Tubal Disease: Diagnosis, Treatment, Types & its Treatment
What is Tubal Disease?
Tubal disease is a medical condition where the fallopian tube, which is a component of the female reproductive system, gets damaged or becomes blocked. Tubal disease is the common cause of infertility in women. There are many reasons for blockage of fallopian tubes, such as endometriosis, infection, prior pelvic surgery or some unexplained causes.
How is Tubal Disease Diagnosed?
Radiologic procedures such as hysterosalpingogram (HSG) are done to look for abnormalities in the fallopian tubes. Tubal abnormalities if found on the hysterosalpingogram or if the hysterosalpingogram findings are inconclusive, then in such cases laparoscopy is done to definitively diagnose and also in some cases to treat the tubal disease.
How is Tubal Disease Treated?
Treatment of Tubal Disease depends on its cause, whether or not the underlying condition is treatable, the preference and the goals of the patient.
What is the Role of In Vitro Fertilization (IVF) in Tubal Disease?
If the tubes are damaged or blocked beyond repair and the patient cannot have kids, then IVF is usually the method which is needed to achieve pregnancy. During an infertility investigation, if the blocked tubes are the only abnormality found, then the mother has a very good chance of pregnancy with in vitro fertilization.
What are the Different Types of Tubal Diseases & How are they Treated?
Proximal Tubal Occlusion
In Proximal tubal occlusion, the fallopian tubes get blocked where they join the uterus.
Causes of Proximal Tubal Occlusion: Some of the causes of Proximal Tubal Occlusion are fibroids, mucus plugs, endometriosis, inflammation or scarring.
Diagnosis of Proximal Tubal Occlusion: Diagnosis of Proximal occlusion is often made by hysterosalpingogram. However, if the fallopian tubes are examined via laparoscopy, then many women who are diagnosed with proximal tubal occlusion on hysterosalpingogram will have normal tubes on laparoscopy.
Treatment of Proximal Tubal Occlusion: For diagnosing and treating proximal occlusion of fallopian tube, a blue dye is injected into the uterus under higher pressure while the patient is under anesthesia. If the proximal occlusion is still seen in the fallopian tubes, then a surgical procedure, called hysteroscopic cannulation, is done to repair the proximal occlusion of fallopian tube.
Hydrosalpinx is a condition where the distal end of the fallopian tubes is blocked, i.e. the end where the tubes connect with the ovary. If both the fallopian tubes are blocked in this manner, then it is almost impossible to get pregnant naturally.
Treatment: Treatment of Hydrosalpinx depends on what the patient wants. Neosalpingoscopy is a laparoscopic surgical procedure which creates a new opening at the distal end of the fallopian tube. Whether this treatment is successful of not depends on the surrounding scar tissue, degree of the dilation; and if barring this, the fallopian tube is otherwise normal.
IVF in Hydrosalpinx: Despite everything, many patients with Hydrosalpinx ultimately need to undergo IVF procedure if they want to get pregnant, because there is a chance of re-occlusion of the dilated and scarred fallopian tubes even after they are surgically opened. Unfortunately, most of the women having hydrosalpinx cannot directly move onto IVF without having to undergo a surgery first. As the fluid present in tubes is unable to drain out the far end, it moves back into the uterus. This backwards flow of the fluid harms the embryos and changes the lining of the uterus and makes it less hospitable to an embryo.
Success Rate of IVF in Hydrosalpinx: According to research, hydrosalpinx cuts the success rates of IVF by nearly 50%. For this reason, surgery is recommended to remove the tubes or open the tubes first before starting IVF to increase the IVF success rate.
Salpingitis Isthmica Nodosa (SIN)
Salpingitis Isthmica Nodosa is a type of proximal tubal disease which is difficult to treat and therefore deserves a special mention.
Causes of Salpingitis Isthmica Nodosa: The exact cause of Salpingitis Isthmica Nodosa is not known; however, prior inflammation in the tube and endometriosis are thought to be related to Salpingitis Isthmica Nodosa.
Diagnosis of Salpingitis Isthmica Nodosa: Hysterosalpingogram done on patients with Salpingitis Isthmica Nodosa typically will reveal images of "cauliflower" lesions, which are the out-pouching of the fallopian tubes. Fallopian Tubes which are affected by Salpingitis Isthmica Nodosa are usually tough and thick when examined via laparoscopy.
Risks with Salpingitis Isthmica Nodosa: Women suffering from Salpingitis Isthmica Nodosa are at increased risk for ectopic pregnancy and infertility. IVF is commonly recommended for patients suffering from Salpingitis Isthmica Nodosa.
Sterilization or Tubal Ligation
If the fallopian tubes are blocked via a prior sterilization procedure by the patient's choice and if the patient wants to have more children then there are 2 options for the patient. First is tubal ligation reversal and the second is In Vitro Fertilization. The insurance usually does not pay for tubal reversal surgery.
Tubal reversal surgery is considered in women who are:
- Under the age of 35.
- Who have a normal ovarian reserve testing.
- The partner should have a normal sperm count
Success Rate of Tubal Reversal Surgery: If the sterilization is done using Filshie clip, Falope Ring, Hulka clip or Pomeroy technique, then the chances of a successful surgical repair are good.
Women who have had fimbriectomy, where the ends of the fallopian tubes are removed; and women whose tubes were coagulated (burned) have less chance of success with a tubal reversal surgery.
Brief Summary Points about Tubal Disease
- Tubal disease is a disease where the fallopian tube becomes damaged or blocked.
- Tubal disease is a common cause of female infertility.
- There are various causes for tubal disease including infection, endometriosis or surgical damage to the tube.
- Some of the types of tubal disease include Hydrosalpinx, Salpingitis Isthmica Nodosa, Proximal Tubal Occlusion and blockage of fallopian tubes from tubal ligation or sterilization.
- The treatment for tubal disease depends on its cause and the patient's goal.
- Tubal disease can be corrected in many ways. If the aim of the patient is to get pregnant, then In Vitro Fertilization (IVF) gives the best chance for achieving pregnancy.
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