I am Dr. Shubhada Sanjiv Khandeparkar, Gynaecologist. Today I am going to take further the topic infertility. The investigations in infertility. Now I am going to discuss the tubal factors in an infertile ladies. Now 30-40% infertility happens because of tubal factors. By the side of the uterus, there are 2 tubes known as fallopian tubes. Generally, tubes get blocked and the eggs which come out from the ovaries and sperm enters to form the embryo. Now embryo slides off and comes into the uterus implants and grows into the uterus. If the tube is blocked, sperm and eggs cannot meet and therefore, infertility happening. Causes are endometriosis and infection. The common infection we are seeing are tuberculosis which is very common in our country, STDs, pelvic inflammatory disease because of repeated white discharge. Another infection can be because of severe abdominal infection. The middle region of the tube can get affected and blocked because of scarring.
The digital end of the tube again has a significant role to play and that gets affected or blocked because of TB. In TB fluids start getting collected inside which we call hydrosalpinx and both the tubes get blocked. So, you see that TB is a very important cause in our country for tubal blockage. How do we diagnose the tubal blockage? One more important cause is an ectopic pregnancy. What is it? The formed embryo sometimes failed to slide into the uterus and gets implanted in the tube. Now the tube is very small and thin and it cannot sustain the growth of the embryo and it ruptures and that is called an ectopic pregnancy. In such cases, we have to diagnose tubal factors. How do we diagnose the tubal factor?
There are 3 ways for diagnosing. The first common way was by x-ray which is called hysterosalpingogram (HSG). In HSG, what we do? We push a small instrument from the mouth of the uterus and it goes inside and come out through the tubes and tells us that the tube is open. This is a quite painful procedure and we have to depend upon the radiologist and x-ray machines. A better modality has also been discovered which is known as sonosalpingography. Now, this can be done without anesthesia. We definitely require a sonography machine and we take the patient in OT and we push the normal instrument in the mouth of the uterus. That is also a very good way to know the tubal patency. The gold standard is a laparoscopy. Now, this is a surgical procedure and you need special training, setup and OT and general anesthesia. At the belly button, we make a small incision which is about 1 cm.
We enter through the scope and a camera is being attached to it. Then we see the picture on the monitor to see entire internal organs. Now laparoscopy helps us to see the uterus, tubes. Its relationship with the tubes and the ovaries whether there are any editions around. We can get the entire genital information about the internal organs. This is a gold standard. Suppose there are editions or endometriosis, we can treat at the same time. through the laparoscope. It helps in diagnosis and the treatment. So, proper training is required to perform laparoscopy. So, today we have covered the common cause of the tubal blockage. This is extremely important for the infertile lady to have the tubes open if they are blocked. The only treatment for her IVF and ICSI where tubes are not required to be patent. And in this case, she has to go for it. So, a determination is extremely important in an infertile couple. So, if you have any query, you can contact me through Lybrate.