About 20-25% of all cases of infertility are related to tubal factor infertility. Tubal factor infertility may be due to one or more of the following reasons:
- Completely blocked fallopian tubes, either one or both, by scar tissue inside the tube or by prior surgery such as tubal ligation
- Tubal scarring without blockage of the tube but with damage to the cells that line the inside of the fallopian tube
- A disturbance in the architecture of the tube such as with a hydrosalpinx (water-filled tube) or scar tissue outside of the tube which distorts the tube
Medical reasons include:
- Pelvic endometriosis
- Pelvic infection, such as pelvic inflammatory disease (PID)
- Scar tissue that forms after pelvic surgery. Some times after tubal ligation, scar tissue may occur over the blockage site. This can be removed easily during a tubal reversal. Tubal reversal is an option in such a case to regain fertility.
Does minor tubal damage cause infertility?
In most cases, any minor damage to the tubes does not account for infertility. It has to be carefully diagnosed whether the infertility problem is only due to tubal damage, or if some other secondary infertility factor also exists.
What standard tests are available for the diagnosis of tubal infertility?
Hysterosalpingogram (HSG) can be performed to investigate the problem. This is an x-ray exam done in a radiology department. The dye is injected through the cervix into the uterine cavity. If the fallopian tubes are open, the dye flows through the tubes and into the abdominal cavity. Sometimes after a tubal reversal, the dye can be seen changing diameters as it passes across the specific site of the tubal reversal.
Does a negative HSG rule out the diagnosis of tubal infertility factor?
Even if the HSG is good (meaning that there is good flow of dye through the tubes), this does not mean that the tubal function is normal. The inside layer of the fallopian tube can be brutally damaged even if the tube is open. Tubes that have damage to the inside cell layer may be the factor of the tubal infertility problem even though the tube is ‘open.’ This is particularly important when considering a tubal reversal as the surgeon chosen must be skilled at performing a tubal reversal without damaging the inside of the fallopian tube.
Management of tubal factor infertility
The management of tubal factor infertility is generally done either by a tubal reversal or by in-vitro fertilization (IVF).