Infertility & Tubal Block - Understanding The Connection!

The fallopian tubes are not mere passages for the egg to travel from the ovaries to the uterus, It is here that fertilization of egg occurs and hence healthy fallopian tubes are essential for conception.

Damaged fallopian tubes is one of the common causes of infertility. This damage can fall under three categories.

1. Both fallopian tubes blocked

2. One blocked and one fallopian tube open

3. Tubal scarring / adhesions/ hydrosalpinx/ pyosalpinx (fluid or pus collection in tubes).

The third is usually an effect of pelvic infections or endometriosis or effect of tubal surgery. Sadly, in most cases, this condition is discovered only after fertility issues occur. Other causes of fallopian tubal scarring/ adhesions include:

1. STDs such as chlamydia trachomatis and neisseria gonorrhoea

2. Adhesions caused by ruptured/unruptured ovarian cysts

3. Endometriosis

4. Previous ectopic pregnancies

Fallopian tubal scarring/block has no recognizable symptoms. Chronic pelvic pain is the only known symptom and that too can be seen only in severe cases. On diagnosing infertility, your doctor will perform one of following tests to determine the patency of your fallopian tubes.

1. Sonosalpingogram (SSG) or Hysterosalpingogram(HSG): This is a type of doppler sonography or X ray respectively, where normal saline (SSG) or radio-opaque dye(HSG) is injected into the uterus with the help of a catheter or cannula. If the liquid does not pass through the fallopian tubes, it is said to be blocked. If spill is seen on both sides, tubal patency is confirmed. This however, does not say much about tubal scarring.

2. Laparoscopy: If SSG or HSG shows tubal block, it needs to be confirmed with laparoscopy, which is considered the gold standard for dignosing tubal pathologies. A small incision is made near belly button and a telescope is passed through the incision. This gives a clear view of genital organs including uterus, tubes and ovaries. A laparoscopy can also be used to rule out other causes of infertility such as endometriosis. These pathologies can also be corrected in laparoscopy in same sitting.

Treatment for infertility caused by tubal block is of two types:

1. Surgery: This is suggested in cases where tubal recanalization or creating new tubal openings or tubal anastomosis is possible.

2. In Vitro Fertilization (IVF): Women with dense tubal blocks usually have poor chances of conceiving naturally. Hence, IVF is the preferred treatment mode. However, your doctor may still advise you to undergo surgery in case of hydrosalpinx or pyosalpinx, and remove the damaged tubes prior to IVF to prevent the adverse effects of fluid/pus on IVF outcome.