Damaged Tubes – Tubal Factor Infertility

Tubal disease, one of the many causes of female infertility, is a disorder in which the fallopian tubes are blocked or damaged. This is usually diagnosed through review of medical history, performing pelvic exam, and undergoing additional tests, including hysterosalpingogram and laparoscopy, to confirm the diagnosis.

Scar tissue, infections and tubal ligation are often causes of tubal disease. The most common reason why tubes get damaged or blocked is a condition called pelvic inflammatory disease (PID). This is an infection that can affect the womb, ovaries or tubes. It’s very common. This infection can block or damage the fallopian tubes, so that eggs may not be able to pass down the tubes and the sperm may not be able to travel up them. Scar tissue resulting from endometriosis or abdominal or gynecological surgery, such as bowel surgery, cesarean section or a ruptured appendix, can block an egg from entering or traveling down the fallopian tube to meet the sperm, preventing fertilisation.

Infections, including chlamydia, can damage the cilia, the tiny hairs lining the fallopian tubes that help transport the egg, often preventing the sperm and egg from meeting. One result of damaged cilia is an ectopic pregnancy, which occurs when an egg is fertilized but, due to the damaged cilia, it is unable to travel to the uterus, growing instead in the wall of the fallopian tube. This condition can result in rupture, internal bleeding and further tubal damage. Many women who have undergone tubal ligation, had their “tubes tied”, decide they want to have a baby at some point after the procedure. These patients most often undergo in vitro fertilization to bypass the blockage. In some rare cases, surgery can be done to reattach tubes after ligation.

There are a number of treatment options available to overcome infertility caused by tubal disease. This includes surgical removal of scar tissue, surgical repair of damaged tubes, tubal ligation reversal or in vitro fertilization. IVF typically provides the best results; however, surgical approaches may be advisable due to insurance issues, or other pelvic findings such as hydrosalpinx or leiomyoma (fibroid)

Tubal reanastomosis is used to reverse a tubal ligation or to repair a portion of the fallopian tube damaged by disease. The blocked or diseased portion of the tube is removed, and the two healthy ends of the tube are then joined. This procedure usually is done through an abdominal incision (laparotomy), but some specialists can perform this procedure using laparoscopy.

Salpingectomy, or removal of part of a fallopian tube, is done to improve in vitro fertilization (IVF) success when a tube has developed a buildup of fluid (hydrosalpinx). Hydrosalpinx makes it half as likely that an IVF procedure will succeed.¹ Salpingectomy is preferred over salpingostomy for treating a hydrosalpinx before IVF.

Salpingostomy is done when the end of the fallopian tube is blocked by a buildup of fluid (hydrosalpinx). This procedure creates a new opening in the part of the tube closest to the ovary. But it is common for scar tissue to regrow after a salpingostomy, reblocking the tube.

Fimbrioplasty may be done when the part of the tube closest to the ovary is partially blocked or has scar tissue, preventing normal egg pickup. This procedure rebuilds the fringed ends of the fallopian tube.

Selective tubal cannulation For a tubal blockage next to the uterus, a nonsurgical procedure called selective tubal cannulation is the first treatment of choice. Using real-time X-Ray or hysteroscopy to

guide the instruments, a doctor inserts a catheter, or cannula, through the cervix and the uterus and into the fallopian tube.

The success of a fallopian tube procedure depends in part on the location and extent of the blockage, as well as the presence or absence of other fertility problems.Clearing a blockage in the part of the tube closest to the uterus (proximal occlusion) is more likely to be successful. These blockages often are functional (such as a mucus plug) rather than structural (such as scarring or other obstruction). Up to 60% of women with proximal occlusion have been reported to have successful pregnancies after tubal surgery.