Ask The Experts - Blocked Tubes
Pacific Fertility Center Team Left to Right: Front: Philip Chenette, MD, Isabelle Ryan, MD, Carolyn Givens, MD Back: Joe Conaghan, PhD, Carl Herbert, MD, Eldon Schriock, MD
Question: My doctor says I have blocked tubes. What causes this and what treatment options are available?
Answer: A blocked fallopian tube is a common cause of infertility. The fallopian tube is the harvester of the egg, floating over the surface of the ovary, picking up the egg after it is released. Sperm meets the egg in the outer one-third of the tube. If the tube becomes blocked, the egg may not be picked up, the tube may not transport sperm, and pregnancy will not occur.
Tubal blockage can occur from infection, such as chlamydia, gonorrhea, appendicitis, or tuberculosis, from an abnormal pregnancy, an ectopic pregnancy, or from surgery, as in a tubal ligation, when the tubes are intentionally tied to prevent pregnancy.
New easier procedures have been developed to improve pregnancy rates in women with tubal blockage. In the past, surgery was performed to fix the fallopian tubes, but these procedures are now rare. Today, techniques like tubal cannulation for proximal tubal occlusion, and salpingectomy for distal tubal occlusion are more often used. The choice of procedure depends on the location of the blockage.
Proximal tubal occlusion (PTO) is the blockage of the fallopian tube at its connection to the uterus. On a hysterosalpingogram, the uterine cavity can be imaged, but the opening to the fallopian tube appears only as a small dimple. PTO is commonly caused by muscular spasm in response to the test but often is an indicator of inflammation of the fallopian tube.
PTO can be treated with tubal cannulation, in which a small tube or wire is used to open the connection to the tube. This procedure can be done on an outpatient basis, using a fluoroscopy, an x-ray technique, or through hysteroscopy, a minor surgical procedure in which a narrow viewing tube is placed into the uterus for a direct look inside.
Hydrosalpinx creates problems for patients undergoing in vitro fertilization (IVF). These blind pockets of fluid sometimes will leak their contents into the uterus, interfering with embryo implantation. Toxic effects on both the uterine lining and the embryo can result. In patients undergoing IVF, the chance for pregnancy if a hydrosalpinx is present drops by 50%. In addition, there is a higher risk of miscarriage and ectopic pregnancy.
Removal of the fallopian tube is a simple laparoscopic procedure that improves pregnancy rates with IVF. The procedure can be performed in under an hour, under anesthesia, as an outpatient procedure. Pregnancy rates with IVF are dramatically improved after removal of the fallopian tube.
PFC's doctors are pioneering other techniques for treatment of tubal blockage that do not require surgery, such as Essure. Essure is a small micro-insert that is inserted into the fallopian tube under hysteroscopy. Without using an incision, the problem tube can be treated, and IVF performed.
Thankfully, medical advancements designed to treat blocked tubes have demonstrated significant success, helping many patients have a successful pregnancy when they otherwise might not have.
-- Philip Chenette, M.D.
Blocked Tube & Open Tube Pregnancy Rates Women with blocked fallopian tubes on average have better embryo quality than those with open tubes. Since there is an obvious single barrier to pregnancy, the chance of problems with eggs and sperm is lower. Patients with tubal blockage cannot conceive on their own, but with treatment can carry and deliver a pregnancy at excellent rates.