Common Causes of Infertility

Blocked Fallopian Tubes and treatment at IVF Clinic, Delhi

What are Fallopian tubes ? 

The Fallopian tubes are hollow tubular structures, one end of which is attached to the fundus of the uterus and the other end is free and floating near the ovary. They transport the egg or ovum released from the ovary to the uterus.
What are Blocked Fallopian tubes ?

A blocked tube or tubes can be a common cause of infertility in women. About 20% of female infertility can be attributed to tubal causes.

What are the causes of blocked Fallopian tubes ?

A blocked fallopian tube can be caused by pelvic inflammation, endometriosis or other conditions affecting the pelvic area. Pelvic inflammatory disease (PID) is the most common cause of tubal blockage. The rate of tubal infertility has been reported to be 12% after one, 23% after two, and 53% after three episodes of PID. Other infections that may occlude or disable the tube include endometritis, infections after childbirth or abortions and intraabdominal infections including appendicitis and peritonitis. The formation of adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. Tuberculosis is a common cause of tubal infection and blockage in developing countries like India.

Fallopian tubes are often blocked iatrogenically as a method of contraception. In these situations tubes tend to be healthy and typically patients requesting the procedure have had children. While tubal ligation is considered a permanent procedure, some patients later regret their decision and want the procedure "undone".

In which places can the tube be blocked ?

Depending on the site at which the tube is blocked, tubal blockage is classified into
Distal tubal occlusion (affecting the end towards the ovary) is typically associated with hydrosalpinx formation and often caused by Chlamydia trachomatis. Pelvic adhesions may be associated with such an infection. In less severe forms, the fimbriae may be aggluntinated and damaged, but some patency may still be preserved.

Midsegment tubal obstruction can be due to tubal ligation procedures as that part of the tube is a common target of sterilization interventions.

Proximal tubal occlusion can occur after infection such as a septic abortion. Also, some tubal sterilization procedures such as the Essure procedure target the part of the tube that is close to the uterus..

How can I find out if my Fallopian tubes are healthy and not blocked ?

While a full testing of tubal functions in patients with infertility is not possible, testing of tubal patency is feasible. A hysterosalpingogram(see tests for female infertility) will demonstrate that tubes are open when the radioopaque dye spills into the abdominal cavity. Sonography can demonstrate tubal abnormalities such as a hydrosalpinx indicative of tubal occlusion. During surgery, typically laparoscopy, the status of the tubes can be inspected and a dye such as methylene blue can be injected in a process termed chromotubation into the uterus and shown to pass through the tubes when the cervix is occluded. Laparoscopic chromotubation has ben described as the gold standard of tubal evaluation. As tubal disease is often related to Chlamydia infection, testing for Chlamydia antibodies has become a cost-effective screening device for tubal pathology.

What is a Hydrosalpinx ?

A hydrosalpinx is a term referring to a fallopian tube that is blocked and filled with fluid. This fluid can cause the fallopian tube to swell up and dilate to a larger size than it was meant to be. Removal of the blockage can be necessary to save the fallopian tube and possibly restore fertility.

Many women are unaware that they have a hydrosalpinx until they seek infertility treatment by an infertility specialist. In the diagnostic phase of infertility treatment, a hysterosalpingogram (HSG) test or ultrasound can show the hydrosalpinx. Laparoscopy is also used for many infertility problems and a hydrosalpinx may be discovered during an unrelated or exploratory laparoscopic procedure.

What are the treatments available for blocked Fallopian tubes ?

1. Tuboplasty is a surgical technique used to restore patency to the tubes and thus possibly normal function. Different types of tuboplasty have been developed and can be applied by laparoscopy or laparotomy. They include lysis of adhesions, fimbrioplasty (repairing the fimbriated end of the tubes), salpingostomy (creating an opening for the tube), resection and reananstomosis (removing a piece of blocked tube and reuniting the remaining patent parts of the tube), and tubal reimplantation (reconnecting the tube to the uterus).
Results of tubal surgery are inversely related to damage that exists prior to surgery. Development of adhesions remains a problem. Patients with operated tubes are at increased risk for ectopic pregnancy.
Surgical repair of fallopian tubes that have been occluded by a sterilization procedure generally have good success rates provided enough healthy tubal tissue is present for the surgeon to perform a tubal reversal.

2. Hysteroscopic tubal recanalisation helps overcome proximal tubal occlusion

3. In vitro fertilization is used to overcome tubal infertility as it is more cost-effective, less invasive, and results are immediate. (See IVF). After stimulation of ovarian follicles, egg cells are removed via a sonographic directed vaginal puncture into the ovary, these eggs are fertilized outside the body, and the resultant embryo placed transcervically into the uterus; - the tubes are bypassed in this process.

While IVF therapy has largely replaced tubal surgery in the treatment of infertility, the presence of hydrosalpinx is an detriment to IVF success. It has been recommended that prior to IVF, laparoscopic surgery should be done to either block or remove hydrosalpinges as the fluid in the tube can leak into the uterine cavity having detrimental effects on implantation of the pregnancy. The affected tube or tubes are sometimes completely removed or cut free from the uterus to improve the success rates of IVF attempts.

Blocked Fallopian Tubes test at IVF Clinic Delhi

At IVF Clinic Delhi we assist patients with the dye tests.



Letters to Dr. Richa Katiyar regarding blocked Fallopian tubes

Hello doctor,

I am Rashmi form Dehradun. I am 28 and married for last 8 years. My husband is of 30 years. We had been trying to have baby but could not. We consulted a doctor in Mussorie in June of 2012. Then there was an Laparoscopy and doctor found that my one tube is blocked and another one is partially block, but the main problem she diagnosed is that both tube were too short, near about 4 cm (thats what she mentioned). Then in the month of August we tried an failed IVF as doctor suggested. Afterwards surprisingly in the month of October same year, I had an normal pregnancy, but after nine weeks as there was no pulse/ heart beat that was aborted (with medicine).

After that last year I went to England with my husband where we stayed 5 month. There we consulted the doctor, after having x ray she told my both fallopian tubes are now blocked but they are in normal size. However now I am very frustrated and please suggest me what should I do. I will be waiting for your reply. Thanks.
Dear Rashmi,

Sorry to learn that you are having problems in conceiving. If currently both the tubes are blocked, then it will be best for us to do IVF for you. Before that, I would like to do a few blood tests like LAC, ACA, GCT to find out why the pregnancy which happened spontaneously did not grow well. Thankfully your age is very good and we can expect a good result with the IVF.

Feel free to contact me for further queries.

Best regards,
Dr. Richa Katiyar


Good Day Ma’am

I am a lady, who is 38 years old. I have been married to 10 years. I felt pregnant in 2005, and unfortunately i had a miscarriage. In 2008 i felt pregnant again for the second time, this time i had a ectopic pregnancy. The child was on my right side of my fallopian tube. There was no chance for a child to survive or grow. An operation was done to remove the fatuous. My right fallopian tube was closed. In 2011, left side of my ovary had semi solid cyst, it was removed at SGRH in 2012. My left ovary was infected; it was also removed with the cyst.
My question- My right ovary is producing eggs but it does not come to the womb. Is it possible for me to take ovulation tablets hence to increase the production of eggs in the right side of the ovary? And on maturity, harvest it from a small incision on the right my ovary to remove the mature eggs because the fallopian tubes are blocked. Hence, taking and fertilizing the egg in the test tube and inserted in my womb at the correct time.

I am not a professional person in this field, as I am living in Jamaica I request you to advise me on the different types of tests to be done in Jamaica, so that when I come to India, it would not waste our time, my procedure to becoming pregnant to be started. I have only three weeks holidays during the month of December to do this, as I am lady from New Delhi who is living in Jamaica with my husband.
Hoping to receive a positive response

Yours sincerely
Patricia

Dear Patricia,

Sorry to learn that you are having difficulty in getting pregnant.

You are welcome to come to New Delhi, India to get IVF treatment done. In this treatment, there is no use of the Fallopian tubes so it is the right treatment for you.

If it is possible to get a few tests done in South Africa, then i will recommend that you get the following done and email me the reports:

AMH (anti muellerian hormone)- blood test
S. TSH- fasting- blood test
Blood Sugar- fasting- blood test
Ultrasound pelvis
Husbands semen analysis.

When did your last menstrual cycle begin?

Feel free to contact me for any further queries.

Best regards,
Dr Richa Katiyar


Dear Dr Richa,

I want to ask you if there is anyother way to have pregnancy apart from IVF; We don't want that process of fertilazation outside the Womb.

Is it posible to insert Sperm direct to the Womb with Syringe or any other way?

Please advise if you have any other better way to do it. Eg Inserting the Sperms to the Tube etc.
Just to remind you my Follopian Tubes are Blocked, one of them partially. If you have any better way I am ready to travel with my Husband to your Clinic.

Thanks.
Judy

Dear Judy,
Has any Doctor ever attempted to open your Fallopian tubes by a process called laparoscopy? Many types of blocked tubes are amenable to treatment and can be successfully opened while many types of blocks cannot. it mainly depends on where the block is situated. If we are able to open the tubes, then we do not need to go in for Test tube baby.

Can you scan and send to me your HSG (Tube test) report/ any other report where the blocked tubes have been diagnosed. Also i want to know your age.

Feel free to contact me for further queries.

Best regards,
Dr. Richa Katiyar



Hello Doctor,

I want to consult with you about my treatment. Firstly want to inform you my treatment history that in 2006 have a laporscopy to open my two tubes's mouth because both were block. In 2009 have a Mymectomy to remove my tumare from my uterus and then remove one ovary and one felipon tube because they were very effected by sist. In 2010 have also another mymectomy to remove my other felopine tube which was in very bad condition for sist. Then I try for IVF in 2011 but it was cancelled because i have no egg, for this doctor cancelled my cycle. I tried in two time in 2011 but all were cancelled. After a long rest I was go to Dr. again. My Doctor suggested me "Tab. Fartinatal" (made by USA) in 3 time in a day for 3 month. After complete my medicine course doctor found two egg. With two egg my doctor try for IVF and one was fertile and indues that in my uterus but my bad luck............
It is my treatment history. I am 39 years old and currently my period is regular and also my husbands semin test report is very fine. I am a working lady.
Now I want to try for IVF again and want your suggestion about my successes rate and then I will take decision for treatment under you or your clinic. Please ................... Thank you.
Dear Farah,

Sorry to learn that you are having difficulty in having a baby. As there are not very good eggs, you have got best chances with egg donation IVF. That will give success rates of bout 75%.

Regards,
Dr. Richa



Hi Richa,

Before I begin I would like to tell something about me and how I came to know about you.

My name is Sukhmani and I am 29 yrs old. I have been married since 2009. I had been surfing the net in search of a solution to my infertility and reached your website.

I have been trying to get pregnant since early this year however in vain. After going through several tests and consultations with doctors i have concluded that:

1. My left Fallopian tube is blocked due to the complications subsequent to my operation for removal of fibroid in my uterus in the year 2006. This has been confirmed by x-ray reports.
2. Rest all seems to be fine as the follicular study reveals that the growth of the follicles is always in line with cycles days in terms of sized and form. Latest study done on and after CD08 revealed the following:

CD08: Right Ovary: 3-4 follicles 13mm Left Ovary: 6-7 follicles 17x15x15mm Endometrium: 5.0mm trilamirar
CD10: Right Ovary: 15x15x15mm Left Ovary: 18x16x18mm Endometrium: 8.8mm trilamirar
CD12: Right Ovary: 15x15x15mm Left Ovary: 20x22x20mm Endometrium: 8.9mm trilamirar

Well that's all I wanted to add. I have written this mail as I find it very comfortable and convenient. I would be very grateful to you if your kind self and revert and suggest me an appropriate treatment and I can't afford a costly treatment.

Thanking you,
Sukhmani

Dear Sukhmani,

Sorry to learn that you are having problems in having a baby.

So is your Left tube totally normal?

Is you husbands semen report normal?

What is your ovarian reserve (tests like AMH- anti muellerian hormone) like?

I will make a plan for your treatment once i have this information.

Best regards,
Dr Richa Katiyar


Hi Richa,

Thank you very much for your response and I am very glad that you have responded.

Following are the details you requested:

So is your Left tube totally normal?
My left tube is blocked. However, my right tube is fine.

Is you husbands semen report normal?
My husband's semen count is also normal i.e. 109 million per ml. Active 65%

What is your ovarian reserve (tests lke AMH- anti muellerian hormone) like?
AMH level is 1.28 ng/ml

Hope the above will help us plan the required treatment.

Thanks and kind regards
Sukhmani

Dear Sukhmani,

Even though your right tube is fine, your AMH is pretty low which means that your Ovarian reserve is not so good.

With this kind of AMH value, it is best to proceed directly to IVF instead of trying to open the blocked tube or do IUI with the functioning tube.

Best regards,
Dr. Richa


Dear Dr.

I found your mail through net.
I have attached document of my wife treatment.
At Ganga Ram Hospital Hospital dr. said that we have open both tube by laparoscopy on 2008 but we get not any success last 5 years.

We have one daughter born in village normal delivery 2001

My age 42 years
Wife age 36 years

Pls confirm what is next option for get preg.
Now it is possible for re-laparoscopy treatment of both tube.

If last option is IVF pls let me know.

with regards,
Sandeep Mittal

Hello Mr. Mittal,

Sorry to learn that your wife is having problems in having a baby.

I have read through your email and also seen the attached document. IVF is the best treatment option for your wife as time is not on her side now and the fallopian tubes are also not so good. Thee is no advantage in doing relaparoscopy.

Best regards,
Dr. Richa


Dear Dr. Richa,

I am 42 years old and am going through secondary infertility. My youngest child is 4 years old.
My height is 163cm and weight is 79 kg. I have not suffered from any medical problems earlier, except for some unknown allergic reactions.
My previous pregnancies were NVD with no complications.

However, we have been trying to conceive for one year with no success.
I visited my gynaecologist and she performed the following tests:

a. FSH, TSH: TSH was 6.2 (high)
b. Sonography: All normal
c. T3 T4: Results will be available on 01 Mar
d. Xray HSG: Possible bilateral blockage of tubes
e. Follicle study: Undergoing

My gynaec is recommending that I undergo laparoscopic surgery to open up the tubes and this scares me as I have not had any surgeries before.

I would like your opinion please and if you undertake laparoscopy procedures as well or just IVF.

Thank you.
Pinki

Dear Pinki,

Sorry to learn that you are having difficulty in conceiving.

When I have a patient who has blocked tubes, I need to decide whether doing laparoscopy or IVF is the better option and I decide by doing the blood test called AMH. This tells me the reserve of your ovaries. If this report is good, the I try to open the tubes by lap surgery but if it is not so good, it means time is not on your side and i need to do IVF.

I suggest that you get AMH- anti muellerian hormone test done, anyday, anytime and let me know the report and then we can plan accordingly.

Feel free to contact me for further queries.

Best regards,
Dr Richa Katiyar