TUBAL PROBLEMS

TUBAL FACTOR INFERTILITY TREATMENT & CARE AT JFC

In a normal pregnancy, an ovary releases an egg into the Fallopian Tube (fallopian tubes on either side of the Uterus connect the ovaries to the Uterus) where it meets with a sperm that fertilizes the egg, following which the fertilized egg travels to the Uterus and attaches itself to the Uterine lining for nine months. On the other hand, when the Fallopian tubes prevents the sperm from reaching the ovary to fertilize an egg or prevents a fertilized embryo from reaching the Uterus for pregnancy, then you’re suffering from a condition called Tubal factor infertility.

HOW IS TUBAL BLOCKAGE CAUSED & IDENTIFIED?

The most common causes of Tubal factor infertility include:

• Previous surgery effects.
• Endometriosis, a disease in which the tissue that normally lines the uterus grows outside it.
• Pelvic Inflammatory Disease (PID) – an infection of the female reproductive organs.
• Sexually transmitted disease (STD), most commonly chlamydia and gonorrhea.
• Ectopic Pregnancy effects.

A Tubal blockage is identified in the following cases:

• When it’s located close to the Uterus, the condition is called a Proximity Tubal blockage (it affects 10 to 25% of tubal disease and is generally an easy condition to treat).
• When the middle of the Fallopian Tube is damaged of scarred, as a result of permanent sterilisation (Tubal Ligation) OR the reversal of that sterilisation (Tubal Ligation Reversal).
• When a blockage is located further from the Uterus (a condition that is called Distal Tubal Blockage). Further a fallopian tube can be completely blocked or partially blocked or narrowed due to scarring which can cause problems getting pregnant.
• When there is damage to Fimbria (finger-like fringes of tissue that help to sweep an unfertilized egg into the fallopian tube). This can prevent the egg from travelling from the ovary into the fallopian tubes.

Patients have a high risk of tubal factor infertility if they’ve had a ruptured appendix or previous abdominal surgeries, including surgeries for ectopic pregnancies, a condition in which the embryo grows outside of the uterus. Due to the location of these conditions, tubal issues are more likely to occur.

SYMPTOMS / DIAGNOSIS OF TUBAL FACTOR INFERTILITY

Symptoms include:

• Inability to become pregnant.
• Damage to the Fallopian Tube.
• Infertility accompanied by signs of pelvic inflammatory disease like chronic lower abdominal pain.

Diagnosis includes:

• HYSTEROSALPINGOGRAM (HSG): An X-ray wherein a dye is passed through the cervix into the Uterus; the dye can be seen and followed through the fallopian tubes to see if they are open or not. In case the tubes are open, then it means that there could be extreme scarring or blockage inside the tube’s lining that cannot be detected with this kind of diagnosis.
• LAPAROSCOPY: A minimally invasive surgical procedure involving a small incision just below the belly-button through insertion of a small surgical instrument, called a laparoscope that allows for viewing of the fallopian tubes. The Laparoscope helps to determine whether or not the tubes are blocked or if there are other issues like Scar Tissue adhesions.

TREATMENT OF TUBAL FACTOR INFERTILITY

There are two main treatments for Tubal Factor Infertility, one is surgical and the other is non-surgical. In case the two fail, then there is IVF that can used to achieve pregnancy.

Ways to repair a tube include:

• TUBAL CANNULATION: It involves insertion of a catheter guided by a wire and attached to a balloon into the fallopian tubes in order to unblock them. An outpatient procedure, it should be performed only if an imaging test shows a proximal blockage in one or both fallopian tubes.
• FIMBRIOPLASTY: It involves rebuilding of the fimbriae, or finger-like ends of the fallopian tube, by sewing the fimbriae back together. This option should be resorted to only for patients with minimal distal tubal blockage.
• SALPINGECTOMY: It involves the surgical removal of the damaged or diseased fallopian tube.
• SALPINGOSTOMY: It involves the surgical creation of an opening into the fallopian tube, often to remove an ectopic pregnancy. However, the tube itself is not removed in the procedure.

TUBAL FACTOR INFERTILITY TREATMENT CONSIDERATIONS

Before going ahead with the decision, the advantages and disadvantages of IVF and tubal surgery should be reviewed with the patient to arrive at the appropriate choice.

Coming to IVF, its main advantages of IVF are good per-cycle success rates and it is less surgically invasive. On the other hand, its disadvantages include cost (especially if more than one cycle is required) and the need for frequent hormone injections and monitoring for several weeks.

Likewise with Tubal surgery, there is the risk of scar tissue and adhesions and also the chance of recurrent blocked tubes after surgery, pelvic infection or an ectopic pregnancy. However, the chances of conceiving naturally after surgery is greater if the patient is young and has a minimal amount of scar tissue blocking the fallopian tubes.

Further, certain patient factors also need to be taken into consideration like:

• Age.
• Ovarian reserve (the number of eggs the patient has).
• Prior fertility outcomes.
• Number of children desired.
• Site and extent of tubal damage.
• Presence of other infertility factors.
• Experience of the surgeon performing the procedure.

In addition, other factors that need to be taken into consideration include patient’s preference, patient’s religious beliefs and the cost and insurance of the treatment procedure.

To decide between the two, if it comes to that, a semen analysis can be performed in the infertility investigation, as these results may influence the decision between tubal surgery and IVF.

LAPAROSCOPY & DYE TEST

It’s an operation to help find out why the woman is having difficulty becoming pregnant. The dye test will expose as to whether the fallopian tubes are blocked or not. Likewise Laparoscopy helps to find out whether if the woman has Endometriosis, pelvic infection, adhesions, ovarian cysts or fibroids.

A laparoscopy and dye test helps to find out the cause of infertility, particularly if the fallopian tubes are blocked. Some minor treatments can be performed at the same time.

A laparoscopy and dye test can help the doctor at JFC find out the cause of your infertility.

Under a Laparoscopy and Dye test (usually performed under a general anesthesia), the Gynecologist will

• Make several small cuts on the abdomen.
• Place surgical instruments, along with a telescope, inside the woman’s abdomen and perform the operation
• Inject a dye, which passes through the cervix, uterine cavity and down the fallopian tubes.

The whole of the surgical operation usually takes about fifteen minutes.

Coming to recovery part, the patient would be able to go home the same day or the day after. Before that, a member of the team at JFC will tell you about the results of the laparoscopy and dye test and then discuss the possibilities of any treatment or follow-up to be taken.