Tubal Factor in infertility
What is function of tube in a woman?
Fallopian tubes are hollow pipe connecting the uterus to the ovaries. Uterus is the womb and ovaries is the egg bank. Every month when the egg is released from the ovary, it is picked by the tubes and transported with the help of microvilli (which are delicate grass like structures) from the ovary towards the uterus. The sperm meets the egg in the middle part of the tube and fertilizes it. The fertilized egg is transferred to the uterus and implantation occurs. Hence, it is important for the tube to be healthy, normal and patent for reproduction.
What are the types of tubal abnormality ?
- Complete tubal blockage. – Either one or both tubes are completely blocked. This prevents fertilization of egg by sperm and hence, infertility.
- Hydrosalpinx or pyosalpinx – In this condition, there is fluid or pus collected in tubes usually due to infection. This creates an unheslthy environment for the fertilization of egg and implantation of embryo.
- Rigid tubes- Sometimes, the tube may be open however the microvilli are destroyed and hence, the tube loses its function.
What are the causes for tubal abnormality?
The major cause for tubal abnormality in India is infection such as sexually transmitted diseases or tuberculosis. The other causes include endometriosis or any previous surgery such as tubal sterilization or an ectopic. These problems cause either complete tubal blockage, partial tubal blockage or destroy the microvilli and thus the functionality of the tubes.
How are tubes evaluated?
There are various methods of tubal evaluation. These tests are directed towards detecting patency of the tubes. In broad terms the information given by them is whether the tube is open or not.
- Hysterosalpingography – This is an invasive test in which dye is pushed through the cervix (mouth of the uterus). This dye fills the uterine cavity and tubes and is seen in the abdominal cavity on X-ray. This concludes that the tube is open. The advantage of this test is that that it is an opd procedure and does not require anaesthesia. However, it can be painful. And it is common for the test to report no spill or in other words blocked tubes which may be false negative.
- Sonosalpingography. – This is an invasive test where in fluid is pushed through the cervix ( mouth of the uterus). This fluid is seen fill the cavity of the uterus and spill out of the tubes in real time with the help of the ultrasound machine. The advantage of this is that it does not use X-ray to visualize and can be less discomforting. However, it is not the confirmatory test in case of blockage detected.
- Laparoscopy with chromopertubation – This is an invasive test requiring anaesthesia. This is done by inserting a camera through the naval and visualizing the uterus and tubes. This is under direct vision. And it gives much more additional information then the above tests. It gives information on the tubal relationship with the ovaries and uterus, and adhesions, and endometriosis. It also allows us to do fertility corrective surgeries.
It is worthwhile to note that the above tests do not give any information on function of the tubes and in patients with previous history of infection or tubal abnormality, one has to keep this in mind.
What are the treatment options?
The treatment options can be divided into medical, surgical or definitive.
Medical treatment is given in presence of any infection. Antibiotics are given to cure the infection. It may cure the infection, however, in most cases if villi are destroyed, they cannot be regenerated. Hence, for all practical purpose, patient will be infertile. Also, there is risk for ectopic pregnancies wherein the pregnancy may be implanted in the tubes instead of uterus due to faulty tubal function and can endanger the life of the patient.
Surgical treatment is offered in case of tubal blockage due to previous surgery on the tubes. The success of these surgeries is not very good. The tube may open up but chance of pregnancy is very low. Incase of hydrosalpinx or pyosalpinx, it is infact advisable to remove the tubes or clip it so that it does not open in the uterus. This prevents the toxic fluid to affect the embryo and implantation.
Definitive treatment in tubal blockage is IVF (Invitro Fertilization). This is because this treatment bypasses the tube and its role and in patients with only tubal blockage gives a very high success rate. In this the egg of the patient is fertilised with the sperm of her partner outside the body and the resulting embryo is transferred into the uterus of the patient.