Tubal Factor Infertility - Tubal Disease
One of the more common causes of infertility is blocked or damaged fallopian tubes. The fallopian tubes are necessary for pick up of the egg that has been released from the ovary. It is inside of the fallopian tube that natural fertilization occurs within 24 hours after ovulation. The tube then transports the fertilized egg or embryo into the uterine cavity at about 6-7 days after ovulation. The embryo begins to attach on day 7 and will bury itself into the uterine cavity. Sometimes, the embryo gets hung up in the fallopian tube and the implantation process will take place there. This is called an ectopic pregnancy and can be very dangerous as the tube will frequently rupture and cause internal bleeding. About 50 women per year die in the United States from a ruptured ectopic pregnancy.
Damage to the fallopian tube is usually the result of an infectious process such as pelvic inflammatory disease (PID). Infections with Gonorrhea and Chlamydia can be very damaging to the tube. Sometimes a ruptured appendix can be the source of tubal damage. More rarely, endometriosis can cause damage to the fallopian tube.
If the fallopian tubes are blocked and dilated this is called a hydrosalpinx. Once the tubes are dilated, the chance for successful tubal reconstructive surgery is small and the risk of ectopic pregnancy is high. The fluid present within the hydrosalpinx contains many toxins released from dying cells that line the fallopian tube. This fluid has been shown to be toxic to embryos. Also, this fluid occasionally leaks backwards from the tube into the uterine cavity. For this reason, many fertility specialists recommend having the hydrosalpinges removed surgically prior to doing in vitro fertilization (IVF). This procedure can be done laparoscopically as an outpatient. The removal of the fallopian tubes that are dilated and damaged can double the pregnancy rates with IVF.