Tubal (Fallopian) Factor Infertility
Once ovulation occurs the egg enters the fallopian tube where it must travel unobstructed to the uterus. Fertilization occurs at the end of the tube where it opens into the uterus. The fallopian tubes can become blocked as a result of endometriosis, adhesions, infection, scarring from previous surgery, congenital defects, or they may have been “tied” for birth control. Tubal damage is usually diagnosed by a hysterosalpingogram or laparoscopy.
Endometriosis can adhere to the tubes causing penetration and obstruction. In “mild” cases, medical intervention with medications such Lupron may be effective, however, laparoscopic surgery is usually the best treatment option. Severe bacterial infections (pelvic inflammatory disease) which are usually caused by Chlamydia or gonorrhea can cause serious damage to the tubes and other reproductive organs. These infections must be treated aggressively with antibiotics to avoid complications such as scarring.
Many women who elected to have their tubes tied as a means of birth control seek to have the procedure reversed. While this is often possible, tubal sterilization is considered a permanent form of birth control. Whether or not the tubes can be reconnected depends upon many factors including where and how they were cut and the degree of scarring. Tubal surgery is very delicate and should only be performed by a reproductive surgeon with advanced training in microsurgery.
In many cases, IVF is the first line treatment for tubal disease because the tubes are bypassed insuring that the sperm and eggs meet and fertilize. Per cycle success rates using IVF are higher than those after tubal anastomosis. However, some couples cannot afford more than one IVF cycle whereas the number of attempts after tubal anastomosis is unlimited.
The surgery is usually performed in “younger” females who have many reproductive years remaining to attempt pregnancy. Older females, who have declining ovarian function, cannot afford to attempt multiple natural cycles after tubal surgery. Ovarian function can decline very rapidly and the best option for these women is IVF. Dr. Deaton performs tubal anastomosis when the likelihood of success is good and the couple chooses the procedure.