younger, the better), how severe and where the blockage is, and the cause of blockage. If just a few adhesions are between the tubes and ovaries and they are not dense, then the chances of getting pregnant after surgery are good.

If you have a blocked fallopian tube that is otherwise healthy, you have a 20% to 40% chance of getting pregnant after surgery.

Your risk of having an ectopic pregnancy is higher after surgery to treat tubal blockage. Your fertility specialist will closely monitor you if you do get pregnant and will be available to help you decide what’s best for you.

However, surgical treatment isn’t always the best option. Situations that may be better for IVF include the presence of significant scarring, moderate to severe endometriosis, or other associated factors like moderate to severe male factor infertility. Your fertility specialist can help you review whether surgical repair or going straight to IVF treatment would be best for your situation.

IN VITRO FERTILISATION

Before the invention of in vitro fertilization (IVF), if laparoscopic surgery didn’t work or wasn’t an option, women with Blocked Fallopian Tubes had no options to achieve pregnancy. The availability of IVF makes conception possible.

In IVF treatment fertility drugs are given to stimulate the ovaries. Growth of eggs is monitored with the ultrasound.  Then, when eggs are ready, using an ultrasound-guided needle introduced through the vaginal wall, your fertility specialist retrieves the eggs directly from the ovaries. In the lab, the eggs are placed together with sperm from the male partner or a sperm donor. Some of the eggs will fertilize and some healthy embryos will result. One or two healthy embryos are selected and transferred to the uterus.

IVF completely bypasses the fallopian tubes, so presence of blockages in the tube doesn’t matter. That said, research has found that an inflamed tube can significantly decrease the chances of IVF success. If you have a hydrosalpinx (fluid-filled tube), your fertility specialist may recommend surgery to remove the tube. Then, after recovery from surgery, IVF can be attempted.

TUBAL LIGATION REVERSAL

Tubal ligation surgery is a permanent method of the birth control. There are different types of the tubal ligation. These include a surgeon cutting the tubes, banding them, clamping them, or placing specialized coils inside them. The idea is to surgically and intentionally block the tubes so the sperms can’t reach the egg.

Around 20% to 30% women later regret having a tubal ligation. The good news is that even though this kind of birth control is considered permanent, it can be surgically reversed for many women. Surgical repair of a tubal ligation is more likely to be fruitful and successful than women having tubal surgery to repair blockages caused by diseases. Micro-surgical repair is less expensive than IVF, costing as much as half per delivery.

Success rates for micro-surgical tubal reversal are excellent and depend on the age of women undergoing reversal. For women younger than 40 years of age, pregnancy rates after two years of reversal are 90%. For women over age of 40, these success rates vary between 40% and 70%.

PREVENTION

Most of the Blocked Fallopian Tubes are caused by pelvic infections. Most of these infections are caused by a sexually transmitted infection. Regular screening for STIs is an important step. If the STI or pelvic infection is caught early enough, treating it may help in preventing the development of scar tissue.

However, majority of pelvic infections are not acute, and often do not cause any signs or symptoms. But “quiet infection” does not mean it is the harmless. The longer the infection is present, the higher the risk of scar tissue forming and creating blocked fallopian tubes.

Once an infection has been diagnosed, prompt antibiotic treatment is important. Treating the infection doesn’t guarantee the tubes will become clear. Antibiotic kills only bacteria. Any damage or scar tissue that has formed will not be reversed by antibiotic treatment. However, treating the disease will help prevent further damage, and may make fertility treatment or later surgical repair more likely to be successful.

Using condoms and getting regular STI screening (especially if you engage in high-risk sexual behaviour) is recommended to prevent fallopian tube damage from STI.

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