Once the eggs mature and are ovulated, they travel from the ovary, through the fallopian tube, to the site of fertilization at the end of the tube. Eggs must be able to make their passage without obstruction.
Tubal disease results when the fallopian tubes are
damaged, or obstructed, thus impeding egg transport.
There are many potential causes of tubal disease including
endometriosis, scarring from previous surgery, severe
pelvic infections, or it can be congenital. Endometrial
implants can attach to the tubes, grow, and even
penetrate the tubal structures.
The hysterosalpingogram
(HSG) is a common fertility test used to rule
out tubal disease. The HSG is an outpatient procedure
involving injecting radio opaque dye into the uterus
and observing its passage through the uterine cavity
and fallopian tubes using x-rays. If there is a blockage
in the tube(s), the dye cannot pass and this is clearly
visualized. Deformities in the uterus can also be
detected by this technique.
Some women seek reversal of a previous
tubal ligation (cut tubes) performed for birth control.
Sometimes the tubes can be reconnected be a skilled
surgeon, depending upon how and where they were cut,
the presence of scar tissue and other factors. In
vitro fertilization is an option for these couples
since the eggs are retrieved surgically and don’t
have to make the passage through the fallopian tubes.
Per cycle success rates are higher using IVF in most
couples. Even though pregnancy is possible after a
tubal ligation, the procedure should be considered
a permanent means of birth control.
In many cases, the tubes are severely
damaged making IVF
the only effective treatment option. The eggs are
retrieved directly from the ovaries and fertilized
in the laboratory, which eliminates the need for tubal
egg transport. Success rates using IVF are typically
higher than tubal reanastamosis. This depends upon
many factors including, other causes of
infertility that may be present, age
of the female, treatment history, and other variables.
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