Tubal Abnormalities – Blocked or Damaged Fallopian Tubes can Cause Infertility
One of the most common causes of infertility is damaged fallopian tubes. The most common cause of injury to the fallopian tubes is infection, typically from a sexually transmitted disease. It is not uncommon for a woman to have been infected and not experience any symptoms. The damage may not be discovered until many years later when she unsuccessfully attempts pregnancy.
During the infertility evaluation, a hysterosalpingogram (HSG) will usually be performed to evaluate the uterus and fallopian tubes. An HSG usually reveals a blockage of the fallopian tube if in fact a blockage is present. However, it is not uncommon for the fallopian tubes to appear to be patent when they are actually damaged and unable to function properly.
The HSG may demonstrate obstruction at the cornual portion of the tube (where the tube connects to the uterus). More commonly, obstruction is seen distally, at the fimbriated end of the tube. The least common segment of the tube to be obstructed (unless the patient has previously undergone a sterilization procedure) is the mid portion of the tube. If one fallopian tube is found to be obstructed, it is not uncommon for the other tube to be damaged as well, even if obstruction of that tube is not seen on the X ray. Usually pelvic infections involve both fallopian tubes causing both to be damaged, even though one tube might be more damaged than the other. It is common for the HSG to show damage to only one tube, yet at the time of corrective surgery, damage is noted in the other tube as well.
If you have a history of increasingly severe pain or cramping with your periods, previous abdominal or pelvic surgery, or a history of any pelvic infection, we will most likely recommend a laparoscopy to further evaluate your fallopian tube status. At laparoscopy the fallopian tubes can often be repaired, and any adhesions that might be compromising normal tubal function can be removed as well. Any fallopian tube disease - even without obstruction – increases the risk of a tubal pregnancy. The risk is increased from 1% to approximately 20% for women who have fallopian tube disease.
Unfortunately only about 30% of couples will conceive within one
to two years following extensive surgical reconstruction of the
fallopian tubes. In vitro fertilization therefore may well
represent a more promising treatment alternative, as it affords
higher pregnancy rates. Some couples may choose to attempt
reconstructive surgery prior to IVF – either because surgery may be
covered by their insurance whereas IVF may not be covered –
or because they desire to try to conceive on their own. At any
rate, if a patient undergoes reconstructive surgery and she fails to
conceive she should consider in vitro fertilization. This is
usually the best recommendation, even if a follow-up
hysterosalpingogram demonstrates tubal patency, as tubal
patency on HSG does not assure that the fallopian tubes will
function properly.
Oftentimes when a fallopian tube is obstructed at the fimbriated
end, the fallopian tube can collect fluid and become a
hydrosalpinx. This severe form of tubal disease significantly
lowers the chance of the patient becoming pregnant – even if the
other tube is perfectly normal. Although the exact mechanism
whereby the hydrosalpinx decreases the chance for pregnancy remains
controversial, many studies have shown that pregnancy rates (even
with IVF) in the presence of a hydrosalpinx are reduced by
approximately 50%. We therefore recommend either surgical repair,
if possible, or removal of the hydrosalpinx prior to beginning any
significant fertility treatment.
