Blocked Fallopian Tubes and Tubal Factor Infertility
Blocked fallopian tubes and tubal factor infertility at a glance
- The fallopian tubes must be open and undamaged to allow the sperm to fertilize an egg and the resulting embryo to be transported to the uterus for pregnancy.
- Tubal factor infertility is the result of scarring, blockage or dilation (hydrosalpix) of the fallopian tube, which can be caused by pelvic surgery, endometriosis or pelvic infections, in particular, pelvic inflammatory disease (PID).
- A hysterosalpingogram (HSG) is the most common way to evaluate the fallopian tubes, which can also be evaluated by a specialized ultrasound (Fem-Vue procedure) or occasionally at the time of laparoscopy.
- Women with tubal factor infertility that cannot be surgically corrected may undergo in vitro fertilization (IVF) for fertility treatment.
- Tubal damage is associated with an increased risk of tubal, or ectopic pregnancy.
What is tubal factor infertility?
The two fallopian tubes are delicate structures that allow for transit between the uterus and the ovary. The fallopian tube allows the sperm to swim from the uterus toward the egg, while the distal end of the fallopian tube (the fimbria) picks up the ovulated egg. Fertilization can then occur in the fallopian tube, which uses its cilia (tiny hair like structures) to sweep the resulting embryo to the uterus.
At least one tube must be clear to allow the sperm to fertilize an egg and the resulting embryo to be transported to the uterus. If the fallopian tube is blocked, scarred or distorted, the egg and sperm cannot combine. Additionally, a partially blocked or damaged fallopian tube may allow the sperm to reach the egg for fertilization but not be able to transport the resulting embryo to the uterus. This can result in an ectopic, or tubal pregnancy, which can be life threatening.
According to the American Society for Reproductive Medicine (ASRM), 25 to 35 percent of female infertility cases are caused by problems with the fallopian tubes. Tubal damage is particularly suspect in women with regular, ovulatory menstrual cycles and a partner with normal sperm.
A tubal blockage is typically categorized by its location.
- Proximal tubal blockage: Located close to the uterus. This can be the result of tubal spasm or a mucous plug. However, it may be due to complete scarring to the proximal tube.
- Mid-segment tubal blockage: When the middle of the fallopian tube is damaged or scarred, it is known as a mid-segment blockage. This is typically caused by tubal ligation or the reversal of a tubal ligation.
Distal tubal blockage: Located toward the end of the tube, a distal tubal blockage causes the fallopian tube to be partially or entirely blocked. This blockage involves the fibria (finger-like projections of the tube). A blocked distal tube frequently dilates and accumulates toxic fluid (hydrosalpinx).
Causes of blocked fallopian tubes
Tubal factor infertility is often caused by a pelvic infection such as gonorrhea, chlamydia or resultant pelvic inflammatory disease. Endometriosis, which causes tissue that normally lines the uterus to grow outside of the uterus, can damage or occasionally cause a block in fallopian tubes.
Damaged fallopian tubes can also be caused by prior pelvic or abdominal surgery, including for ectopic pregnancy or a ruptured appendix. The location of these surgeries increases the risks of tubal damage.
Symptoms and diagnosing tubal factor infertility
Many women suffering from tubal factor infertility may experience no symptoms other than the inability to get pregnant. Some women may experience lower abdominal pain in addition to infertility.
Because the fallopian tubes and uterus are soft tissues, they cannot be seen on a standard X-ray. Fallopian tubes can only be seen on ultrasound when they are dilated or full of fluid. Identifying blocked or damaged fallopian tubes can be done with a hysterosalpingogram Fem-Vue procedure or laparoscopy.
A hysterosalpingogram (HSG) is the most common way to evaluate the fallopian tubes. A small amount of X-ray contrast dye is injected into the uterine cavity to outline the cavity of the uterus and tubes. An expert can tell from the resulting image if there is an abnormality within the uterus and if the fallopian tubes look normal and clear.
While an HSG is an excellent technique to diagnose problems with the uterus or fallopian tubes, it does not reveal anything about the ovaries – which are also soft tissue – or how they are working in relation to the fallopian tubes.
If the extent of tubal damage cannot be clearly determined by HSG, a laparoscopy may be recommended. This minimally invasive surgery utilizes a laparoscope inserted through a small incision below the belly button to view the fallopian tubes.
Treatment of blocked fallopian tubes and tubal factor infertility
Damage to the fallopian tube usually results in damage to the cilia. While surgery can open some blockages of the fallopian tubes, it cannot repair the cilia. For this reason, surgical repair can only be considered if the damage to the tube is minor.
Any time a fallopian tube is operated on there is the risk of increased scarring. Tubal surgery also increases the risk for ectopic pregnancy. If the damage to the tube is significant, pregnancy will likely only be achieved through reproductive technologies such as IVF.
Repairing a tube may be done multiple ways, including:
- If an imaging test has shown that a woman has a proximal tubal blockage, a tubal cannulation may be performed. This outpatient procedure involves inserting a catheter guided by a wire into the fallopian tube and inflating a balloon to unblock the tube. This will only be successful if the blockage is due to spasm or a mucous plug. Cannulation cannot resolve proximal tubal scarring.
- A laparoscopic procedure known as a frimbrioplasty attempts to repair scarred fimbria. A frimbrioplasty should only be considered for minimal distal tubal blockage.
- Removing the fallopian tube entirely because of the damage or disease is referred to as a salpingectomy. This may be used to treat hydrosalpinx.
- A salpingostomy can save the fallopian tube, while surgically creating a new opening in the tube. This is often used to remove an ectopic pregnancy.
As surgical repair is only of limited benefit and should only be considered with minimal tubal damage, IVF is frequently recommended to treat tubal infertility. This treatment for tubal factor infertility has a high rate of success.
Fertility outlook after blocked fallopian tube treatment
When choosing between surgery to correct tubal factor infertility or IVF, there are several factors that should be taken into account. These include the mother’s age and ovarian reserve, the extent of the tubal damage, other infertility factors, the number of children desired and prior fertility outcomes.
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There are risks and benefits with both IVF and surgical treatment options. Understanding and discussing those risks and benefits with a fertility specialist can help patients make the right choice for them when it comes to tubal factor infertility.