Tubal factor infertility occurs when a blockage in the fallopian tubes will not allow the egg and sperm to meet. Tubal factor infertility accounts for about 25-30% of all cases of infertility.
What causes tubal factor infertility?
Infections, abdominal surgery, and diseases such as endometriosis can cause scarring to any portion of the fallopian tube. The delicate ends of the fallopian tubes (called the fimbria) are particularly vulnerable to damage. They have the important job of picking up the egg that has been ovulated from the ovary. Glands within the inner tube naturally produce a watery fluid. If the end of the tube closes off due to scarring, that fluid collects within the tube, producing a sausage-shaped swelling that is called a hydrosalpinx.
Chlamydia and gonorrhea are two common sexually transmitted infections that can cause tubal infertility. A ruptured appendix or even pelvic tuberculosis can cause a tubal infection. Surgery can also damage your fallopian tubes.
Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.
What are the symptoms of tubal factor infertility?
Most women with tubal infertility are asymptomatic. Often they don’t realize their fallopian tubes are blocked until they consult a doctor for infertility, though women with extensive tubal damage may experience chronic pelvic pain.
How is tubal factor infertility diagnosed?
To confirm whether or not one or both fallopian tubes are blocked, your doctor may perform one of these two procedures:
- Hysterosalpingogram (HSG): Tubal factor infertility is usually investigated first with an HSG, which is an X-ray examination performed by a physician. It can be performed in the radiology suite of a hospital or in a clinic. A catheter is inserted into the cervix and is held in place by an inflatable balloon. Radiographic contrast (dye) is injected and the uterine cavity fills. X-ray pictures are taken during the procedure. The uterine cavity is evaluated for the presence of congenital uterine anomalies, polyps, fibroids, or scar tissue. The dye should then travel through the fallopian tubes and spill into the pelvic cavity. This shows whether the fallopian tubes are open or blocked; if blocked, it can show us where the blockage occurred (proximal—near the uterus, midpoint, or distal—near the end of the tube). If the dye spills into the pelvic cavity and collects in an abnormal way, it may suggest pelvic scar tissue.
- Laparoscopy (LSC): In this minimally invasive outpatient procedure, a surgical instrument called a laparoscope is inserted through a very small incision below your belly button. The surgeon can look through the laparoscope to see if one or both of your tubes are open. The laparoscope can also be used to look for other problems that may affect fertility, such as scar tissue (adhesions) or endometriosis.
How is tubal factor infertility treated?
If your tubes are blocked or damaged, your treatment options include in vitro fertilization (IVF) or surgery:
- In vitro fertilization (IVF): Although some tubal problems are correctable with surgery, women with severely damaged tubes have such poor chances of achieving pregnancy naturally that IVF offers them the best option for a successful pregnancy. If the woman has a hydrosalpinx, the fluid inside the damaged tube may leak back into the uterine cavity. Even if a good embryo from IVF is placed into the fallopian tube in a woman with hydrosalpinx, the patient has a lower pregnancy rate because the fluid has been shown to be toxic to the embryo and also it may wash the embryo away. It is for this reason that providers may wish to remove or block the fallopian tubes so that the fluid does not leak back into the uterine cavity.
- Surgery: If your tubes are not badly damaged, surgery might help you get pregnant naturally. Your chance of conceiving after surgery is better if you are young, have a minimal amount of scar tissue blocking the tubes, and if your male partner has healthy sperm. The biggest risk after tubal surgery is the possible development of an ectopic (tubal) pregnancy. An ectopic pregnancy is a serious health problem that is more likely to occur after tubal surgery or tubal disease. Even if the tubes are open at the completion of surgery, there is always the risk that they re-close later on.