Tubal Infertility

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Hydrosalpinx

Tubal Adhesions

Laparoscopy

Tubal cannulation

The fallopian tubes are the pathway to fertility. Sperm travel upward through the fallopian tubes to find an egg. After fertilization, the embryo travels back through the tube to the uterus. The fallopian tubes are a two-way path that allows the sperm and egg to meet and combine and the embryo to arrive in its resting place, the uterus. With such a delicate and sophisticated pathway, it is common for problems to develop in the tubal system.

Evaluation of these problems can be complex, and devising a treatment plan requires a close relationship with a physician with experience in these areas. A few common scenarios are as follows:

Hydrosalpinx (Blocked Tube)

A hydrosalpinx carries risk of infection and very low pregnancy rates even after treatment. Hydrosalpinx can be treated laparoscopically, a procedure known as fimbrioplasty. In fimbrioplasty, an incision is made in the end of the tube and the edges of the incision are folded or flowered back, leaving an open tube. The best outcomes occur in young women with a small hydrosalpinx. Unfortunately, the tube often closes back up, and pregnancy rates are relatively low. Even when the fallopian tubes are bypassed, via techniques such as in vitro fertilization, a hydrosalpinx can have adverse effects on pregnancy rates. Basically a small hydrosalpinx in a young woman might be repaired, with the understanding that further surgery might be necessary if the repair is unsuccessful; a larger hydrosalpinx should be removed, as these lower the chance of pregnancy with in-vitro fertilization.

Tubal Adhesions (Scar Tissue)

Some patients with an otherwise normal evaluation, including a normal Hysterosalpingogram, can have subtle adhesions over the fallopian tube and ovaries. These adhesions appear like cobwebs over the surface of these organs, and can prevent eggs successful ovulation, prevent the tubes from picking up eggs, and limit the mobility of the tubes. Patients at special risk for these problems include those who have used IUDs, had abdominal problems, such as appendicitis or an ovarian cyst removal. Limited adhesions benefit from laparoscopy. The adhesions can be removed with scissors, cautery, or a laser. Age is a significant factor in who will respond to these procedures, younger women benefit more than older women.

Treating these problems is highly individualized and depends on the patient's age, medical problems, and patient wishes. The available procedures are:

Laparoscopy

Laparoscopy is the classic procedure to evaluate and treat tubal disease. Under anesthesia, an incision is placed in the belly button, and a small television camera is placed through the incision. The doctor can look at the pelvic organs, and introduce some treatment equipment through small ¼ inch incisions. Problems can be treated with scissors, cautery, or a laser.

Tubal cannulation

For the treatment of a tube blocked near the opening of the uterus, a tiny wire is placed through the cervix and uterus and into the tube. The wire gently opens the tube and may relieve an obstruction in this area. Tubal cannulation can be performed in the X-Ray department under fluoroscopy or via a hysteroscope. A physician who is experienced in the techniques is essential.