In healthy women, the fallopian tubes perform the function of carrying the eggs from the ovaries to the uterus. In order for a woman to become pregnant, at least one of the tubes must remain open; if an obstruction occurs, the sperm and egg cannot meet in the fallopian tubes, where conception usually occurs. Obstruction of the fallopian tubes is a problem that affects 40% of infertility cases in women, therefore it is very important to be able to recognize and treat it.
Steps
Part 1 of 3: Medical Treatments
Step 1. Ask your gynecologist about infertility medications
If only one of the tubes is closed and you are a substantially healthy woman, your doctor will be able to refer you to fertility therapy based on drugs such as Clomid, Serophene, Follistim, Gonal-F, Fertinex, Ovitrelle, Lupron or Pergonal. These medicines make it easier for the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thereby increasing the chances of ovulating and becoming pregnant (using the open fallopian tube).
- Keep in mind that these drugs are not effective if both tubes are blocked. If this is your case, you will need to find more invasive treatments.
- The most common risks when taking fertility drugs are multiple pregnancy and ovarian hyperstimulation syndrome (OHSS); the latter occurs when the ovaries fill too much with fluid.
Step 2. Consider laparoscopic surgery
If your doctor thinks you can have this operation, he or she may advise you to open blocked tubes and remove any scar tissue present. However, this method does not always work; success depends on the age of the woman, the cause that caused the obstruction and its extent.
- If the block is relatively small, you have a 20-40% chance of getting pregnant after surgery.
- The procedure is not painful, because it is performed under general anesthesia. Risks of this operation may include a bladder infection and irritation of the skin around the site of the surgery.
- If you have a specific blockage of the fallopian tubes, known as a hydrosalpinx (in which the tubes fill with fluid), you shouldn't have surgery. In this case, discuss other possible options with the gynecologist.
- This type of surgery increases the risk of future ectopic pregnancies. If you become pregnant after the laparoscopic operation, your doctor will need to closely monitor the progress of your pregnancy to make sure there are no signs of tubal obstruction.
Step 3. Discuss the possibility of a salpingectomy with your gynecologist
This operation consists in the removal of a part of the fallopian tube, which is carried out in the case of hydrosalpinx, that is, an accumulation of fluid in the tube itself. The operation is done before attempting an in vitro fertilization.
If fluid blocks the final part of the tube, a salpingostomy will be performed. An opening is created in the tuba near the ovary. Following surgery, it is quite common for the tube to become occluded again due to scar tissue
Step 4. Consider selective tubal cannulation
If the obstruction is close to the uterus, this is the best procedure. The surgeon will insert a cannula through the cervix, uterus and fallopian tube in order to open the blocked part of the latter.
- This procedure is performed on an outpatient or day-hospital basis and is less invasive than laparoscopic surgery. Depending on the specific case, you will be subjected to general or local anesthesia.
- This type of surgery is not recommended if you have other conditions, such as genital tuberculosis, if you have had other fallopian tube surgeries in the past, or if your tubes are severely damaged or full of scar tissue.
- Potential risks of this procedure include tearing of the tube, peritonitis (infection of the tissues around the organ) or failure to recover tube function.
Step 5. Go for in vitro fertilization
If the treatments do not lead to the desired results (or the gynecologist thinks they are not suitable for your specific case), you have other chances of getting pregnant. The most common technique is in vitro fertilization (IVF), in which the doctor fertilizes an egg with the sperm outside the body and then inserts the embryo into the uterus. This way blocked fallopian tubes are no longer a problem.
- The success of this type of procedure depends on several factors, including your age and the cause of your infertility. Keep in mind that this is a very time-consuming technique and is very expensive.
- Risks include ectopic pregnancy, multiple births, premature births and low birth weight, ovarian hyperstimulation syndrome, miscarriage, as well as stress due to emotional, mental and financial burden.
Part 2 of 3: Diagnosis
Step 1. Know that you may not have symptoms
Although some women with a particular type of blocked fallopian tube may experience abdominal pain or increased vaginal discharge, most do not have any symptoms. Women typically find they have this problem when they try to have a child.
Step 2. Make an appointment with your gynecologist if you have been trying to get pregnant for a year without success
Medically, the term "infertility" refers to the lack of conception after at least one year of unprotected sexual intercourse. If this is the case, see your family doctor or gynecologist as soon as possible.
- If you are over 35, you don't have to wait a year. Make an appointment after six months of regular unprotected sex.
- Keep in mind that "infertility" is not synonymous with "infertility". In the first case, you can still get pregnant, with or without medical intervention; do not think that you will never be able to have children.
Step 3. Schedule a fertility assessment
Your doctor will likely recommend that you and your partner have a full fertility test. The partner will have to provide a sperm sample, in order to rule out problems with sperm count and motility. You will be subjected to a number of different tests to confirm that your hormone levels are back to normal and that ovulation is regular. If the results of all the tests are negative, the gynecologist will advise you to have a check of the fallopian tubes.
Step 4. Evaluate the sonohysterography
Your doctor may recommend this procedure to check, through an ultrasound instrument, for any masses in the uterus that could sometimes cause obstruction of the fallopian tubes.
Fibroids, polyps, and other masses near the fallopian tubes could cause blockage
Step 5. Undergo a hysterosalpingography
It is a test that consists of injecting a special dye through the cervix to the fallopian tubes; an x-ray can show if the tubes are patent or obstructed.
- The procedure is done without anesthesia and you will only experience slight cramps or some discomfort. However, taking ibuprofen one hour before the exam may help.
- The surgery typically takes no more than 15-30 minutes. Potential risks are a pelvic infection or damage to cells or tissues due to X-ray exposure.
- If your doctor thinks your tubes are blocked, he or she may use an oily dye during the procedure, as the oil can sometimes remove the blockage.
Step 6. Find out from your doctor if laparoscopy is appropriate for your specific case
Based on the results of the different tests, the gynecologist may recommend a laparoscopic surgery - a procedure that consists of an incision made near the navel - to find (and in some cases even to remove) any tissue blocking the tube.
The surgery is usually done only after you have undergone other infertility tests; this is also because the procedure is rather risky: it is done under general anesthesia and therefore involves all the risks associated with any other type of more invasive surgical operation
Step 7. Get a diagnosis
The various tests will need to determine whether the blockage affects one or both fallopian tubes. Ask your doctor to explain the severity of the obstruction in detail. Getting the most accurate diagnosis possible will help define a treatment.
Part 3 of 3: Knowing the Causes of Obstruction
Step 1. Sexually transmitted infections (STIs) can lead to a blocked tube
Knowing the cause of the obstruction can help the doctor define effective therapy. Sexually transmitted infections are some of the main causes of obstruction. Chlamydia, gonorrhea, and other STIs facilitate the formation of scar tissue that blocks the tubes and prevents pregnancy. This problem can remain even when the infection is treated and eradicated.
Step 2. Learn about the role of pelvic inflammatory disease (PID) in obstruction of the fallopian tubes
This pathology can be a consequence of a sexually transmitted infection and can lead to obstruction. If you have (or have had in the past) this inflammatory disease, you run a higher risk of developing tubal blockage and therefore infertility.
Step 3. Be aware of the potential risks associated with endometriosis
In women with this disorder, uterine tissue grows beyond its normal location, invading the ovaries, fallopian tubes, and other organs. If you have endometriosis, be aware that you may have blocked tubes.
Step 4. Don't rule out uterine infections
With this type of infection, possibly caused by a miscarriage, it is possible that scar tissue has formed that blocks one or both fallopian tubes.
Although it is a rather rare pathology, pelvic tuberculosis can also be one of the factors responsible for obstruction of the tubes
Step 5. Consider ectopic pregnancies from the past
Pregnancies are defined as ectopic when the fertilized egg implants itself in the wrong place, usually in the fallopian tube. With this type of conception, pregnancy cannot go to term and when the tube bursts or the fertilized egg is removed, scars and obstructions can remain.
Step 6. Evaluate previous surgeries
If you have had operations in the abdominal area, including surgery on the fallopian tubes themselves, the risk of developing blockages is greater.
Advice
- Know that even if you find no effective cure for obstructed tubes or getting pregnant, you still have other options. You can consider adopting a child if being a mother is very important to you.
- Keep in mind that if you only have one blocked tube, you can still get pregnant even without any medical treatment. Whether or not you need a particular therapy depends on the cause that caused the obstruction and the health of your reproductive organs. Consult your gynecologist to find the right solutions for you.
- Infertility can be very stressful and traumatizing, so it's important to be able to manage emotions. Consider seeing a therapist or joining a support group if you feel overwhelmed; also try to maintain good daily habits: eat a healthy diet, exercise regularly and sleep a lot.
