Tubal factor infertility is female infertility caused by diseases, obstructions, damage, scarring, congenital malformations or other factors which impedes the fertilization process in the fallopian tubes. In today’s world, tubal factors contribute to 25-30% of infertility cases. Most women are unaware about Tubal Factor Infertility being a leading cause for infertility, it is only when they consult a doctor for infertility with chronic pelvic pain does this condition come to light. Hence, early detection, consultation and diagnosis for Tubal Factor Infertility and Infertility Blocked Fallopian Tubes is extremely important.The major cause of TFI is PID (pelvic inflammatory disease) with infection ascending from the lower genital tract. Chlamydia Trachomatis & Neisseria Gonorrhea are the common organisms causing PID. The incidence of genital tuberculosis( Mycobacterium tuberculosis) is also found to be on the rise.
Tubal damage from PID causes inflammation and long term tubal changes such as tubal occlusion and thickening thus making it unsuitable for fertilization to occur. The risk of infertility increases with the number and severity of pelvic infections. The incidence of infertility is 10-12% after one episode, 23% to 35% after two episodes and 54-75% after three episodes. Moreover the risk of ectopic pregnancy can increase six to seven fold after an episode of PID.
Tubal Factor Infertility is on the rise. Other causes of TFI include septic abortion, endometriosis,scarring from abdominal & pelvis surgeries, cornual fibroids & bilateral tubal ligation( iatrogenic). The diagnosis of TFI can be established by a combination of clinical suspicion based on patient history and diagnostic tests. Hysterosalpingography and Sonosalpingography are basic out- patient screening tests for ascertaining tubal patency.Laparoscopy is the gold standard for diagnosis of tubal factors in infertile women . It has high specificity. The nature of pathology that affects the tubes can be identified along with the site of occlusion ( proximal/distal). Co-existing uterine and ovarian pathologies can also be diagnosed . In patients with proximal tubal occlusion(cornual) hysteroscopic guided cornual cannulation can be attempted at the same sitting.
Depending on the patient’s age, location and severity of tubal disease, male factor status, tubal microsurgery or ART are the recommended treatment options. Tubo-tubal anastomosis, Adhesiolysis, Salpingostomy, Tubal Recanalisation are the various micro-surgical procedures performed to overcome TFI. Success rates could be as low as 10% -35% for women with severe tubal disease. Of course ART with its improving success rates is the final solution for majority of patients with TFI. It is important to choose an experienced surgeon before undergoing any surgery. If you have experienced any of the factors above, you can get in touch with me at [email protected] or schedule an appointment with me. I would be more than happy to help you