In a typical menstrual cycle, once the follicles reach maturity, the luteinizing hormone (LH) surge occurs, which causes ovulation 36 hours later. The egg is ovulated into the end of the fallopian tube and travels to the distal end where fertilization occurs. Any condition that impedes, or blocks, egg transport through the tubes can cause tubal factor infertility. In many of these cases in vitro fertilization (IVF) is the treatment of first choice.
Sometimes endometriosis will attach to the fallopian tubes causing scarring and/or adhesions “on” the tubes, leading to obstruction. In addition, severe pelvic infections (pelvic inflammatory disease or PID), caused by a variety of microorganisms, including Chlamydia and gonorrhea, can severely damage the fallopian tubes.
In other cases, women who previously had their tubes tied, seek to have the procedure reversed. While this is sometimes possible, tubal sterilization should be considered a permanent form of birth control.
To begin the evaluation of the fallopian tubes and uterus, the infertility specialist orders a hysterosalpingogram (HSG). In this test, dye is inserted into the uterus and x-rays are taken as it flows back through the tubes. Blockages are seen as concentrations of dye.
In vitro fertilization (IVF) is usually recommended as a first line treatment when moderate to severe tubal damage is present. However the fertility specialist may recommend surgery if the tubal blockage is not severe. This depends on a number of patient specific variables that include age, where, and how, the tubes were “cut” or damaged, other underlying causes of infertility, etc. Data clearly demonstrates that IVF produces higher per cycle success rates than tubal reconstruction does.
A patient with tubal sterilization may opt for a tubal reversal if she is young and has no other factors contributing to her infertility. The advantage to tubal reversal, in appropriately screened cases, is that even though the per cycle success rates are lower than IVF, numerous natural intercourse cycles can be attempted.
