Wednesday 3 October 2007
Blocked Fallopian Tubes- Treatment Options
Tubal factors are said to account for about 20 to 30 percent of all infertility cases around the world. The main contributing factor: blocked fallopian tubes. A blocked fallopian tube, although not necessarily life threatening, can be a very serious cause for concern because although conventional surgery may provide relief from the condition, damage to the tubes are generally considered irreversible and hence, subsequent pregnancy may prove almost impossible -but not quite. The fallopian tubes play a major role in conception. It is within a fallopian tube that fertilization normally occurs and the tubes serve as the pathways for the egg to travel from the ovaries towards the uterus for implantation. When the tubes are substantially blocked, the meeting of the sperm and egg may be prevented and hence, natural fertilization might be impossible. During the times when fertilization does happen, the zygote may still be unable to reach the uterus and ectopic pregnancy, a life threatening condition, could occur.
Pregnancy in the presence of blocked tubes is often difficult but not impossible. Assisted Reproductive Technology (ART) techniques provide artificial conception or a meeting of the egg and sperm outside the woman's body. The resulting mix or the zygote is then delivered into the uterus or the unaffected fallopian tube and pregnancy can result. These techniques however, are not always successful. ART practitioners try to increase the chances of impregnation by delivering more than 1 zygote or egg-sperm mix hence, this procedure can often lead to multiple births.
Another option for pregnancy-hopeful women with blocked tubes is to resort to Endoscopic Fallopian Tube Recanalisation; which works best with proximal tubal occlusion & a method of Tactile Cannulation using Laparoscopic guidance has been pioneered by us and published in peer-reviewed journals (see pictures) . Alternative remedies have proven quite effective in helping women get pregnant. The generally accepted method of unblocking fallopian tubes was through tubal surgery which can be done through microsurgical techniques either during open abdominal surgery (laparotomy) or using laparoscopy through a small incision in the abdomen. The latter procedure however must be conducted by a surgeon trained in the field of microsurgery and has hands-on knowledge of laparoscopy. There are many different surgery techniques for unblocking fallopian tubes and the differences generally involve the length of the incision, the area affected, the type of blockage present, and the method of unblocking applied (e.g. complete removal or creation of another opening). Tubal reanastomosis involves the complete removal of the blocked portion of the tube and a subsequent joining of the healthy ends. This procedure is usually done with laparotomy or abdominal incision.
Salpingectomy involves the surgical removal of the infected or blocked fallopian tube. It is usually done on patients who have a hydrosalpinx and want to improve their chances at pregnancy through in vitro fertilization (IVF). This procedure is preferred over salpingostomy which is another surgical procedure available for dealing with hydrosalpinges (fluid-filled blocked fallopian tubes).
Salpingostomy is a procedure that requires an incision through the affected fallopian tube. In neosalpingostomy, the idea is to create a new opening in the part of the tube closest to the ovary while in linear salpingostomy the incision serves as the pathway to release the blockage. Neosalpingostomy is generally used in dealing with hydrosalpinges. This technique however more often than not merely provides temporary unblocking as it is a common occurrence for scar tissue growth to reseal the new opening created by neosalpingostomy thereby effectively blocking of the tube once more.
When the problem is a partial blockage or a scarring in the fimbriae (fingerlike projections at the end of the fallopian tube near the ovary), Fimbrioplasty is an option where the blockage or the scar adhesions are removed and the fringed ends are rebuilt such that wafting motion of the fimbriae are restored. The fimbriae move in sweeping motions such that the egg released by the ovary will be caught then guided towards the uterus.
The relative success of the surgery will depend on the health and condition of the patient and the location of the blockage. It is shown that clearing blockages near the uterus are more likely to be successful. Furthermore, the amount of tube that remains after the surgery will determine the ability of the tube to regain its normal function and hence, the subsequent ability of the woman to get pregnant.
Surgery is generally an invasive form of treatment but recent technologies already provide for less invasive procedures as against the traditional open abdominal option such as Laparoscopy. It involves the use of a laparoscope (camera or ultrasound) which is inserted into a small incision through the abdominal wall. The body part requiring surgical treatment will be seen through a monitor which, is connected to the laparoscope.
Surgery procedures also involve risks some of which are spread of pelvic infection, the formation of scar adhesions among the reproductive organs or with the abdominal cavity, and the increase in the possibility of tubal ectopic pregnancy.