FERTILITY (BLOCKAGE OF THE TUBES)
Fallopian tubes are female reproductive organs that connect the ovaries and the uterus. Every month during ovulation, which occurs roughly in the middle of a menstrual cycle, the fallopian tubes carry an egg from an ovary to the uterus.
Conception also happens in the fallopian tube. If an egg is fertilized by sperm, it moves through the tube to the uterus for implantation.
If a fallopian tube is blocked, the passage for sperm to get to the eggs, as well as the path back to the uterus for the fertilized egg, is blocked. Common reasons for blocked fallopian tubes include scar tissue, infection, and pelvic adhesions.
When an obstruction prevents the egg from traveling down the tube, a woman is said to have a blocked fallopian tube (tubal factor infertility). This can occur on one or both sides and is the cause of infertility in a lot of women.
Women with blocked fallopian tubes usually do not experience any symptoms. Many women assume rather wrongly that since they are having regular periods, their fertility is fine, but that is not always the case.
Each month, when ovulation occurs, an egg is released from one of the ovaries. The egg travels through the tubes, and into the uterus. The sperm also swims from the cervix, through the uterus, and through the fallopian tubes to get to the egg. Fertilization usually takes place while the egg is traveling through the tube.
If one or both fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg. This prevents fertilization and pregnancy. It is also possible for the tube to be blocked only partially. This carries the risk of a tubal pregnancy, or ectopic pregnancy.
TYPES OF TUBAL DISEASE
- Hydrosalpinx:-
A condition in which the fallopian tubes are blocked at the end at the point where they meet the ovary. If both tubes get blocked this way, it becomes next to impossible to get pregnant without assistance
- Proximal tubal occlusion:-
The blockage of the fallopian tubes at the point where they connect to the uterus. Mucus plugs, fibroids, endometriosis, scarring or inflammation can cause this type of tubal disease.
- Salpingitis isthmica nodosa (SIN):-
This is one type that deserves special mention because it is one type proximal tubal disease that is not easily correctible. The cause of SIN is yet to be established. However, it is associated with endometriosis.
Tubal ligation or sterilization:-
If the tubes are blocked due to a prior sterilization procedure, the patient has two choices: tubal ligation reversal or IVF. The best candidates for tubal reversal surgery are women under 35 years old with normal ovarian reserve testing and a partner with a normal sperm count.
CAUSES OF BLOCKED FALLOPIAN TUBES
Fallopian tubes are usually blocked by scar tissue or pelvic adhesions.
These can be caused by many factors, including:
- Endometriosis:-
Endometrial tissue can build up in the fallopian tubes and cause a blockage. Secondly, endometrial tissue which forms on the outside of other organs can also cause adhesions that block the fallopian tubes.
- Previous ectopic pregnancy:-
This can certainly scar the fallopian tubes.
- Pelvic inflammatory disease:-
This disease can cause scarring or hydrosalpinx.
- Some sexually transmitted infections (STIs):-
Chlamydia and gonorrhea for example can cause scarring and possibly lead to pelvic inflammatory disease.
- Fibroids:-
Fibroid growths can block the fallopian tube, especially where they attach to the uterus.
- Previous abdominal surgery:-
Previous surgery, especially on the fallopian tubes themselves, can lead to pelvic adhesions that block the tubes.
SYMPTOMS OF BLOCKED FALLOPIAN TUBES
- Normally, blocked fallopian tubes would not cause symptoms. Most women would not know that heir tubes are blocked until they have problems with getting pregnant.
- In some instances, blocked fallopian tubes leads to mild, regular pain on one side of the abdomen. This usually happens in a type of blockage called a hydrosalpinx. This is when fluid fills and enlarges a blocked fallopian tube.
- The conditions that lead to a blocked fallopian tube can cause their own symptoms, endometriosis for example causes very painful and heavy periods and pelvic pain. It can increase one's risk for blocked fallopian tubes.
EFFECT ON FERTILITY
Blocked fallopian tubes happens to be a common cause of infertility. A blocked tube can prevent sperm and an egg from meeting and joining in the fallopian tube for fertilization.
Pregnancy without treatment will be impossible if both tubes are fully blocked, if the fallopian tubes are partially blocked, one could potentially get pregnant. However, the risk of an ectopic pregnancy increases. This is because it's harder for a fertilized egg to move through a blockage to the uterus. In these cases, in vitro fertilization (IVF) may be recommended, after considering all options and concluding that treatment is possible.
The blockage however most unlikely to affect fertility If only one fallopian tube is blocked, because an egg can still travel through the unaffected fallopian tube Fertility drugs can help increase chances of ovulating on the open side.
WHEN TO SEE A DOCTOR
When to seek help sometimes depends hugely on the age factor:
From puberty up to age 35, the recommendation is to try to get pregnant for at least a year before testing or treatment.
Women between 35 and 40, should discuss all concerns with their doctor after six months of trying.
Women beyond age 40, may need to begin testing or treatment right away.
Normally, a doctor may also want to begin testing or treatment right away if the partners have known fertility problems, or if one has a history of the following medical conditions; irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.
RISK FACTORS
Certain factors may put one at higher risk of infertility, including:
- Age:-
The quality and quantity of a woman's eggs naturally declines with increasing age. Women in their mid-30s will have the rate of follicle loss speeded up. This will result in fewer and poorer quality eggs which will in turn make conception more difficult secondly, it increases the risk of miscarriages.
- Alcohol:-
Stick to modest alcohol consumption rate. (E.g. no more than one alcoholic drink per day).
- Smoking:-
Smoking increases one's risk of miscarriage and ectopic pregnancy, besides damaging the cervix and fallopian tubes, it has also been found to affect the ovaries negatively and deplete a woman's eggs prematurely. Patients are advised to stop smoking before beginning fertility treatment.
Being significantly underweight or overweight may affect normal ovulation. Having a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
- Sexual preferences and history:-
Sexually transmitted infections (STIs) such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases the risk of a sexually transmitted infection which may cause fertility problems later.
DIAGNOSIS
Blocked tubes are usually diagnosed with a specialized x-ray called a Hysterosalpinogram, or HSG. This happens to be one of the basic fertility tests that is ordered for most couples that are struggling to conceive. It involves placing a dye through the cervix using a tiny tube. Once the dye is in place, x-rays of the pelvic area are taken.
If everything is normal, the dye will go through the uterus and fallopian tubes and spill out around the ovaries and into the pelvic cavity. If the dye doesn't get through the tubes, then the patient may have a blocked fallopian tube.
Other tests that may be ordered include blood test to check for the presence of chlamydia antibodies (which would imply previous or current infection), ultrasound, exploratory laparoscopic surgery, or hysteroscopy (in which a thin camera is placed through the cervix to look at the uterus).
COMPLICATIONS
Ectopic pregnancy is the most common complication of blocked fallopian tubes and its treatment. If a fallopian tube is partially blocked, an egg may be fertilized, it may however get stuck in the tube, resulting in an ectopic pregnancy, which is a medical emergency.
Another source of complication is surgery that removes part of the fallopian tube. This also increases the risk of ectopic pregnancy. Often times doctors recommend IVF instead of surgery for women with blocked fallopian tubes who are otherwise healthy, because of these risks.
TREATMENT
If the patient is healthy, and has one open tube, she might be able to get pregnant without much help. The doctor may recommend fertility drugs to increase the chances of ovulating on the side with the open tube. This however, cannot be an option, if both tubes are blocked.
- In Vitro Fertilization (IVF)
Before the invention of in-vitro fertilization (IVF), women with blocked tubes had no options to get pregnant if repair surgery didn't work or wasn't an option.
IVF treatment entails the taking of fertility drugs to stimulate the ovaries. Then, the doctor retrieves the eggs directly from the ovaries using an ultrasound-guided needle through the vaginal wall. The eggs are then put together with sperm from the male partner or a sperm donor in the lab. Some of the eggs fertilize resulting in embryos. One or two healthy embryos are chosen and transferred to the uterus.
The IVF procedure completely avoids the fallopian tubes, so that blockages do not matter. In cases of hydrosalpinx (fluid-filled tube), the doctor may recommend surgery to remove the tube. Then IVF can be tried, after the patient recovers from surgery.
- Laparoscopic Surgery
Laparoscopic surgery can be used to open blocked tubes or remove scar tissue in some cases. Unfortunately, the chances of success depends on how old the patient is, how bad and where the blockage is, as well as the cause of blockage. If it is only a few adhesions between the tubes and ovaries, the chances of getting pregnant after surgery are good.
A patient with a blocked tube that is otherwise healthy, has averagely a 20% to 40% chance of getting pregnant after surgery. The risk of ectopic pregnancy becomes higher after surgery to treat tubal blockage.
However, surgical procedure is not always the best option. Situations like the presence of significant scaring, moderate to severe endometriosis, may be better for IVF.
- Tubal Ligation Reversal
Commonly known as 'getting the tubes tied', tubal ligation surgery is a permanent form of birth control. There are different kinds of tubal ligation. They may include the surgeon cutting the tubes, banding them, clamping them, or placing specialized coils inside them. The intention is to block the fallopian tubes so the sperm does not reach the egg.
The good news is that even though this kind of birth control is considered permanent, it can be reversed for many women.
THE POSSIBILITY OF PREGNANCY
The chances for pregnancy will depend on the treatment method and severity of the blockage, but it is possible to get pregnant after treatment for blocked fallopian tubes.
When the blockage is near the uterus, a successful pregnancy is more likely. Rates of success are lower if the blockage is at the end of the fallopian tube near the ovary.
Depending on how much of the tube must be removed and what part is removed, the chances of getting pregnant after surgery for tubes damaged by an infection or ectopic pregnancy is rather small.
FALLOPIAN TUBE PROBLEMS
Problems with the fallopian tubes also account for a huge chunk of infertility cases. Sometimes, the tubes may be blocked or they may be scarred as a result of disease or infection.
When an egg is released from the ovaries, it travels through the fallopian tubes, which are narrow ducts that connect the ovaries to the uterus. Normally, the egg will join with the sperm in the fallopian tubes during conception and the now-fertilized egg will continue on to the uterus. However, the fallopian tubes are fragile to the extent that there's no way for the egg to become fertilized by the sperm if they are blocked.
Diseases such as endometriosis, pelvic inflammatory disease, infections and some sexually transmitted diseases can damage the fallopian tubes.
GETTING PREGNANT WITH FALLOPIAN TUBE PROBLEMS
The doctor may suggest a laparoscopy or a Hysterosalpinogram (HSG) to determine whether the fallopian tubes are blocked or not. In this test, liquid dye is inserted by catheter through the vagina (cervix) into the uterus. X-rays are subsequently taken to see if the dye flows freely into the abdomen or if there is a blockage. There is yet another method of HSG, which can be done with ultrasound instead of X-ray and that uses saline and air or foam.
If the patient is ovulating normally, the doctor might also consider employing assisted reproduction techniques that may bypass the fallopian tubes entirely. These may include;
- intracytoplasmic sperm injection (ICSI),
- artificial insemination directly into the uterus (IUI) and
- In vitro fertilization (IVF).
PREVENTION
The following tips may help optimize fertility for women who are planning to get pregnant soon or in the future;
- Avoid alcohol:-
The use of alcohol may lead to decreased fertility, any alcohol use can affect the health of a developing fetus. Women should avoid alcohol, if they plan to become pregnant, and should not drink alcohol while they are pregnant.
- Limit caffeine:-
Research suggests that caffeine intake of less than 200 milligrams a day would not affect the ability to get pregnant.
- Maintain a normal weight:-
Overweight and underweight women are at increased risk of ovulation disorders. However, one will need to exercise moderately should the need to lose weight arise. This is because strenuous, intense exercise of more than five hours a week has the propensity to decrease ovulation.
- Quit smoking and tobacco use:-
Tobacco has multiple negative effects on fertility, not to mention general health and the health of a fetus.
- Reduce stress:-
Many studies have shown that couples that experience psychological stress had poor results with treatment of infertility. People should, find a way to reduce stress before and during the effort to become pregnant.
- Regular checks for STIs:-
A huge percentage of blocked fallopian tube cases are caused by pelvic infections. Most of these infections are caused by sexually transmitted infections. Therefore, regular screening for STIs, as well as getting worrisome symptoms checked out right away, is an important step in preventing tubal infertility.
However it is important to note that most infections are not acute, and rarely result in any signs or symptoms. Being 'quiet' does not mean they are harmless. If the infection persists for long, the risk of scar tissue forming and creating inflamed or blocked tubes becomes higher. Once an infection has been detected, quick antibiotic treatment is important. Treating the infection doesn't guarantee the tubes will be clear. The antibiotics can only kill the bacteria but treating the disease can help prevent further damage, and may make fertility treatment or later surgical repair more likely to succeed.
