Tubal Factor Infertility
The fallopian tubes perform necessary functions such as egg pick-up, egg transport, fertilization, and embryo transport from the fallopian tube to the uterus.
Tubal disease, a disorder in which the fallopian tubes are blocked or damaged, is responsible for approximately 25 to 35 percent of all female factor infertility. Tubal factor infertility is any anatomic abnormality that prevents the sperm and egg from uniting and fertilizing normally, or by preventing the normal transport of an embryo to the uterine cavity.
Types of Tubal Disease
Tubal disease can be caused by infections or other conditions. Scar tissue can result from endometriosis, previous surgery, ruptured appendix, or other trauma. Pelvic inflammatory disease (PID), caused by undiagnosed and untreated sexually transmitted diseases—such as chlamydia—can also cause damage.
Types of tubal conditions include:
Proximal tubal occlusion– the sperm can’t reach the portion of the fallopian tube where fertilization normally occurs.
Distal tubal disease, which ranges from mild adhesions to a complete blockage.
Hydrosalpinx is a fallopian tube that is filled with fluid. It is caused by an injury to the end of the tube, which causes the fringe-like ends of the tube to stick together (agglutinate) and close. Glands in the tube produce a watery fluid that collects within the tube and causes swelling. It is known that the fluid in a dilated tube can be toxic to the embryo and could affect implantation. Studies have shown that it can also cause chronic inflammation of the endometrium or the lining of the uterus, altering early pregnancy processes.
Diagnosing Tubal Factor Infertility
Tubal factor infertility is typically diagnosed with a hysterosalpingogram (HSG), a sonohysterosalpingogram (SSG, or Saline Sonogram) or a Laparoscopy. Even if one of these tests finds that the fallopian tubes are “patent” (open), that does not mean that tubal function is normal. Tubes that are open but have scarring may not be able to perform all the necessary functions.
Treating Tubal Factor Infertility
The treatment for tubal factor infertility is usually surgery or in vitro fertilization (IVF), which bypasses the fallopian tubes. There is not a lot of research comparing pregnancy rates with tubal surgery vs. IVF. In modern reproductive medicine, however, IVF has become the preferred method of treatment in most of the cases of tubal factor infertility due to higher success rates. In addition, the surgical options to open fallopian tubes vary depending on where the obstruction is located.
In 2015, the Practice Committee of the American Society for Reproductive Medicine (ASRM) assessed optimal treatment methods for tubal factor infertility and issued an opinion on tubal surgery. They came to the following conclusions:
- There is good evidence to support HSG as the standard first line test to assess tubal patency, but it is limited by false positive diagnoses of proximal tubal blockage.
- The evidence is fair to recommend tubal cannulation for proximal tubal obstruction in young women with no other significant infertility factors.
- The evidence is fair to recommend laparoscopic fimbrioplasty or neosalpingostomy for the treatment of mild hydrosalpinges in young women with no other significant infertility factors.
- There is good evidence for recommending laparoscopic salpingectomy or proximal tubal occlusion in cases of surgically irreparable hydrosalpinges to improve IVF pregnancy rates.
When deciding on treatment for tubal factor infertility, talk with your fertility doctor about the pros and cons of surgery vs. IVF.
Factors to consider include:
- your age
- ovarian reserve
- number and quality of a partner’s sperm
- number of children desired
- the site and extent of tubal disease,
- presence of other infertility factors
- the risk of ectopic pregnancy and other complications,
- the surgeon’s experience
- the success rates of the IVF program
- your preference.
Dr. Benjamin Sandler is an assistant clinical professor at the Mount Sinai School of Medicine and attending physician in the division of Reproductive Endocrinology and Infertility at Mount Sinai Medical Center in New York. He is co-director of Reproductive Medicine Associates of NY. Dr. Sandler completed his residency in Obstetrics and Gynecology at Michael Reese Hospital and Medical Center in Chicago, and a subspecialty fellowship in infertility and reproductive medicine at the Mount Sinai Medical Center in New York. Dr. Sandler is board-certified in Obstetrics and Gynecology and is well recognized for his role in creating and popularizing many current in vitro fertilization protocols.