Infertility, related to tubal factors, is common in more than 1/3 of all cases. The two fallopian tubes provide the pathway for the egg to travel to the uterus, once it’s been released from the ovary. When the egg is prevented from traveling through the tube, due to a blockage within the fallopian tube, this is known as tubal factor infertility.
In some cases tubal factor infertility effects just one of the tubes, making it difficult for you to become pregnant. When both tubes are blocked, it can make it impossible for you to become pregnant without medical intervention. In cases where both tubes are severely damaged, or diseased, IVF is the only sure course to take in order to become pregnant.
Causes of Tubal Factor Infertility
There are several events and conditions which can result in a blockage of the fallopian tubes. By far, the most common reason for tubal blockage is related to pelvic inflammatory disease (PID). As many as 1 in 8 women with PID experience infertility. The majority of the time, women develop PID from a sexually transmitted infection (STI). There are also non-sexually transmitted infections which can contribute to PID, and develop naturally from bacteria in the cervical or vaginal area.
Even after the infection is remedied, and PID is no longer present, the disease can leave scarring in and around your fallopian tubes. This can cause tubal factor infertility.
In addition to PID, some common causes of tubal infertility are:
- An ectopic pregnancy
- Prior surgical procedure involving fallopian tubes
- Previous, or current, STI, especially gonorrhea or chlamydia
- Abdominal surgery
- Uterine infection due to abortion, or miscarriage
- A rupture of the appendix
3 Types of Tubal Factor Infertility
There are several ways in which your fallopian tubes can become blocked and cause tubal factor infertility. However, there are three distinct types of blockages, based on location within your fallopian tubes. Depending on the type of the blockage, surgery may be able to open the pathway so the egg can become fertilized, and implant in your uterus. These three types are:
- Proximal Block is the term used to describe a fallopian tube blockage at the connection to the uterus. These types of blockages are typically the result of PID, endometriosis, or pelvic adhesions. A hysteroscopic procedure can open the tube and promote natural conception. This procedure is highly successful, especially in women under the age of 35.
- Medial Block is located in the mid-area of your fallopian tube. Medial blockages are fairly uncommon, and are usually caused by endometriosis, severe pelvic infections, tubal ligation, and pelvic tuberculosis. It is much more difficult to access surgically. The usual procedure is a laparoscopic surgery which cuts the tube, cauterizes the lesions, and reconnects the fallopian tube. The success rate is low and in some cases tubal repair is not recommended at all. For those whose fallopian tubes are seriously damaged or diseased, removal of the tube(s) is often the healthiest option.
- Distal Block is a difficult blockage to treat. The fallopian tubes are blocked at the end, usually due to a pelvic adhesion, or a pelvic infection. If the adhesions are on the outside, the blockage is treatable. By using a laparoscopic procedure, the adhesions can be removed, opening the tubes back up.Unfortunately, if the adhesions are inside the tube, surgery may not correct the problem. Once the tubes are opened, they could become blocked again and such an approach is no longer recommended (neo-salpingostomy). This interior (or intrinsic) blockage can increase your risk of having an ectopic pregnancy.Distal blockage is commonly known as hydrosalpinx as the tubes can accumulate toxic fluid that can drainage backwards into the uterine cavity and damage the lining or the walls of the uterus. In such cases, IVF success rates can be low and the risk of a miscarriage high. When one-sided or bilateral (both sides) hydrosalpinx occurs, the standard treatment is the removal of these diseased tissues to eliminate the drainage of the toxic fluid. This approach is then followed by standard IVF treatment.
Symptoms of PID or Infection
One of the most difficult issues with tubal factor infertility is that, other than not being able to conceive, there really are very few symptoms. Being aware of the signs of pelvic infection, or STI, can help prevent this type of infertility (pelvic pain, fever above 101°, foul vaginal discharge, nausea, and pain during intercourse), but in many cases, the symptoms are mild, and go unnoticed. In any case, if you suspect you’ve been exposed to an STD, or may have developed an infection, seek medical attention immediately.
For those who have tubal factor infertility hope is not lost. There are certain procedures that may correct your blockage, and restore your fertility. IVF is also highly successful for those who have tubal factor infertility. Now is the time to investigate your options.