Tubal Disease

Once the ovarian follicles reach maturity, a surge of LH initiates ovulation 34-36 hours later. The ovulated eggs must travel from the ovaries through the fallopian tubes to the uterus. Fertilization occurs in the distal (away from the ovary) part of the fallopian tube.fallopian tube

If the tubes are blocked or damaged, the eggs cannot successfully make their passage.

One way a blockage is identified is in a test known as the hysterosalpingogram (HSG). In this test, dye is injected into the uterus and allowed to back flow through the tubes. Sequential x-rays are taken and a blockage shows as a collection of the radiopaque dye.

Tubal damage can have many causes including endometriosis. Endometrial tissue can attach to the tubes causing obstruction and in severe cases, penetration. The tubes can also be blocked if scar tissue forms from previous surgeries. Rarely, a woman will have a congenital defect where one or both of the tubes are missing.

Many women have their tubes tied as a means of birth control. While it is sometimes possible to “reconnect” the tubes, tubal ligation should be considered a permanent means of birth control. Our reproductive surgeons, fertility specialists have extensive experience in delicate microsurgical techniques including repair of the fallopian tubes. The ability to repair the tubes hinges upon where and how they were tied, how much of the tubes remain, and the skill of the surgeon.

Even though tubal reconnection is sometimes possible, most fertility experts recommend in vitro fertilization (IVF) as the first line treatment for severed tubes. In vitro fertilization bypasses the tubes because the eggs are retrieved directly from the ovaries. Per cycle success rates with IVF are higher than they are for tubal reanastamosis.

However – younger, otherwise fertile females, may elect tubal reanastamosis even though the “per cycle” success rates are lower. This is because they can try an unlimited number of “intercourse cycles” whereas the number of IVF cycles may be limited by cost. The more cycles conducted the higher the chances for pregnancy. Older women usually do not have the “luxury” of years of trying and should usually opt for IVF.