What is Fallopian Tube(s)?
Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus. Inside the tube, the sperms and the egg meet (“fertilization”) to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts. Tubal factor accounts for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier).
What are the reasons for tubal blockage?
Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion”. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.
How can I understand that the tubes are blocked?
Unfortunately, most women do not have signs or symptoms suggesting tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, previous ectopic pregnancy, appendicectomy or gynaecological surgery, or feel severe pain during periods or during intercourse, there is a chance of tubal blockage.
How the tubes are tested?
Whether tubes are open (“patent”) or not, is usually checked by a special X-ray, called Hystero-salpingogram (HSG), in which a contrast material will be given through the neck of the uterus (cervix). It is cheaper and easily available. However, some women can feel discomfort during HSG. Usually some pain-relief medications are given during the procedure.
Another method is Saline Infusion Sonography (SIS), in which water is inserted inside the uterus with the ultrasound probe put inside the vagina (TVS). It is more accurate than HSG and causes less discomfort.
Both HSG and SIS are done in out-door basis, without any need of anesthesia.
When Laparoscopy is advised?
If HSG or SIS show both the tubes are blocked, then the only way to confirm the blockage is by laparoscopy. This is, because, sometimes, the spasm of the muscles of the tube during HSG or SIS can lead to “false positive” result; that means if tubes are found to be blocked by those tests, the tubes may actually be found open actually during laparoscopy.
Laparoscopy is also advised to check the tubal patency, if there are other reasons (like removal of cyst or severe pain) or when HSG or SIS could not be done for technical difficulties.
Laparoscopy is done under general anaesthesia with two or three small opening (key-hole surgery) in the abdomen and a coloured material (“dye”) is introduced through the uterus.
What are my options if tubes are found to be blocked in HSG?
You still can consider SIS as a second test to check tubal patency. However, if SIS also shows the “block”, then there are simply two options. You can consider laparoscopy or go for IVF straightforward. It depends on your age, other fertility factors (condition of the sperms and ovaries), duration of infertility and your wish.
What are the merits and demerits of laparoscopy?
If you are at younger age, other fertility factors normal and the infertility is of shorter duration, laparoscopy may be the suitable approach for you. If laparoscopy confirms the patency of the tube(s), you can try for pregnancy naturally, by ovulation induction or by IUI (Intrauterine Insemination), depending on your circumstances.
Sometimes, attempt can be made to remove the block by laparoscopy. At the same time, the condition of your ovaries, uterus and the surrounding areas can be assessed in better way and treated, if necessary.
However, if laparoscopy confirms the blockage of both the tubes, you will require IVF. Moreover, although it’s a safe procedure in most cases, there some anaesthesia and surgery-related risks.
When should I go for IVF?
If the conditions of your ovaries or partner’s sperms are not satisfactory, your age is on the higher side, or infertility is of long duration, directly going for IVF would be the better option for you. In that case, you can avoid the risks and costs related to laparoscopy. Of course, if laparoscopy confirms tubal block, the only fertility-treatment option remaining for you is IVF. Again, if you fail to conceive within 6-12 months’ time after laparoscopy, even when the tubes were found open, you may need to consider IVF.
Tubal test by HSG or SIS is a part of routine infertility investigation. If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy. Many factors are to be taken into account before final decision.