Dr. Gunasheela Gynaecologist & Obstetrician, Chairperson Of The Indian Branch Of Royal College Of Obstetricians And Gynaecologists Of U.K.

What Is Tubal Infertility?
Can It Be Reversed?
How Is It Diagnosed?
What Is The Treatment?
Gynaecologist and Obstetrician Dr. Sulochana Gunasheela gives the answers…

Got A Query?

All About Tubal infertility…

That cause of tubal infertility is one of the most undesirable problems. Roughly about 12% of infertile couples have their problems attributed to tubal pathology. Blockage of tubes produced by operative interference for the sake of family planning is reversible provided the segment of the tube removed is at optimum position and length. On reversing the blockage, one can expect 80 – 85% spontaneous pregnancy. But tubal infections causing tubal blockage can very rarely be reversed. One must understand that the tube is not just a conduit for the passage of sperm and ova. The tube at the uterine end has the function of selecting suitable spermatozoa by forming a bottleneck at that position. The sperm population deposited in the upper end of the vagina goes on dwindling as the spermatozoa moves towards the tube. If there are 100 million sperm deposited at the top end of the vagina during sexual intercourse, hardly 2 to 3 hundred sperm reach the middle of the fallopian tube. The tube has the function of picking up the ovum from the ovary at its distal end. The ovum lingers in the dilated free end of the tube, for a day during which time the sperm swim up against the current produced by the hairy lining of the fallopian tube. The sperm should reach the ovum before the ovum gets aged and for the union between the sperm and ovum to take place. The fertilized ovum now called as the pre-embryo gets propelled towards the uterine cavity, the propulsion being assisted by the ciliary movement of the tubal lining and the tubal wall. This movement of the tube is called peristalsis.

How Does A Fallopian Tube Get Damaged?

When a tube is diseased, the cilia of the tubal lining gets destroyed. The tube becomes rigid because of inflammatory scarring and peristalsis also disappears. This is the reason when the patency of a diseased tube is reestablished, it may still be of no value. On the other hand, it may even become a dangerous structure. Even with partial patency and altered functional capacity of the tube, the sperm and ovum meet each other and form an embryo. But the tube may not be capable of propelling the embryo into the uterine cavity. The fertilized ovum continues to grow in the lumen of the tube forming a tubal pregnancy. This can even be a life threatening condition because the tube might rupture as the pregnancy grows, causing a serious haemorrhage in the peritoneal cavity.

Tubal obstructive disease may be caused by sexually transmitted diseases and the organisms responsible are gonococci, chlamydia, mycoplasma etc.

Diagnosis Of Tubal infertility

Tubal patency tests are several. One can introduce a radioactive dye into the lower end of the uterus known as cervical canal. As the dye fills up the uterus and enters the tube on either side and overflows from the free end of the tube (distal end) one can take x-ray pictures. This is known as x-ray hysterosalpingography. Many a time the patient is tense either because of fear or pain. The tube gets into spasm and the dye may not be passed into the tubes even if they are patent. When hysterosalpingography does not show patency, one can do a laparoscopic examination. During laparoscopy, one can introduce a thin telescope through a small keyhole incision into the abdominal cavity and focus on pelvic organs. The assistant instills a watery solution containing a bluish dye through the lower end of the uterus and forces the solution through the tubes. The dye coming out from the free fimbrial end can be seen through the telescope. This method of testing the tubal pathology is superior to x-ray examination because the tube can be visualized along its entire length from one end to the other. The proximity of the tubal fimbria to the ovary can be ascertained and tubal mobility can also be checked. In the process, any other problem or evidence of disease process in the pelvic cavity can also be recognised.

During laparoscopy, one can conduct some therapeutic (curative) procedures as well. For eg, the tubes which are fixed by adhesive bands can be released. The fimbrial portion of the tube sometimes gets clumped together losing the function of its free tentacles. These can be released and a new fimbria reconstructed. This is the advantage of laparoscopy as against hysterosalpingography, but laparoscopy would still be considered an invasive procedure and it should be done only if the hysterosalpingography does not show the tubal patency.

Treatment

When the tubes are hopelessly damaged, the patients can be taken up for invitro fertilization (test tube baby) treatment. The test tube baby procedure consists of collecting the ova from the ovary, fertilizing them outside the body and the embryos so formed introduced directly into the uterine cavity, completely side tracking the fallopian tubes.

Dr. Gunasheela particularly focuses on the study of infertile couples. Equipped with her own laboratory in Bangalore, the Gunasheela Institute of Research in Reproduction, she has developed the Assisted Reproductive Technology (ART). She has received international acclaim for in-depth knowledge and research on infertility. She is the Chairperson of the Indian branch of Royal College of Obstetricians and Gynaecologists of U.K. and a member of the Advisory Board of National Academy of Medical Sciences, New Delhi. Further, she is an "Expert Member for Accreditation of Units involved in ART" on the Indian Council of Medical Research, New Delhi.

Did you find this column useful? Write a review or send in your. Click here
 

Other Articles By Gunasheela

Age and Infertility-How old is too old?
Infertility : Myth v/s Reality
Making  Sense Of Menopause
Postmenopausal Therapy
Stressed Out Over Infertility
Understanding ART- Solutions For Infertility
Unexplained Infertility
Your Guide To Infertility Treatment