Blocked Fallopian Tubes and Conception

BlockedTube and Conception

There is nothing as Complicated as Human Anatomy and it is hard to believe how something as simple as a Fallopian Tube, can be  part of something as complicated and as miraculous as Human Reproduction. 

What are Fallopian Tubes?

Fallopian tubes are also called oviduct or uterine ducts. They are a pair of long narrow ducts attached to the uterus on one side. The other side of the Fallopian Tube has finger like projections that sit over the ovaries.

What are the functions of Fallopian Tubes ?
  • Collect the oocyte released from the ovary from the open end of the tube (fimbrial end – called so because of the finger like projections). 
  • Facilitate passage of sperms from the uterine cavity towards the oocyte.
  • Provide an environment favorable for fertilization. This includes adequate nutrients, appropriate temperature, pH and many other factors.
  • Propel the fertilized embryo into the uterine cavity.
How is a blocked Fallopian Tube diagnosed? Is Laparoscopy better than HSG ?

Tubal Patency is diagnosed by the following methods:

HSG – Hysterosalpingography

To know more about the procedure, please visit the link. The following figure shows how an HSG Report looks when:

  • One tube is blocked  – Unilateral Cornual Block (Spillage of dye on one side only)
  • When both tubes are Patent or Normal (free spillage of dye on both the sides)
  • When both tubes are Blocked – Bilateral Block (No spillage of dye on both sides)
Diagnostic Laparoscopy 

To assess tubes, Laparoscopy is considered to be the gold standard technique. However, in some cases, HSG may be the first investigation performed for tubal assessment.

Other less frequently performed tests for assessing tubal patency are: 

Saline infusion sonohysterosalpingography (SIS):

This is done by introducing saline into the uterine cavity and fallopian tubes and performing an ultrasound scan simultaneously. The procedure is aslo named Saline infusion HSG.

Hystero-contrast sonography (HyCoSy):

Ultrasound contrast agents are used for tubal assessment using contrast mode. This shows the passage of hyperechoic contrast agent through tubal lumen and delineates it and locates the site of block or constriction. Results of HyCoSy have been found to correlate well with laparoscopic findings, better than SIS but more expensive than HSG.

 
What are the causes of Blocked Fallopian Tubes ?

Most common cause of blocked fallopian tubes is an infection, or what is commonly referred to as Pelvic Inflammatory Disease (PID). Various organisms cause infections of the genital tract, Chlamydia and Tuberculosis being the commonest.

Other causes of blocked fallopian tube include Surgery on or around tubes, Endometriosis, Fibroids, Past history of ectopic pregnancy, past history of tubal sterilization operation etc.

 
Can I conceive with blocked fallopian tubes ?

If one tube is blocked and the other tube is open and functioning normally, natural conception is possible. However, if both tubes are blocked, it is very unlikely to conceive spontaneously. If at all one does conceive naturally in spite of blocked or bad tubes, there could be a very high index of suspicion for Ectopic Pregnancy.  

 
Can blocked fallopian tubes be opened by surgery ?

In cases where obstruction is because of kinking of tube which is because of adhesions outside the tubes, Laparoscopic Surgery gives very good results. Other cases where Laparoscopy can successfully treat blocked tubes are Tubal Recanalization, Post Tubal Ligation, Myomectomy when fibroids block fallopian tubes, adhesiolysis of endometriotic adhesions etc.

Hysteroscopic cannulation is also done for blocked fallopian tubes when the block is proximal  and at the cornual (near the uterus) region of fallopian tube.

In some cases, blocked fallopian tubes cannot be opened with Laparoscopy or Hysteroscopy. In these cases, IVF or adoption is the only available option.

 
Can IUI be tried in case of blocked Fallopian tube ?

No. One of the main functions of the Fallopian tube is to facilitate the passage of sperms towards the ovum, hence in case of blocked tube, there is no point in attempting IUI as the chances of fertilization will be very negligible.

 

What are the treatment options for blocked fallopian tubes ?

If tubes are irreversibly blocked, IVF or IVF ICSI solves the problem by bypassing the fallopian tubes.

Even if the tubes are blocked, IVF ET is successful as fertilization is done outside the body (In the IVF Lab) and the embryo or blastocyst is transferred directly into the uterus. The functions of fallopian tube are carried out in the IVF Laboratory in petri dishes, test tubes and incubators and therefore IVF is also called test tube baby. To know more about IVF please read the related link .

What are my chances of conception using IVF in case of blocked fallopian tubes ?

Blocked Fallopian tubes are like silver lining to the cloud of infertility. A diagnosis of blocked fallopian tube comes as a relief as compared to couples facing Unexplained Infertility. It usually means that both the partners have high chances of  having normal eggs and sperms, and attempting IVF has high chances of success in such cases. To know more about IVF Success Rate and reasons for IVF Failure please read our blog.

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