When a woman has a problem in the fallopian tubes, different surgical procedures can be performed to solve it. The fallopian tubes must be permeable and functional for a woman to become pregnant naturally, so tubal problems affect female fertility.
It´s important to differentiate this type of surgery from tubal ligation, since the latest is an intervention to voluntarily block the tubes as a permanent method of contraception.
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Why are fallopian tubes important?
The fallopian tubes, uterine tubes or oviducts are the tubes that connect each ovary to the uterus.
The uterine tubes are responsible for collecting the oocyte released by the ovary at ovulation. In addition, the oviducts must allow the oocyte to meet the sperm for fertilization to occur and, subsequently, transport the fertilized oocyte (embryo) to the uterus.
It is necessary for the embryo to reach the uterus for a pregnancy to develop correctly since the uterine endometrium is where the implantation of the embryo takes place. If the embryo implants outside of the uterine cavity, it would be an ectopic pregnancy.
Therefore, any problem in the tubes that alters their permeability or movement will hinder the previously mentioned functions and, the achievement of pregnancy. In fact, if the problem occurs in both tubes, it can even make gestation impossible.
Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.
You can read more about tubal factor infertility in this article: Tubal Factor Infertility - Causes and Treatments.
Blocked fallopian tubes
Fallopian tube obstruction is undoubtedly one of the most common problems faced by couples who have difficulty in achieving pregnancy.
These obstructions in the uterine tubes are an obstacle that prevents the spermatozoa and the oocyte from coming into contact and, therefore, make pregnancy difficult or impossible.
The obstruction may be unilateral (only one tube is blocked) or bilateral (both fallopian tubes are blocked).
A unilateral obstruction hinders but does not naturally prevent pregnancy since there is still a functional tube. However, a bilateral obstruction will prevent fertilization and natural pregnancy.
Causes
Among the main problems that cause fallopian tube obstruction we can find:
- Salpingitis: is the name given to inflammation of the oviducts. This inflammation may be due to a sexually transmitted disease (STD) or an infection migrated from other organs.
- Hydrosalpinx: is an obstruction characterized by the accumulation of fluid at the end of the tube, causing its dilation and distension. Hydrosalpinx may be caused by an infection.
- Endometriosis: is the growth of endometrial tissue outside the uterus, which in this case could grow in one of the tubes. This disease is a frequent cause of infertility and can be a potential cause of tubal obstruction if it appears in the fallopian tubes.
- Pelvic or abdominal surgery, due to the creation of adhesions.
In addition to these causes, it is possible that the fallopian tubes are congenitally altered, for example, a birth defect.
Treatment of obstructed uterine tubes
When the tubal obstruction is due to infection, the treatment consists of the administration of the necessary antibiotics and anti-inflammatory drugs. Nevertheless, it will also be necessary to assess whether the obstruction affects one or both fallopian tubes and the woman's reproductive eagerness when establishing the best therapeutic option.
Unilateral obstruction
In the case that only one tube is blocked, natural pregnancy can be achieved. However, time to achieve gestation may increase.
Taking this into account, these women may end up opting to undergo assisted reproductive techniques such as artificial insemination (AI) or in vitro fertilization (IVF).
Bilateral obstruction
When a woman presents bilateral tubal obstruction, it is possible to perform surgery to permeabilize the tubes. However, this procedure does not usually provide the desired results and the tubes do not fully recover their function. This is why many patients with bilateral tubal obstruction choose to undergo assisted reproductiontreatments. In this case, IVF is the indicated technique, since it doesn't require the fallopian tubes to be functional.
It is important to mention that the removal of a hydrosalpinx by salpingectomy (resection and surgical removal of one or both fallopian tubes) prior to IVF treatment may improve the chances of success. This prevents tubal fluid from refluxing into the uterine cavity, which can affect the results of the reproductive treatment.
These surgical treatments on the fallopian tubes are generally performed laparoscopically. In this way, the damage caused to the patient is reduced and the recovery time is shorter. However, despite being a less invasive procedure than conventional laparotomy surgery, this alternative is also performed under general anesthesia.
Fallopian tube surgery for ectopic pregnancy
Ectopic pregnancy occurs when the embryo implants outside the uterine cavity. It should be noted that the fallopian tubes are the most common site of ectopic pregnancy. While some ectopic pregnancies resolve on their own, others require medical and even surgical treatment.
Surgical treatment of ectopic pregnancy is performed laparoscopically whenever possible. This intervention can consist of:
- Salpingotomy: a cut in the tube, to eliminate the gestational sac, but to keep the uterine tube intact. It is performed if the condition of the tube allows it.
- Salpingectomy: removal of the entire tube presenting the ectopic pregnancy. This option is performed when the tube is severely damaged.
In cases of salpingotomy, active trophoblast may remain in the tube after the operation, for example, embryonic remains. To avoid further surgery, medical treatment could be indicated.
Nevertheless, the surgical approach can also be used for the treatment of ectopic pregnancy in locations other than the fallopian tubes.
FAQs from users
In what situations is it strictly necessary to perform a salpingectomy?
Salpingectomy is the surgical removal of one or both fallopian tubes.
In medicine, there is not always data to support diagnostic or therapeutic behavior. This is not the case when, in the context of the study of reproductive dysfunction, a hydrosalpinx appears.
A hydrosalpinx is the dilation of the fallopian tube due to the presence of fluid inside it. When diagnosed, salpingectomy before in vitro fertilization treatment improves the chances of achieving a pregnancy. This is according to the review carried out by the Cochrane Library, probably the most rigorous and reliable organization of researchers when making recommendations in health sciences.
Therefore this would be a case where salpingectomy would be highly advisable. This is what science says but the Law makes clear the right to patient autonomy. The law says: "Any action in the field of health of a patient needs the free and voluntary consent of the affected person, once, received the information provided in Article 4, has assessed the options specific to the case". Because of this bioethical principle of autonomy, the patient can decide, even though she knows that the prognosis of the in vitro fertilization treatment worsens, not to undergo a salpingectomy. The concept of "strictly necessary" is therefore relegated to what the patient, properly informed, decides.
Is surgery a solution to blocked fallopian tubes?
Fallopian tube obstruction occurs when the tubes become blocked, clogged or in the presence of fibrotic processes that cause them not to function as they should. They are a major problem of infertility. Some studies establish that in 20-24% of the cases of female infertility there is some type of tubal alteration.
Tubal unblocking surgery is extremely complex, requires a long time to assess its effectiveness, and we cannot guarantee that it will be 100% effective. This type of procedure can again lead to the formation of adhesions, tubal fibrosis and may be one of the reasons for the formation of an ectopic pregnancy (outside the uterine cavity).
For all these reasons, IVF is the treatment of choice in cases of bilateral tubal obstruction.
Is it possible to reverse a tubal ligation?
Indeed, there is a surgical way to reverse tubal ligation. However, this procedure is not always possible and/or guarantees a natural gestation, due to the fact that the tubes have to heal and recover their permeability and movement.
Therefore, a different alternative to the reverse tubal ligation when the tubes are tied is the In Vitro Fecundation (IVF).
You can read more information about this topic in this link: What Are Your Chances of Pregnancy After Tubal Ligation?
Recommended readings
In this article we have discussed ectopic pregnancy and its surgical treatment. If you want to learn more about ectopic pregnancy, you can visit the following link: What Causes an Ectopic Pregnancy? - Symptoms, Diagnosis & Treatment.
However, if you are interested in the subject and want to continue reading more in depth about salpingectomy, we recommend you read the following article: Salpingectomy: How are the fallopian tubes extracted?
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References
Carpinello O, DeCherney A. A different time for tubal surgery. Fertil Steril. 2019 Nov;112(5):829-830.
Daniilidis A, Balaouras D, Chitzios D, Theodoridis T, Assimakopoulos E. Hydrosalpinx: Tubal surgery or in vitro fertilisation? An everlasting dilemma nowadays; a narrative review. J Obstet Gynaecol. 2017 Jul;37(5):550-556.
Gomel V. The place of reconstructive tubal surgery in the era of assisted reproductive techniques. Reprod Biomed Online. 2015 Dec;31(6):722-31.
Melo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, Becker C, Granne IE. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020 Oct 22;10:CD002125.
Ng KYB, Cheong Y. Hydrosalpinx - Salpingostomy, salpingectomy or tubal occlusion. Best Pract Res Clin Obstet Gynaecol. 2019 Aug;59:41-47.
Zarei A, Al-Ghafri W, Tulandi T. Tubal surgery. Clin Obstet Gynecol. 2009 Sep;52(3):344-50.
FAQs from users: 'In what situations is it strictly necessary to perform a salpingectomy?', 'Is surgery a solution to blocked fallopian tubes?' and 'Is it possible to reverse a tubal ligation?'.
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