Tubal Factor Infertility
Introduction: For pregnancy to occur, every part of the complex human reproduction process has to take place just right. The steps in this process are as follows:
- One of the two ovaries releases a mature egg.
- The egg is picked up by the fallopian tube.
- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
- The fertilized egg travels down the fallopian tube to the uterus.
- The fertilized egg implants and grows in the uterus.
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of these factors.
The fallopian tube is an active, muscular organ that retrieves the egg from the ovary and coaxes it toward the oncoming sperm. If adhesions restrict the tube’s mobility or if infection has stripped the tiny cilia from the tubal lining the tube cannot perform its vital job.
Tubal factor infertility accounts for a large portion of female factor infertility. When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
- Pelvic inflammatory disease (most prevalent), an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
- Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of the uterus
- Pelvic tuberculosis, a major cause of tubal infertility worldwide
Diagnosis: The diagnosis of tubal occlusion can be established by a combination of clinical suspicion based on patient history and diagnostic tests, such as hysterosalpingogram (HSG)(gold standard), sonohysterosalpingography, and laparoscopy with chromopertubation. During HSG, (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to determine if the uterine cavity is normal and whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you’ll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
Treatment: Depending on the nature and degree of tubal dysfunction as well as the age and ovarian reserve of the patient, various treatments for tubal infertility are available. For proximal tubal obstruction, transcervical tubal cannulation with tubal flushing is a reasonable first approach. Surgical techniques for tubal repair, such as salpingostomy or fimbrioplasty for distal tubal obstruction, can provide good results. The key to successful fertility surgery is minimizing the damage from infection, from the organs drying out, and from bleeding.
- Avoid using tobacco (cigarettes) and marijuana. They reduce fertility, especially by reducing sperm counts.
- Avoid exposure to harmful chemicals.
- Avoid excessive alcohol use. It may damage eggs or sperm.
- Limit sex partners and use condoms to reduce the risk of getting sexually transmitted infection (STI). Untreated STIs can damage the reproductive system and cause infertility. If you think you may have an STI, get treatment promptly to reduce the risk of damage to your reproductive system.
- Stay at a body weight that is close to the ideal for your height. It will reduce the possibility of hormone imbalances. This is very important for men as well as for women.