Female fertility is controlled by reproductive hormones. An imbalance in these may cause an inability to ovulate (release an egg) called anovulation.  Anovulation may lead to symptoms of a hormonal imbalance, or possibly a woman may not ovulate due to a hormonal imbalance.  This cyclic balance between hormones is needed for fertility in women.

After menopause, imbalance is normal due to the aging process. For some younger women, even in their thirties or younger, symptoms of early onset of these hormonal imbalances and the associated disorders has become more and more of a problem.

What factors may present in young female patients?

Hormonal imbalance may be dependent on some continuing factors in a woman’s life, such as:

Nutrition or lack of it,

Basic diet imbalance,

Environmental reasons, including pollution,

Stress,

Contraceptive and birth control medication,

Exercise or lack of it,

Above average consumption of non-organic foods,

Animal products that have disproportionate amounts of estrogen,

Anovulation.

Anovulation may lead to the significant problem of disturbing hormones.  When a woman is not ovulating it means she may be producing too little of one hormone, and/or too much of another.  The production of progesterone from the ovaries does not take place during an anovulatory cycle.  The direct cyclic result is that the normal value or level of progesterone starts to decline. Also, the estrogen level starts to rise.

Note:  The amount of these hormones produced in a woman’s body can fluctuate from one month to the next even in healthy women, but is that there is an incorrect relationship between progesterone and estrogen levels which may lead to infertility.

Some surgical procedures may affect one’s ability to ovulate for a short period of time. For example, after a tubal reversal some women may undergo a temporary phase of hormonal imbalance between progesterone and estrogen levels. This will resolve as the body recovers from the tubal reversal.

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.