Fallopian tube are essential for successful conception. One-third of the cases of infertility are due to blocked tubes. In this blog we will discuss commonly asked questions.
Every month, the ovary releases an egg, which is picked up by the fallopian tube. In the fallopian tube the egg gets surrounded by sperms and out of millions, one sperm will get entry in to the eggs and fertilise it.
The embryo created stays in the tube for 4 days and keeps developing.
By day 5, it travels to the uterus, where it implants and pregnancy occurs.
So an open and normal functioning fallopian tube is vital for natural conception. If the tube is blocked or damaged (photo), then sperm and egg will not be able to meet and pregnancy will be almost impossible.
An open and normal functioning fallopian tube is vital for natural conception
What causes damage to the Fallopian tubes?
Most common cause is infection –fallopian tube infection can be caused by:
Sexually transmitted infections like chlamydia, gonorrhoea,
infection after abdominal surgery,
miscarriage, termination of pregnancy or
Even subtle infections, which might not have given you symptoms, can still cause tubal damage.
Smoking – both active and passive smoking can damage the tube.
Previous ectopic pregnancy
Fibroid – depending on its position can block the tube.
Most common cause of tubal blockage is infection
Even subtle infections, without any symptoms symptoms can still cause tubal damage.
What are the symptoms of tubal damage?
Tubal damage does not have any symptoms. It is diagnosed while investigating infertility.
If you have hydrosalpinx, occasionally the fluid of the hydrosalpinx can flow in the uterine cavity and come out of vagina as vaginal discharge.
You might have symptoms due to the factors causing tubal blockage like symptoms of PID, endometriosis.
Tubal damage does not have any symptoms.
How to diagnose tubal block?
No body is born with a blocked tube. Tubes get block if you had infection, surgery, endometriosis or ectopic pregnancy.
If you do not have any of these risk factors, then your chances of having a blocked tube is extremely low.
In that case you can carry on trying naturally if there are no problems with ovulation or sperm parameters in your partner.
Majority will fall pregnant naturally. If you do not conceive in 6-12 months, then you can consider tests like HSG or HyCoSy.
HSG: dye is instilled in to the uterus and X-Ray taken. If the tubes are open then dye can be seen flowing through the tube. The dye will not flow out of the tube if it is blocked. The procedure can be uncomfortable, sometimes painful.
However, 6 out of 10 women, the tube will be found to be open if the HSG is repeated or laparoscopy is undertaken.
If your tubal blockage is diagnosed with HSG, then remember to recheck it with repeat HSG or laparoscopy.
Tubal blockage diagnosed with HSG, should be confirmed with repeat HSG or laparoscopy.
HyCoSy: instead of Xray, USS is used to see if the dye is flowing through the tubes. It has additional benefit that during the USS, the ovaries and uterus can also be assessed. It can also to be combined with 3D scan to improve the accuracy of the results.
During HyCoSy, the ovaries and uterus can also be assessed
Laparoscopy & Dye test: If you have symptoms of endometriosis like pain in the lower abdomen, painful periods then do laparoscopy to test tubes. The advantage is that along with the tube test its can be checked if you have endometriosis and can be treated at the same time.
If you have pain abdomen, then laparoscopy and dye test is recommended.
I have only one fallopian tube. Is it possible for me to get pregnant?
If only one tube is blocked and the other is normal, you have good chances of falling pregnant naturally or by IUI if there are no other causes of infertility.
Even if you ovulate from the ovary on the other side, the normal tube can pick up the egg.
A systematic review of 10 studies, including almost 3000 patients showed that women with one tube blocked had same chances of pregnancy as women with both normal tubes while having IUI.
What are the options if both tubes are blocked?
If both the tubes are blocked, then options are surgery or IVF.
Surgery cannot be done for all cases. It is successful only:
where the damage is minimal,
the wall of the tube is otherwise healthy,
However, the risks are:
increased risk of ectopic pregnancy,
surgical and anaesthetic complications and
Tubes can get blocked again.
Surgery to fix tubal damage is only possible if the block is mild and rest of the tube is healthy
Surgery to fix tubal damage carries increased risk of ectopic pregnancy
IVF is preferred if:
If there are other factors for infertility like abnormal sperm parameters, if you are older or trying for a long duration.
if the tube are badly damaged and beyond repair
In that case you should not waste time in trying fixing the tubes and instead move on with IVF sooner. Delaying IVF will only reduce your chances of success.
IVF has become the main treatment option for tubal blockage.
Can you open a blocked tube without surgery?
ONLY if the block is in the proximal end, SOMETIMES it can be treated without surgery. The treatments are:
tubal flushing or
Tubal flushing basically means flushing the tube with dye during hysterosalpingogram (HSG). This can clear up any minor block due to mucus plug.
There is evidence of increased pregnancy rate in women in first 3-6 months after HSG, more so when the HSG is done with oil-soluble dye
Tubal cannulation is another treatment, that can be done at the same time of HSG- is a procedure where a fine wire is passed under XRay guidance through the vagina into the uterus and to the proximal end of the tube to clear the block.
Both Tubal flushing and cannulation are ONLY possible if the block is MILD.
How do you treat hydrosalpinx?
Unfortunately, if you have hydrosalpinx, it means the tube is grossly damaged. Surgery to treat hydrosalpinx will not increase your chances of pregnancy and you should not waste time and move on with IVF sooner.
Do not waste time in trying to fix hydrosalpinx. Move on with IVF.
If you have hydrosalpinx, then there is good evidence to suggest that it can lower the success of IVF by 50%, as the fluid can trickle back to the uterus and can be toxic to the developing embryo.
Hence if Hydrosalpinx is detected, then you would be advised to remove it or at least clip it or disconnect it from the uterus by laparoscopy before IVF.
Open and normal functioning fallopian tube is vital for natural conception
Most common cause is infection
Smoking can cause tubal block, so avoid smoking
Even with one patent tube you have good chances of falling pregnant naturally. See specialist is not pregnant within 6-12 months.
IVF has become the main treatment method for women with tubal block.
Surgery can be done only in few cases.
Written by: Dr Anupa Nandi