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Surgical Treatment Options for Tubal Disease

Tubal disease is a fairly common cause of infertility, according to the American Society for Reproductive Medicine. The ASRM reports tubal disease accounts for up to 35% of all infertility cases. When a woman experiences tubal disease, it’s often undiagnosed until fertility becomes an issue. At that point the cause of an inability to become pregnant naturally is discovered to be blocked fallopian tubes, caused by tubal disease.

The Role of Fallopian Tubes in Conception

In order to understand how tubal disease impacts the ability to conceive a child, you need to understand how your fallopian tubes aid in conception. The fallopian tubes are muscular tubes that carry the mature egg from the ovaries to the uterus. The tubes are lined with hair-like fibers that move the egg down to the uterus, and also move the sperm up to the egg. When fertilization occurs, the fallopian tube moves the fertilized egg to the uterus where the now-embryo will continue to grow and develop.

When your tubes are blocked, due to tubal disease that has caused scar tissue, through an infection, or previous surgery, it creates an impediment that can result in infertility. In some instances, a fertilized egg can’t travel to the uterus, and results in an ectopic pregnancy, a painful and dangerous condition. Tubal disease is considered any condition resulting in blocked, or damaged, fallopian tubes.

Common Causes of Tubal Disease

Your fallopian tubes can become blocked, or damaged, for a few different reasons, and the location of the blockage determines treatment. Here are some common reasons for tubal disease and blockage:

  • Scar Tissue: Scar tissue can form in or on the fallopian tubes as a result of endometriosis, cesarean section birth, gynecological surgeries and procedures, bowel surgery, ruptured appendix, or internal trauma to the pelvic region.
  • Sexually Transmitted Disease:Left undiagnosed, or untreated, certain STDs can cause pelvic inflammatory disease (PID), which can impair the function of your tubes. Chlamydia and gonorrhea are common STDs that cause PID.
  • Tubal Ligation:Tubal ligation, or having your tubes “tied” is a common method of birth control. The fallopian tubes are cut, or tied, blocking the way for an egg to become fertilized. In some cases women opt to reverse their tubal ligation, in hope of becoming pregnant.

Diagnosis of Tubal Disease

Tubal disease is diagnosed using hysterosalpingogram (HSG). This is a test in which dye is injected through the vagina into the cervix, and along the path to the uterus. X-rays are used to determine the viability of your uterus and fallopian tubes, insofar as conception and pregnancy. The test is performed either while you’re on birth control, or immediately after your period, before you ovulate, so it will not disrupt a potential pregnancy, although this is extremely rare.

Treatment for Tubal Disease

If the HSG comes back with results pointing to a blocked tube, then there are a few options to help you become pregnant. Depending on the location of the blockage, the most successful treatment for your tubal disease infertility may be IVF.

Blocked tubes at the connection to the uterus is called a proximal block. In this case many women opt for hysteroscopic tubal cannulation. Using a cannula, a balloon is inserted into the tube and inflated to open it up. In women under 35, the success rate for this procedure is 40%-50%.

A mid-tubal blockage is a rare occurrence. The fallopian tube shows a blockage at the mid-point usually as a result of a severe infection, a tubal ligation, endometriosis, or pelvic tuberculosis. If the tubes are badly damaged, swollen, or obviously diseased, repair is not recommended, and the tube will be removed.

For those who have a distal blockage, at the end of the tube, it’s possible to treat the blockage. Tubal disease in this location is usually the result of adhesions, caused by a prior pelvic infection. When the adhesions are outside of the tube, a laparoscopy procedure is highly successful.

When the adhesions are located inside of the tubes, the tuboplasty procedure is less successful, and the tubes frequently get blocked again, requiring additional surgery, and possibly removal of your tubes. This type of blockage also carries a higher risk of ectopic pregnancy.

If you have hydrosalpinx, a condition that causes fluid to fill the blocked portion of the tube, near the ovary, then it is necessary to remove the afflicted tube. This is to prevent infection, which could affect the uterine cavity, and further impair pregnancy, or cause miscarriage. Removal of the afflicted tubes will also help the success of your IVF treatment.

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