Madhavi (name changed), a 26-year-old lady and her husband Karthik, 32 years of age have been trying for a baby for the past two years. They have been informed by their Specialist that Madhavi has tubal block. The couple wants to know why tubal block occurs and what are the treatment options?
Eggs are picked up by the fallopian tube and fertilization (the process of forming the embryo when egg and sperm meet) occurs in the distal end of the fallopian tube. If the tube is blocked or damaged then fertility is impaired.
How common is the tubal disease responsible for infertility?
Tubal factor infertility is relatively common and in about 15% of couples, the subfertility is due to the tubal factor.
The commonest cause of tubal damage is due to sexually transmitted infections such as Chlamydia and gonorrhea. This leads to the scarring of tubes and also damages other reproductive organs. In India, genital tuberculosis is common and is an important cause of tubal disease.
Infections following miscarriages and delivery are also another important cause of secondary subfertility. Many women choose to have their tubes tied as a form of permanent birth control and sometimes situations change unexpectedly and many women seek tubal reversal surgery.
The tubal factor is usually assessed by an X-ray test called a hysterosalpingogram (HSG). This is a technique in which a fine plastic tube (catheter) through which dye is injected is passed through the cervix (neck of the womb) into the uterus. The passage of dye through the uterus and fallopian tubes can be watched on a screen and recorded on x-ray films. In the vast majority of patients, the HSG is performed quickly and easily and provides important information to aid the diagnosis of the fertility problem.
The second technique of assessment is by the laparoscopy and dye test.
A laparoscopy is an inspection of the pelvic cavity and organs using a laparoscope, a small telescope with an attached camera that is inserted through a cut, approximately 1 cm long, below the navel. A blue dye is passed through the cervix and is observed by the doctor looking through the laparoscope to see if it flows through the tubes into the pelvic cavity, implying that the tubes are open. The whole pelvic and abdominal organs can be inspected using this procedure.
Tubal blocks caused by infection are frequently seen in multiple segments and also causes scarring and immobilization of tubes. Hence only in the mild cases of tubal damage, surgery has a role. Surgery (recanalization procedure) can be offered to women who had sterilization operations in the past and are keen to have further children with relatively good success.
IVF - InVitro Fertilisation (test tube baby) is the treatment option. In this procedure, eggs can be picked up from the ovaries, fertilized outside the body, and can be returned to the womb for implantation and further growth thereby bypassing the function of the tubes.
Genital tuberculosis is an important cause of infertility in India and can cause a tubal block in the women and can also blockage of the reproductive tract in the male. The initial treatment is with antituberculous drugs for 9 months which is usually sufficient to clear the infection and the conception rates improve post-treatment.
DR.S.VYJAYANTHI, MD, DGO, DNB, MRCOG (London), MSc (Embryology) (UK)
Head of Department and Consultant in Infertility, Reproductive Medicine and Surgery