BLOCKED FALLOPIAN TUBES

Hear from the top rated IVF Center clinic in Delhi - As the function of the Fallopian tubes is to unite the sperm and the egg, blockage of both fallopian tubes will result in infertility as the sperm and egg can never meet. Blocked Fallopian tubes is one of the commonest (35-40%) causes of female infertility and is also called as ‘Tubal factor infertility’.

The human Fallopian tube is a narrow 10 cm structure that start from the sides of the uterus and end near the ovaries in the form of fimbriae. These fimbrae function to “catch” the egg every month at the time of ovulation and transport the egg near the uterus where it stays and waits for the sperm to come after intercourse. Thus, the tube is a dynamic structure and there are innumerable tiny hair-like structures in the inside of the tube called “Cilia”. These cilia play a key role in the transport of the sperm and egg, thus helping in fertilisation.

Causes of tubal block

Symptoms of tubal block

• Most commonly there are no symptoms and the woman is not aware she has tubal block - the only ‘symptom’ is Infertility
• Sometimes there could be pain in lower abdomen due to infection or adhesions
• White discharge per vaginum
• Pain while having intercourse
• Sometimes the block in the tube cause an embryo to get stuck. This leads to ectopic pregnancy (pregnancy in Fallopian tube instead of uterus). This is an abnormal condition and happens because tubes are sometimes not blocked completely but partially.

How to diagnose tubal block?

There are various methods by which the block can be detected :

• HSG or Hystero-Salpingo-graphy : A dye is injected into the uterus from the vagina. This dye then flows into the tubes and if tubes are open they should be visualised in an X-ray. If there is a block the tubes won’t be seen and this helps in the diagnosis
• Sono-salpingography : Here instead of a dye being injected a special saline solution which has Sono-visible properties is slowly instilled inside of the uterus and simultaneously a trans-vaginal ultrasound is performed to see the tubal structure. Advantage of no exposure to radiation and quick procedure
• The Gold standard in diagnosing tubal block is through Laparoscopy. A telescope is inserted via the umbilicus (navel) and simultaneously a blue coloured dye is injected into the uterus by an assistant at the vaginal end. If tubes are patent the dye should come out of both tubes. If one tube is blocked the dye won’t come out of that tube. If both tubes are blocked the dye would not be seen at all.
• Laparoscopy or “key hole surgery” has many advantages like direct visualisation of the tubes as well as other pelvic organs like uterus and ovaries. Also, it helps in recording the findings and viewing them for future reference. If the block is minor and/or other intervention is needed (example fulguration of Endometriosis disease spots) that can also be done simultaneously. So it can become both a diagnostic as well as a therapeutic procedure.

Treatment

There are two major lines of treatment for blocked tubes :-

(a) Tubal surgery where attempt is made to repair the block or make a new opening

(b) IVF or ICSI (assisted conception methods)

In previous years, before the invention of IVF, tubal surgery was the only hope for childless couples facing tubal block. But now, after significant advances in the IVF technology, tubal surgery is rendered almost obsolete. Indeed, most patients seen by us at Janini IVF who are diagnosed to be patients of tubal block would be advised to go for IVF only, rather than tubal surgery. Being the best IVF Center in Delhi, we know there are many reasons why IVF wins over tubal surgery :-

1. IVF is now financially within the reach of the common man. Tubal surgery in some sittings can be more expensive.
2. IVF procedure is basically growing the eggs, taking them out of the body through a needle and fertilising them with sperm in the laboratory. Essentially we are bypassing the tubes here. So the function of the tubes (to make the egg and sperm meet) is done by us inside the laboratory. We don’t need the tubes now - whether they are stuck / blocked / jammed or whatever the case maybe. Indeed, the very first IVF done in the world back in 1978 was done because the mother had bilateral tubal block. IVF is a classical treatment for tubal block.
3. IVF has the advantage of freezing extra embryos for future use. If the couple conceives and has a baby, if after a few years want to have a second child then can go for frozen embryo transfer with the same embryos that were made many years ago.
4. Most important is the success rate. Today, no matter how good the surgeon is, the success of tubal reconstructive surgery is not more than 50-60% in best scenario. Why is it so? Well because the same condition that led to the block in the first place could be active and can lead to a re-block. More importantly, the cilia inside the tubes are rendered useless after prolonged damage. Even if the tubes are opened up after surgery, because the cilia don’t work the tubes are essentially useless, in spite of being open. It is commonly spoken in medical circles that reconstructive surgery may lead to “PATENT tubes, but don’t lead to POTENT tubes”.
5. Even if surgery is successful, it can have side-effects as well. For example it is seen that patients who undergo surgery and re-open their tubes have higher incidence of Ectopic pregnancy later on.
6. The same applies to a procedure called “tubal cannulation” as well. Tubal cannulation is done by passing a thin tube across a block that is in the portion of the tube close to the uterus. This is commonly done via hysteroscopy. Again, the success rates of IVF far outweigh those seen with tubal cannulation.
7. IVF or ICSI is effective if there are other factors present, like poor sperm count. Whereas surgery on the tubes won’t help in those other factors.

Because of the above reasons, today, with such an advanced science of IVF are reproductive medicine, tubal reconstructive surgery is rarely performed anymore. There is only one condition of Hydrosalpinx (tubes filled with infected fluid) where surgery is recommended to remove the tubes before performing IVF.

Reversal of sterilisation procedure

Tubal ligation or banding is the most common method of permanent family planning in India. But a lot many women who have undergone tubal sterilisation later on regret doing it. There could be an unfortunate demise of one of the children, or there could be a desire of having another child. Whatever maybe the reason, these ladies come to us for a “Re-canalisation” procedure or reversal of sterilisation procedure. This Re-anastomosis procedure is done by cutting both ends of ligated tube and joining them where the tissues are healthy.

To them we tell them the same thing. Instead of going for tubal re-anastomosis IVF is much more safe, effective, efficient solution to getting pregnant with much higher success rates than trying to re-open the tubes.