Tubal disease accounts for 15-20% of all infertility cases. Fallopian tube is the place where egg is fertilized by the sperm. If tubes are blocked, sperm cannot fertilize the egg and leads to infertility. The best treatment option for tubal disease is in vitro fertilization (IVF).
Hysterosalpingogram (HSG) is routinely used test to diagnose tubal patency. This test can be done right after the period ends and before ovulation. Radiopaque dye is injected in uterine cavity and x-rays are taken to evaluate the inside of the uterus as well as the fallopian tubes.
When tubes are blocked at the end and filled with fluid, the pathology is called hydrosalpinx.
This is due to a prior pelvic infection or pelvic adhesion. Pelvic adhesions can be treated with laparoscopy and tubes can be opened. If the problem is extrinsic such as pelvic adhesions, success rates are high.
If the tubes are damaged from the inside (intrinsic) due to a prior pelvic infection, repair of such tubes is not very much successful. Tuboplasty can be done to repair tubes, but in most cases surgery is not successful and requiring additional surgery to remove them. Additionally, if woman becomes pregnant, the risk of having ectopic pregnancy is increased.
The current recommended treatment for hydrosalpinx is removal of hydrosalpinx followed by IVF. Removal is recommended prior to IVF because blocked tubes can contain toxic fluid that can drain back into the uterine cavity at the time of implantation.
Ectopic pregnancy is one of the serious complications of pregnancy and the number one cause of death in the first trimester. If undetected, the ectopic pregnancy will continue to enlarge inside the tube and eventually tear the tube and results in excessive intra-abdominal bleeding, which can have serious implication to woman health. It is possible to detect an ectopic pregnancy as early as possible with a transvaginal ultrasound and beta hCG hormone measurements.
Once the ectopic pregnancy happens usually the tubes are not functioning well, or they are damaged leading to difficulty in natural conception. In such cases the treatment is usually the In Vitro Fertilization.
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