Blockage of tubes.Does it sound familiar.Well you might have come across the term on one of the so many infertility help groups or blogs or Google in general where a female might have mentioned it as her cause of infertility.
What tubes do? They carry the egg released from the ovary in the tube where it gets fertilised by the sperm and moves into the uterus.If tubes are blocked this essential step won’t happen normally in the body.Why tubes get blocked.Most of the time we don’t find a reason but the common ones are previous pelvic infections.In India pelvic Tuberculosis is a common condition but still not as common as suspected by the IVF specialists.Other infections can be chlamydia or other sexually transmitted infections and the disease called endometriosis.
There are many such stories to talk about but I will choose one such case history randomly to make you understand more about tubal factor in Infertility.
A couple came to me for infertility investigations.What I found on Sonosalpingography i.e passing the saline through the tubes while observing it with an ultrasound machine that the tubes were bilaterally blocked.So now if there is a block ,what do you do?
Open the tubes or proceed for IVF where you bypass the need of tubes by fertilising the eggs outside the body.Of course I got her tested for genital tuberculosis as well as gave her azithromycin tablet just incase she had Chlamydia( After all a tablet of Azee comes cheaper than the test for Chlamydia).So there was no evidence of genital tuberculosis .
In modern day infertility treatment tubal surgery unless very minimal has got no role.Opening of tube doesn’t mean that the doctor has been able to restore the normal functioning as well as structure of the fallopian tube.Which would simply mean that you are not sure even if the doctor has opened the tube still you will get pregnant or not.There is also an increased chance of Tubal or ectopic pregnancy.So no doctor who follows evidence based medicine will give you an option of ‘opening the tube’.
The more realistic and cost effective treatment is IVF.Only 35 % but still it is a realistic option of conception per cycle.Even in IVF there is 4% increased chance of ectopic pregnancy that spontaneous conception but still it is better option than a tubal surgery any day.
Now this couple insisted upon tubal surgery and I did perform a hysteroscopic cannulation and laparoscopic fimbrioplasty.It opened one side of the tube.But was it the correct treatment.No it wasn’t. At least it isn’t the evidence based option.If I think in terms of my monitory benefit it is all good but probably that wasn’t the idea.the idea was to help them conceive.But who knows whats in store for her.miracles happen and if by chance the sperm sneaks in through that tube it was the wisest decision on part of the couple.If they failed or if she has an ectopic pregnancy,few more years would be wasted.Eggs would be little more old.More chance of having aneuploidy and chromosomal defect.Poor IVF response and if she conceives more chance of miscarriage.
Fingers crossed and let me hope she conceives.