Did we know, tubal factor infertility accounts for about 25-30% of all cases of infertility? Tubal factor infertility occurs when there is a blockage in the fallopian tubes. Fallopian tubes are organs of the female reproductive system that connects each ovary to the uterus. Many couples complain that they are not conceiving despite several efforts to plan a conception. Getting the fallopian tubes checked could be one of the options to avoid any fertility-related issues. Onlymyhealth spoke to Dr. Radhika Sheth, Consultant Fertility Specialist, Cloudnine Group of Hospitals, Mumbai (Malad and Vashi) to understand how blockage in the fallopian tube can impact fertility.
How Fallopian tubes work?
All women know about their menstrual cycle and what happens when they are on your periods. For the uninitiated, an egg is released every month from the ovary, almost in the middle of a woman’s menstrual cycle. This egg goes from the ovary to the uterus. The male sperm after releasing into the vagina also travel to the uterus through fallopian tubes to meet the egg. The fertilization of an egg with the sperm, thus, happens in the fallopian tube. This is why these tubes play an important role in fertilization process. For implantation, the fertilized egg then moves to the uterus.
Now, you can understand what a blocked fallopian tube can cause. If the tube is blocked, the sperm won’t be able to reach to the egg. Also, the egg won’t be able to go to the uterus. This can cause on both sides. In most cases, the fallopian tube is partially blocked. This increases the chances of ectopic pregnancy.
Causes and symptoms of blocked fallopian tubes
Some notable causes of blockage in the fallopian tube can be:
- Pain in the belly
- Pelvic inflammatory disease
- Sexually transmitted infections (STIs)
- Past ectopic pregnancy
- Fibroids: These masses can block the fallopian tube, particularly where they attach to the uterus.
- Past pelvic surgery: Past surgery, especially on the fallopian tubes themselves, can lead to scarring and pelvic adhesions that block the tubes.
Women with blocked tubes quite often are asymptomatic. The diagnosis is usually made during infertility work-up. In some cases, however, some of the causes of blocked fallopian tubes can have their own symptoms. In some cases, a blockage in a fallopian tube can lead to ectopic pregnancy.
A hydrosalpinx is a type of tubal blockage that causes the tube to swell up and fill with fluid. A hydrosalpinx may cause lower abdominal pain and unusual vaginal discharge.
Diagnosis of blocked fallopian tube
Hysterosalpingography (HSG): Hysterosalpingography is an X-ray procedure to check the uterine cavity and shape of the fallopian tubes. A dye is put inside the tubes, and if the dye does not pass through the tubes, the fallopian tubes could be blocked. 15-20% of women may have false blocks in an HSG. These false blockages appear to be at the cornual region which is the junction where the fallopian tube and uterus meet. This often happens due to transient ‘corneal spasm’ due to momentary pain as the dye is passing through the uterus. Laparoscopy is often needed to confirm if these blocks are genuine or false.
Laparoscopy: Tubal patency can be confirmed by laparoscopic surgery. If a blockage is found during the procedure, it may be possible to fix it and open the tubes in certain cases by laparoscopy.
Treatment for Blocked Fallopian Tubes
If one tube is open and healthy, natural conception is possible. Fertility drugs may be advised to increase the chances of ovulation on the side with the open tube. This, however, is not an option if both tubes are blocked.
In certain cases, laparoscopic surgery can open blocked tubes. However, this treatment does not always work. The chance of success depends on the exact location, size, and cause of the tubal block. The chance of conceiving after surgery if the tubes are otherwise healthy is 20-40%.
The couple should be counselled that the risk of ectopic pregnancy is higher after surgery to treat tubal blockage. Also, surgical repair may not always be the best option. IVF may be a better option in these cases. These include moderate to severe endometriosis, male factor infertility and advanced age of the female partner.
In-Vitro Fertilization (IVF)
Considering that fallopian tube blockage can affect conception and the woman may not be able to embrace motherhood, IVF is the best option. Earlier when IVF was not here, women with failed repair surgery didn’t have an option to get pregnant. Now that IVF is here and the success rate is very high, this treatment can be considered by women to get pregnant. In IVF, fertility drugs are given to the patient to stimulate the ovaries. Then, under anaesthesia, an ultrasound-guided needle is inserted into the vagina to retrieve eggs. This process is done in a laboratory. The female's eggs are mixed with male sperm and made to fertilize. When the embryos are formed, one or two of them are transferred to the woman’s uterus for implantation and conception. IVF process bypasses fallopian tubes and therefore, blockage doesn’t create any hindrance in the pregnancy process. This is a promising treatment option with a 50% success rate, however, this is an expensive procedure but women with the blocked fallopian tube can consider this.
How to prevent fallopian tube blockage?
As per experts, the most common cause of fallopian tube blockage is pelvic infection. Also, some cases may also be due to sexually transmitted infections. In order to prevent fallopian tube blockage, sexually active women must get sexually transmitted infections screenings done at regular intervals. To prevent tubal infertility and keep sexual health in place, getting regular screenings done upon experiencing the symptoms. Diagnosing STI or pelvic infection timely can prevent tubal infertility caused due to fallopian tube blockage.
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