Accurate functioning of fallopian tubes
Accurate tubal function involves:
1. The fimbria of the Fallopian tube picking up the egg
2. Transportation of the egg through the Fallopian tube by the cells that line the inside of the tube
3. Fertilization of the egg by a healthy sperm which can penetrate the egg’s protective covering
4. Transfer from the fallopian tube into the uterus where the embryo implants
If implantation occurs in the tube, this results in a tubal pregnancy.
For the above processes to occur, the tube must be open. Many patients have undergone a tubal ligation procedure which has closed the tube. Tubal reversal is a challenging surgery that can be done by an experienced surgeon that allows one to regain the previous anatomy and physiology of the healthy tube. After a tubal reversal, fertility prognosis is based on accurate functioning of the tubes. Other infertility factors may also be present which may hinder conception.
What types of tests are available in the work-up of tubal disease?
Most fertility physicians will examine the history of the patient and may suggest any of the following tests according to the degree and nature of the disease history:
1. Hysterosalpingography (HSG) is the most commonly used method
2. Laparoscopic chromopertubation is a more invasive technique standard in the diagnosis of tubal disease
3. Sonohysterography with the use of contrast medium is not as accurate as HSG in diagnosing tubal blockage
4. Chlamydia serology is the most cost-effective and least invasive diagnostic test
Various available treatments according to the degree and nature of tubal disease
Treatment depends on degree and nature of the tubal dysfunction, while the age and ovarian reserve of the patient determine what options are available for the patient.
1. With the existence of a hydrosalpinx, prophylactic surgery can remove the hydrosalpinx
2. For proximal tubal obstruction, a possible first treatment is transcervical tubal cannulation with tubal flushing
3. For tubal repair in tubal obstruction, some surgical techniques include salpingostomy and fimbrioplasty
Many patents now prefer in-vitro fertilization and embryo transfer by bypassing the tubal problems altogether. In certain situations, in combination with in-vitro fertilization and embryo transfer, any above type of treatment may be used in dealing with tubal dysfunction. If the tubal disease is secondary to a history of a tubal ligation, then a tubal reversal may be the best option for restoring fertility. Tubal reversal has a better rate of subsequent pregnancy for those patients with a history of tubal ligation.