Tubal Factor
[1] Damaged fallopian tubes are the cause of infertility in up to 25 percent of infertile women. The incidence of tubal damage is increasing, partially due to the frequency of sexually transmitted diseases in our society. The good news is that many women with tubal damage can achieve pregnancy through the use of modern techniques. Advances in reproductive medicine such as surgical treatment and in vitro fertilization (IVF) now make pregnancy an achievable goal for many women with tubal damage.
Tubal damage can result from tubal ligation (tubal sterilization) for contraceptive purposes, tubal infection, or scarring. There are two types of tubal blockage: proximal tubal blockage is located close to the uterus and distal tubal blockage is located away from the uterus. Proximal blockage can be caused by previous pelvic infection, a thickening and inflammation of the tubal wall, mucus plugs or endometriosis. Distal tubal blockage is generally caused by pelvic inflammation which may be secondary to infection or endometriosis. Scar tissue may also be present in women who have undergone previous abdominal or pelvic surgery.
Because tubal factor infertility is a common problem, tests to determine if the tubes are open and undamaged are an important part of the infertility work-up. Most physicians rely on two tests, a hysterosalpingogram (HSG) and a diagnostic laparoscopy. Both tests help physicians to determine the location and severity of tubal damage.
Infertility caused by blocked or damaged tubes can usually be treated with surgery or assisted reproductive techniques such as In Vitro Fertilization (IVF).
IVF bypasses the tubes altogether. This technique is often preferable to surgery when the tubal damage is more advanced or when a previous surgical approach has been unsuccessful. The woman is given ovulation-inducing drugs to produce multiple eggs, which are collected by a fine needle placed through the top of the vagina. After retrieval, the mature eggs are mixed with sperm in a petri dish. Depending on various factors, fertilization occurs about 60-90 percent of the time in the lab. The resulting embryos are carefully incubated for one to three days and then placed into the woman's uterus via a procedure known as embryo transfer.
Infertility due to damaged fallopian tubes is common. Fortunately, when the tubal damage is mild to moderate, modern surgical techniques can often help to achieve pregnancy. Some tubal surgeries are now being performed as outpatient procedures through the laparascope, thus minimizing recovery time and expense. For women with severe or surgically uncorrectable tubal disease, in vitro fertilization offers a chance of achieving pregnancy. For women who have had tubal ligations, microscopic tubal reversal frequently results in acceptable pregnancy rates. Although women with infertility due to tubal factors once had a poor prognosis, today they have a good chance of experiencing the joys of parenthood.
