Female infertility | Tubal Disease

TUBAL DISEASE

Diseases of the fallopian tube are a relatively common cause of infertility. Once the eggs are released from the follicles on the ovary, they must travel unimpeded through the fallopian tubes to the uterus. Any blockage, or other damage to the fallopian tubes, can prevent passage of the egg.

Diseases of the fallopian tube are a relatively common cause of infertility. Once the eggs are released from the follicles on the ovary, they must travel unimpeded through the fallopian tubes to the uterus. Any blockage, or other damage to the fallopian tubes, can prevent passage of the egg.

Tubal blockage can occur for many reasons including endometriosis, pelvic inflammatory disease, scarring secondary to surgery, congenital absence or deformity, and other reasons. Diagnosis is usually made by observing the flow of radiopaque die through the fallopian tubes during a hysterosalpingogram.

Endometriosis is a common cause of tubal obstruction wherein the endometrial implants attach to, and sometimes penetrate, the tubes. Serious pelvic infections can lead to damaged fallopian tubes and can also affect the ovaries, uterus and other reproductive organs. Proper treatment of these infections with appropriate antibiotics is critical to avoiding damage.

Pelvic Inflammatory Disease

Serious infection of the pelvis can cause tubal obstruction. Microorganisms, such as Chlamydia are common causes and it is very important that these infections be treated early with the appropriate antibiotics.

The fallopian tubes can also be scarred from previous surgeries and some women seek to have tubal sterilization procedures reversed. While surgical tubal reversal is sometimes possible, tubal ligation should be considered permanent. Realistically, in today’s culture with high divorce rates, the number of women seeking reversals has increased. The ability to reconnect the tubes depends largely upon where and how they were tied.

Rarely, women are born with absent or deformed tubes.

Some women chose tubal ligation as a means of birth control and seek to have the procedure reversed.

IVF avoids the tubes because the eggs are retrieved and fertilized in the laboratory. Even though the per cycle success rates for surgical connection are lower, some women choose surgery because there is no limit to how many cycles they may try.

The number of IVF cycles may be limited by cost. In the long run, however, it appears that the IVF is a better choice than tubal ligation.

IVF is often the treatment of first choice dependent upon several factors. In general, the per cycle success rates with IVF are much higher than those after tubal reanastamosis (reconnecting the tubes).
 

One consideration is how and where the tubes were tied. Oftentimes, the tubes are damaged when tied and scar tissue forms especially when procedures such as electrocautery were used. This greatly reduces the chances for success. Another consideration is the age of the female.

When the tubes can be reconnected, the per cycle success rate is approximately 10-15%. The advantage is that there is no limit to the number of natural intercourse cycles that can be attempted except for age. Fertility declines with age, sometimes very rapidly, and numerous natural attempts may not be possible. Cost is a limiting factor for the maximum number of IVF cycles.

IVF usually yields success rates in the 40% range depending on the cause(s) of infertility and the clinic. If tubal factor is the only cause, studies show that the chances of conceiving a baby with IVF are higher than tubal reanastamosis.

Our physicians make their treatment decisions after careful evaluation of each case and in depth discussions with each couple.

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