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Tubal Factor Infertility
Tubal disease, a disorder in which the tubes are blocked or damaged, is responsible for approximately 25 percent to 35 percent of all female factor infertility. Tubal factor infertility is defined as any anatomic abnormality that prevents the sperm and egg from uniting.
Types of Tubal Disease
Tubal disease can be caused by infections or other conditions. Scar tissue can result from endometriosis, previous surgery, ruptured appendix or other trauma. Pelvic inflammatory disease (PID), caused by sexually transmitted diseases, such as chlamydia, that goes undiagnosed and treated, can also cause damage.
Types of tubal conditions include:
- Proximal tubal occlusion in which the sperm is prevented from reaching the portion of the fallopian tube where fertilization normally occurs
- Distal tubal disease in which a woman can have disease ranging from mild adhesions to a complete blockage.
- Hydrosalpinx is a fallopian tube that is filled with fluid. It is caused by an injury to the end of the tube, which causes the end to close. Glands within the tube produce a watery fluid that collects within the tube and produces swelling.
Diagnosing Tubal Factor Infertility
Even if one of these tests finds that the fallopian tubes are "patent" (open), that does not mean that tubal function is normal. Tubes that are open, but have scarring may not be able to perform all the necessary functions such as egg pick-up, egg transport, fertilization and embryo transport from the fallopian tube to the uterus.
Treating Tubal Factor Infertility
The treatment for tubal factor infertility is usually either surgery or in vitro fertilization (IVF), a treatment option that bypasses the fallopian tubes; however, there is not a lot of research comparing pregnancy rates with tubal surgery vs. IVF. In addition, the surgical options to open fallopian tubes vary depending on the location of the obstruction.
In early 2012, the Practice Committee of the American Society for Reproductive Medicine assessed optimal treatment methods for tubal factor infertility and issued a Committee Opinion: Role of Tubal Surgery in the Era of Assisted Reproductive Technology, with the following conclusions:
- There is good evidence to support HSG as the standard first line test to assess tubal patency, but it is limited by false positive diagnoses of proximal tubal blockage.
- The evidence is fair to recommend tubal cannulation for proximal tubal obstruction in young women with no other significant infertility factors.
- The evidence is fair to recommend laparoscopic fimbrioplasty or neosalpingostomy for the treatment of mild hydrosalpinges in young women with no other significant infertility factors.
- There is good evidence for recommending laparoscopic salpingectomy or proximal tubal occlusion in cases of surgically irreparable hydrosalpinges to improve IVF pregnancy rates.
When deciding upon treatment for tubal factor infertility, talk with your fertility doctor about the pros and cons of surgery vs. IVF. Factors to consider include your age, ovarian reserve, the number and quality of a partner's sperm, the number of children desired, the site and extent of tubal disease, the presence of other infertility factors, the risk of ectopic pregnancy and other complications, the experience of the surgeon, the success rates of the IVF program, cost and your preference.