BLOCKED FALLOPIAN TUBES: WHAT NEXT ?

We have been trying for a year, yet have not conceived. How can the fallopian tubes affect fertility? I have already undergone tubal ligation. Can I conceive again?                                              I have history of ectopic pregnancies. Are my fallopian tubes healthy?                                                If you are clouded by these questions, it is time to consult your fertility specialist for better guidance.

Let us acquaint ourselves to how important these thin, delicate fallopian tubes are.                                 The fallopian tubes play a very crucial role in establishing a pregnancy. It is the passageway for the egg and the sperm, wherein the fertilization first occurs. During ovulation, the released egg is picked up by the fimbriae (finger-like projections at the end of the tube) and is then directed towards the tube to meet the sperm. The fallopian tubes help nourish initial embryo development.

Tubal factor infertility accounts for almost 25% of all factors. Any disturbance in the tubal anatomy hampers the union of the egg and the sperm. The block or occlusion can be either proximal or distal. Proximal tubal block prevents the sperms from reaching the site of fertilization. Distal tubal block or adhesions interfere with the egg pick-up by the fimbriae from the adjacent ovary. This can also lead to a condition called the “hydrosalpinx”, wherein the tube gets distended with fluid. This impairs fertility rates by affecting implantation of embryos too.

What exactly leads to blocked fallopian tubes?

• Prior history of any pelvic infections. Sexually transmitted infections affect tubal motility.
• Tuberculosis, one of the most common causes of tubal block in India. Most of the women are caught unawares when they cannot conceive naturally.
• Any tubal /abdominal surgeries can distort the tubal anatomy and cause adhesion formation, i.e cause the organs to abnormally stick to one another.
• Past history of any ectopic pregnancy (pregnancy in the tube) impairs the normal functioning of the tube. So, damaged tubes can be partially open, which can lead to recurrent ectopic pregnancies.

How do we diagnose this?

After a year long struggle of infertility, we usually recommend our patients to investigate the possibility of blocked tubes. Certain tests help us detect the block:

• HSG (Hysterosalpingogram)-  An X-ray test which uses a contrasting dye to rule out an obstruction. Inserted through a thin tube into the uterus, this test takes around 10-15minutes of your time.
• Sonohystero-salpingogram- This test can be done alternatively to an HSG. It has the advantage of diagnosing a hydrosalpinx and uterine fibroids as well.
• Laparoscopy- The ultimate gold standard test to detect a blocked fallopian tube. This technique has the advantage of an overall visual inspection of the pelvic cavity and correction of any block at the same time.

Treatment of blocked fallopian tubes:

Modern fertility treatment has surpassed the technique of tubal reconstructive surgeries. Though these surgeries are a legitimate option too, the improved success rates with ART techniques make IVF a sensible and an easier option. In case of hydrosalpinx, clipping of the tube prior to an IVF cycle is mandatory in order to avoid embryo implantation failures.

Thus, IVF is the best choice and the recommended course to achieve pregnancy post blocked tubes.