TUBES AND INFERTILITY

The Fallopian tubes are ‘pipe like’ structures on either side of the uterus which connect the inside of the uterus to the surface of the ovaries. Eggs released from the ovary are travel into the tubes at the time of ovulation. When a woman has sexual intercourse, the sperms travel from the vagina to the uterus and then to the tubes. If this happens close to the time of ovulation, one of the many sperms can ‘fertilise’ the egg leading to a pregnancy. This pregnancy then travels to the uterus and gets attached to the wall of the uterus and grows there.

TUBES AND INFERTILITY

Since the tubes have a vital role in conception, damage to the tubes or a block in the tubes can cause infertility. Tubal damage can cause the pregnancy from moving normally to the uterus and to abnormally grow inside the tube – this is called an ‘ectopic pregnancy’.

WHAT CAUSES DAMAGE TO THE TUBES?

The most common cause for tubal damage is infection. Tubal damage can be caused by sexually transmitted infections like Chlamydia and Gonorrhoea. Infections like tuberculosis can cause severe damage to the tubes. Appendicitis or infection from other pelvic organs can also cause tubal damage.
Using a surgical technique to ‘cut and separate the tubes’ is a method of permanent contraception (sterilisation). This needs to be reversed if a woman desires to conceive.
Scarring of the tubes can happen due to endometriosis, a previous tubal pregnancy and surgery to the tubes.
A rare condition called ‘salpingitis isthmica nodosa’ can cause blockage of the tube and prevent its normal functioning.

HOW IS TUBAL DAMAGE DIAGNOSED?

Most doctors rely on three tests to assess the functioning of the tubes: a hysterosapingogram (HSG), a hysterosalpingo contrast sonography (HyCoSy) and a diagnostic laparoscopy.
A hysterosalpingogram is an x-ray study in which a liquid, dye-like solution is injected through the cervix to assess the inside shape of the uterus and fallopian tubes. This procedure is performed before ovulation to avoid x-ray exposure to a fertilized egg. An HSG is performed while the patient is awake and causes moderate cramping. Using the HSG, your doctor may be able to tell whether the tubes are open or damaged, and whether the uterine cavity is normal.
A hystero contrast salpingography is similar to a HSG, but ultrasound is used instead of x-ray to assess the tubes. Diagnostic laparoscopy is considered the ‘gold standard test’ as it can determine the patency and the outer condition of the tubes as well as the cause of tubal damage. This procedure is performed under general anaesthesia. The doctor inserts a laparoscope – which is a long, thin, telescope through an incision in the navel (belly button) into the abdominal cavity. Other small incisions in the abdomen may be made to insert various instruments to aid visualization of the fallopian tubes, ovaries, and other pelvic contents. Laparoscopy is usually combined with hysteroscopy – a procedure where a very thin telescope like instrument is put through the cervix into the cavity of the uterus to assess it.
A dye is flushed into the uterus up through the tubes to determine if they are open. A problem which is diagnosed during laparoscopy is usually treated at the same sitting, which is a major advantage compared to the other tests.

HOW IS TUBAL FACTOR INFERTILITY TREATED?

Damage to the tubes can sometimes be corrected by surgery. This is not always possible and depends on the cause of the damage and the extent to which the damage has occurred.
A block to the tube at the point of attachment to the uterus can be corrected by a procedure called as trans-cervical cannulation, which is done at the time of a hysterolaparoscopy.
If the tubes are damaged because of a sterilisation operation, they can be ‘re-connected’ by a surgery called as ‘microtubal re-anastomosis’. If there are adhesions to the tube or in certain other cases of tubal damage, microsurgical procedures can be used to correct this.
Most of these surgeries were historically performed by an open surgery, but are now performed laparoscopically – giving both good success rates and early recovery

IVF FOR TUBAL FACTOR INFERTILITY

In many cases, damage to the tubes cannot be treated by medicines or by surgery because of the extensive nature or severity of the disease. In such situations, the best option is IVF – where medications are given to stimulate egg growth, the eggs are collected under anaesthesia and fertilised with the man’s sperms. The resulting embryos are then put back in the uterus.