Tubal factor infertility accounts for up to one quarter of all cases of infertility. This includes cases where both the fallopian tubes are blocked, or one is blocked, or one (or both) are scarred.
What causes tubal disease?
It is usually caused by pelvic infection (e.g. pelvic inflammatory disease (PID) or appendicitis), by pelvic endometriosis, or by scar tissue that forms after pelvic surgery.
Diagnosing and treating tubal disease
The diagnosis can be made in a number of ways. Most commonly a Saline Infusion Hysterosonography (SIS) is used to diagnose tubal disease. It is a less invasive test that involves inserting a small amount of saline into the uterus. This is allows the lining of the womb to be clearly seen on the ultrasound scan It is a useful test but is being superseded in many parts of the world by HyCoSy or saline sonography. These do not require X-Ray technology but rather vaginal ultrasound (like you may have when being monitored for fertility treatment). HyCoSy uses a special contrast dye while the saline test uses sterile salty water (saline). These are much less invasive than the older tests and may themselves be overtaken by three-dimensional ultrasound in years to come.
If the SIS test is inconclusive then a Laparscopy and dye test is used. A camera is placed through your belly button (usually) to inspect the pelvis. This is especially useful if other features are present e.g. pain which might suggest endometriosis (often treated at the same time). Dye is passed through the tubes and patency (or blockage or swelling) confirmed. The most common cause of blocked tubes is infection (PID) of which the most common infection is chlamydia. About 70% of women who have blocked tubes have had a chlamydia infection although it is often silent and they will not have even been aware of it.
In cases of relatively minor tubal damage it can be difficult to be certain if it is solely responsible for the infertility – or simply an additional factor in addition to other significant contributing causes. From a practical point of view, the presumptive diagnosis is of tubal factor unless the degree of scarring is very minimal. In this event, and if no other cause of infertility is found, then a diagnosis of unexplained infertility may be warranted.
Suspect you have tubal disease?
If you suspect you may have tubal disease and have been trying to conceive for 12 months (or 6 months if you are over 35 years of age) you should consider booking an appointment with a fertility specialist.
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