What is tubal block/ tubal infertility/ tubal disease/ tubal occlusion ?
The fallopian tubes are an important part of the female reproductive system as it is the site where the fertilization occurs. It is a muscular tube lined with ciliated (hair-like) lining that connects the uterus to the ovaries. The main function of the fallopian tubes in conception is that it picks up the ovum released by the ovary and helps the sperm travel up from the uterus for fertilization to occur. Once fertilized, the cilia help in moving the embryo down the uterus for implantation.
Damaged or blocked fallopian tubes is a common cause of female infertility(around 30%). It can prevent a women from getting pregnant by interfering with the movement of the sperm to the egg or the fertilized egg to the uterus.
Causes of tubal block :
Fallopian tubes are easily damaged or blocked due to their small size. There are various causes for tubal blockages, the most common being scarring on the walls of the tubes caused by infection or surgery. The more frequent causes of tubal block are :
- Pelvic Inflammatory Disease ( PID)
PID is an infection that can develop when sexually transmitted diseases (STDs) or other infections go untreated leading to blockages of one or both the fallopian tubes. These can be caused by gonorrhoea or chlamydia which causes repeated inflammation leading to scarring or scar tissue which causes block of the tube.
- Endometriosis
Endometriosis is when the tissue from the women’s lining of the uterus i.e. the endometrium grows outside the uterus, fallopian tubes being the most common site. During menstruation, the uterine endometrium is typically shed and released from the women’s body in the form of period bleeding. However, the endometrial tissue that is growing outside of the uterus does not shed like normal and the bleeding can cause inflammation which heals by scar tissue formation leading to tubal block.
- Surgery
Past surgeries of the uterus particularly those for medical problems like uterine fibroids, endometriosis or any other type of abdominal surgery can cause scarring. These can lead to tubal block and affect the egg’s ability to travel through the fallopian tubes causing infertility. Surgery done for ectopic pregnancy to prevent rupture of tubes can also lead to scarring causing tubal block.
- Other conditions like a ruptured appendix , swelling and fluid at the end of the fallopian tube (called as hydrosalpinx) might lead to tubal blockage.
Symptoms :
Most of the times, there may not be any symptoms visible in a women with tubal block. They might just have difficulty in conceiving leading to infertility. However, the cause behind the tubal blockage like PID or endometriosis do have symptoms and the women with tubal block might present with the same. These include abdominal pain, irregular or heavy bleeding, painful periods or pain during intercourse. In case of hydrosalpinx, a women may also experience vaginal discharge with abdominal pain.
Diagnosis of blocked fallopian tubes :
Hysterosalpingography (HSG) and Laparoscopy can be used to diagnose whether the tubes are blocked or patent. HSG is a test, where in the doctor injects a solution containing dye with contrast into the uterus and visualizes with X-ray. If the tubes are not blocked, the dye fills the uterus and spills out from the tubes. If there is any blockage or swelling or coiling of the tubes, the tube is not visualized and these conditions can be easily identified.
In case there is tubal blockage as determined by HSG, Laparoscopy – a minimally invasive surgery can be done to clear the block.
Treatment :
The treatment of the tubal disease might vary depending on the cause of the block. In some cases, surgery may be recommended to remove the blockage. However, surgery is not always beneficial. In case if the tubal block cannot be treated by operating, a women may still be able get pregnant through other methods like IVF.
Types of treatment for blocked fallopian tubes include:
- Salpingectomy or Salpingostomy (incase of hydrosalpinx) – in salpingectomy, the doctor removes a part of the blocked fallopian tubes and in salpingostomy, a new opening is created in the fallopian tube near the ovary. Both these procedure helps in making the egg reach the uterus for implantation by bypassing the blockage. Doctors may recommend either procedure depending on the placement of the blockage.
- Tubal cannulation – in case of tubal blockage, especially if it’s close to the uterus, a non surgical procedure called tubal cannulation might be done. In this with the help of X-ray or USG, a doctor guides a catheter through the vagina and uterus until it reaches the blockage. Then he inflates a small balloon or uses a thin wire to remove the blockage.
- Tubal ligation reversal – this is done in women who have undergone previous tubectomy or tubal ligation operation. Here, the doctor surgically removes the part of blocked or ligated part and joins both the ends of the fallopian tube (tubal reanastomosis). This is especially useful in women who have had tubal ligation using tubal clips or rings.
Fertility after treatment for damaged or blocked fallopian tubes :
There are various factors that play a role in women’s ability to conceive even after the treatment of tubal block. These include – age, length of fallopian tubes, amount of tubal scarring and severity of associated fertility conditions. Between 10% – 80% of women whose treatments are successful are able to get pregnant in the future.
Sometimes even after trying everything, the damaged or blocked tubes cannot be treated. In such cases, the women can conceive with the help of IVF. IVF is helpful even in women who has no fallopian tubes. That is because in IVF procedure, a fertilised egg at the embryo stage is placed directly into the uterus bypassing the need for the sperm and egg to travel to the fallopian tubes or of a resulting embryo to travel to the uterus.
Please do not hesitate to consult your gynaecologist or your healthcare provider if you have any queries concerning any symptoms or treatment for tubal block.
