the mature eggs are "ovulated" from the ovarian
follicles on the ovaries, they must travel unimpeded
through the fallopian tubes until they reach the site
of fertilization. Fertilization occurs in the ampulae
of the fallopian tube, near the end furthest away from
the uterus. Tubal factor infertility is relatively common
and occurs when damage to the tubes prevents the passage
of the eggs through the fallopian tubes.
of Tubal factor Infertility.
Endometrial (uterine lining) tissue can travel through
the pelvic cavity and attach to the surface of the tubes.
(This is discussed in detail in the section on endometriosis.)
Once this tissue or cells are implanted; they bleed
each month as does the uterine lining. As these cells
grow and divide, it penetrates the tubes and may cause
scarring or constrictions of the tubes, thus creating
Inflammatory Disease (PID) - PID is caused by serious
bacterial infections in the pelvic cavity. Chlamydia
and gonorrhea are common organisms that can lead to
PID. If these infections are not treated appropriately,
and promptly, scarring of the tubes and damage to other
reproductive organs can occur.
from Previous Surgery(s)- Scar tissue can form after
any surgery, including a laparoscopy, appendectomy,
abdominal surgery, myomectomy (removal of fibroids),
tubal surgery, etc. When this tissue forms near or within
the fallopian tubes, it can cause obstruction and blockage.
Very rarely a woman may be born with only one of no
Surgery for Birth Control- Many women choose to
have their "tubes tied" as a form of permanent
birth control. No woman should have her tubes tied if
there is any chance that future pregnancy may be desired.
Even so, life situations unexpectedly change and many
women seek tubal reversal surgery.
Tubal Factor Infertility
factor is usually diagnosed by a hysterosalpingogram
(HSG). The HSG is an outpatient radiology examination
where contrast dye is injected into the uterus and its
path is followed on X-ray as it travels through the
fallopian tubes to the pelvic or abdominal cavity. If
there is a blockage, there will be a buildup of dye
at the point of the obstruction. Tubal factor is also
sometimes diagnosed during the laparoscopy.
Tubal Factor Infertility
two primary treatments for tubal factor are: 1) Surgery
to remove the blockage or reconnect the tubes. 2) In
vitro fertilization (IVF). In cases of severe tubal
blockage IVF is usually the treatment of first choice
since the eggs are retrieved directly from the ovary
eliminating transport through the tubes.
tubal surgery or IVF will be more effective depends
upon several factors including where and how the tubes
were tied (destroyed). The per cycle success rates with
IVF are higher than those with tubal anastomosis (tubal
women opt to try tubal surgery even though the per cycle
pregnancy rates are lower. A healthy woman in her mid-twenties
can have natural intercourse every month, and even if
the success rates are less than 20%/cycle, she has a
good chance of achieving pregnancy after 6 cycles. The
IVF success rates for this same woman may be at least
40-55%/cycle (depends upon the specific practice) but
she may not be able to afford numerous IVF attempts.
general, women with tubal factor infertility in their
thirties are encouraged to choose IVF. This is because
egg quality (ovarian reserve) can decline rapidly in
this age group and there may not be time for multiple
today's technology the pregnancy outcome for women with
tubal factor is excellent.