Fallopian tube disease or damage
Infertility can be caused by blockage of the fallopian tubes. Evaluation of the tubes involves a hysterosalpingogram (HSG) or a saline infusion sonogram (SIS). Depending on where the fallopian tubes are blocked, the best fertility treatment may be in vitro fertilization. If fallopian tube disease is the only cause of infertility, pregnancy rates with IVF are typically quite good.
What causes tubal disease?
There are many possible causes of damaged or blocked fallopian tubes. Some of these affect the proximal tube (the part of the tube that is connected to the uterus), while others affect the distal tube (the end near the ovary). Proximal tubal occlusion is usually caused by either an infection (gonorrhea, chlamydia) or a plug of menstrual tissue that tried to flow backward into the pelvis rather than forward into the vagina. Distal tubal occlusion has many causes as well. Previous abdominal or pelvic surgery can cause scar tissue in the pelvis which can block the end of the tube, preventing the egg from entering the tube at ovulation. Endometriosis can also cause inflammation and scarring in the pelvis which can also result in blocking of the ends of the tubes. Infections in the pelvis, such as gonorrhea, chlamydia or even appendicitis, can cause scarring of the tubes or damage the cells in the tube that help to transport the egg/embryo down the tube into the uterus. Finally, tubal ligation blocks fallopian tubes preventing the egg and sperm from meeting in the tube.
How is tubal disease treated?
Treatment of proximal fallopian tube obstruction involves the passage of a small catheter into the origin of the tube, which usually dislodges the blockage. Treatment of distal fallopian tube obstruction usually involves laparoscopic surgery to try to reopen the tubes. Tubal ligation can be reversed in some cases and this procedure can have a good rate of success. Any surgical correction of fallopian tube damage can result in an increase in pregnancy rates, but also increases the risk of ectopic or tubal pregnancy. Any pregnancy after these treatments should be very carefully monitored to make sure implantation has occurred in the uterus, rather than in the fallopian tube.
Many patients with tubal disease will require or will choose to undergo IVF. During this procedure, eggs are removed from the body and fertilization takes place in the laboratory instead of in the fallopian tube. Then embryos are placed into the uterus. This bypasses the damaged fallopian tubes, resulting in a very high chance for a normal intrauterine pregnancy and only a minimal chance of an ectopic pregnancy.
If you have any questions, please contact our San Antonio fertility center.