The fallopian tubes are a part of the reproductive system in the female body. Their function is to collect the egg and by propulsive movements transport the egg towards the uterus. For pregnancy to occur, the tubes should be open and they should function normally.
Tubal Factor is implicated in 15-25% of the cases of infertility. Tubes can be damaged i.e.. blocked or their normal function can be disturbed leading to improper functioning. Repeated pelvic infections in females, history of tuberculosis, endometriosis, any pelvis mass like fibroid, large ovarian cysts, history of pelvic radiotherapy for cancers can cause tubal factor infertility. Often, the damaged tubes have fluid collection in them which is known as hydrosalpinx. This collected fluid has harmful chemicals which are toxic to embryo development.
There are various tests to evaluate the tubal patency:
- The most simple is sonosalpingogram (SSG). It is done routinely in clinic under ultrasound guidance. A very small diameter rubber catheter is placed inside the uterus and saline is injected which comes out of the tubes freely if the tubes are open. There is no cut or stitch in this process.However, the functioning of the tube cannot be seen in tubal patency tests.
- Another test which helps in visualising the tubes is known as hysterosalpingogram( HSG). In this test radioopaue dye is injected inside the uterus and when the dye flows inside the tubes, its photographs are taken with the help of X ray machine. This test deliniates the tube clearly and pathologies like tubal distortion , blockage of tube , beading of tubes, convolutions of the tube , presence of hydrosalpinx can be easily made out.
- Tubes can also be tested during laparoscopy where a telescope inserted through a keyhole below the umblicus inside the abdominal cavity and fluid can be seen coming out through the tubes directly.The laparoscopy is an invasive test which involves anaesthesia administration, but it has an added advantage that any pathology can be treated in the same setting.
The treatment options for tubal pathology depend on many factors. The age of the female partner, duration of infertility, history of failed treatments, the extent of damage to the tube, presence of hydrosalpinx, patient preferences should be taken into consideration and thorough counselling should be done. Sometimes when the patient is anxious during the tubal test evaluation, the reports can show false tubal blockage, which should be ruled out laproscopically. The HSG film should be read by an experienced infertility expert who can pick up subtle abnormalities and this can make huge differences in the management of the problem.
IVF is offered for those patients where age of the female partner is advanced, couple has a long duration of infertility, multiple IUI failures, ovarian reserve is less, associated male factor infertility is present, the tubes are moderately to severely damaged or there is presence of hydrosalpinx . In IVF, mature eggs are directly picked up from the ovaries with the help of needle placed through the vagina and then each egg is injected with a healthy sperm ( ICSI) in the laboratory. The embryos are transferred into the womb. In this way, the damaged tubes are bypassed and pregnancy can be achieved.
In the era of IVF where the tubes can be bypassed, the role of tubal surgery has become limited. However if a couple is young, there is no other infertility factor, the tubal pathology is mild and there is no hydrosalpinx , tubal surgery can be attempted. It should be kept in mind that the results of tubal surgery in terms of pregnancy, depend on patient profile, the extent of damage to tubes, and surgeon expertise. If a hydrosalpinx is present then the tube should be detached from the uterus (tubal clipping) to prevent backflow of toxic fluid from the damaged tubes to the uterus.. This procedure is called laparoscopic tubal clipping and it is done to improve the chances of pregnancy outcome.