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. Your physician will review your medical history and do a complete pelvic exam to diagnose a tubal disorder. It is often necessary to undergo additional tests, including hysterosalpingogram and laparoscopy, to confirm the diagnosis.
TUBAL FACTOR INFERTILITY
Once the mature eggs are "ovulated" from the ovarian follicles on the ovaries, they must travel unimpeded through the fallopian tubes until they reach the site of fertilization. Fertilization occurs in the ampulae of the fallopian tube, near the end furthest away from thae uterus. Tubal factor infertility is relatively common and occurs when damage to the tubes prevents the passage of the eggs through the fallopian tubes.
CAUSES OF TUBAL FACTOR INFERTILITY
Endometriosis- Endometrial (uterine lining) tissue can travel through the pelvic cavity and attach to the surface of the tubes. (This is discussed in detail in the section on endometriosis.) Once this tissue or cells are implanted; they bleed each month as does the uterine lining. As these cells grow and divide, it penetrates the tubes and may cause scarring or constrictions of the tubes, thus creating blockages.
Pelvic Inflammatory Disease (PID) - PID is caused by serious bacterial infections in the pelvic cavity. Chlamydia and gonorrhea are common organisms that can lead to PID. If these infections are not treated appropriately, and promptly, scarring of the tubes and damage to other reproductive organs can occur.
Scarring from Previous Surgery(s)- Scar tissue can form after any surgery, including a laparoscopy, appendectomy, abdominal surgery, myomectomy (removal of fibroids), tubal surgery, etc. When this tissue forms near or within the fallopian tubes, it can cause obstruction and blockage.
Congenital- Very rarely a woman may be born with only one of no fallopian tubes.
Tubal Surgery for Birth Control- Many women choose to have their "tubes tied" as a form of permanent birth control. No woman should have her tubes tied if there is any chance that future pregnancy may be desired. Even so, life situations unexpectedly change and many women seek tubal reversal surgery.
Diagnosing Tubal Factor Infertility Tubal factor is usually diagnosed by a hysterosalpingogram (HSG). The HSG is an outpatient radiology examination where contrast dye is injected into the uterus and its path is followed on X-ray as it travels through the fallopian tubes to the pelvic or abdominal cavity. If there is a blockage, there will be a buildup of dye at the point of the obstruction. Tubal factor is also sometimes diagnosed during the laparoscopy.
TREATING TUBAL FACTOR INFERTILITY
The two primary treatments for tubal factor are: 1) Surgery to remove the blockage or reconnect the tubes. 2) In vitro fertilization (IVF). In cases of severe tubal blockage IVF is usually the treatment of first choice since the eggs are retrieved directly from the ovary eliminating transport through the tubes.
Whether tubal surgery or IVF will be more effective depends upon several factors including where and how the tubes were tied (destroyed). The per cycle success rates with IVF are higher than those with tubal anastomosis (tubal reversal surgery).
Many women opt to try tubal surgery even though the per cycle pregnancy rates are lower. A healthy woman in her mid-twenties can have natural intercourse every month, and even if the success rates are less than 20%/cycle, she has a good chance of achieving pregnancy after 6 cycles. The IVF success rates for this same woman may be at least 40-55%/cycle (depends upon the specific practice) but she may not be able to afford numerous IVF attempts.
In general, women with tubal factor infertility in their thirties are encouraged to choose IVF. This is because egg quality (ovarian reserve) can decline rapidly in this age group and there may not be time for multiple "natural attempts".
With today's technology the pregnancy outcome for women with tubal factor is excellent. Infertility due to damaged fallopian tubes is common. Fortunately, when the tubal damage is mild to moderate, modern surgical techniques can often help to achieve pregnancy. Some tubal surgeries are now being performed as outpatient procedures through the laparoscope, thus minimizing recovery time and expense. For woman with severe or surgically uncorrectable tubal disease, in vitro fertilization offers a chance of achieving pregnancy. For woman who have had tubal ligations, microscopic tubal reversal frequently results in acceptable pregnancy rates. Although woman with infertility due to tubal factors once had a poor prognosis, today they have a good chance of experiencing the joys of parenthood.