Obstruction of fallopian tubes
One of the most common factors preventing conception and pregnancy in women is fallopian tube obstruction.
The fallopian (uterine) tubes are paired hollow organs that connect the uterus with the ovaries. For successful conception, an egg is released from the ovary during ovulation and enters the fallopian tube, where it meets a sperm cell and fertilization occurs. The fertilized egg then travels through the fallopian tube toward the uterus.
If, for any reason, the egg or sperm cannot pass through the fallopian tube, pregnancy cannot occur naturally.
Causes of Fallopian Tube Obstruction
Inflammation of the fallopian tubes and female reproductive organs resulting in adhesions and tubal obstruction;
Gynecological or abdominal surgery, for example, surgery for acute appendicitis;
Intrauterine procedures — infected abortions, dilation and curettage of the uterine cavity;
Endometriosis, which may also affect the fallopian tubes.
Symptoms
Women with fallopian tube obstruction usually experience no discomfort, pain, or changes in their general well-being. Ovulation and menstruation may occur normally, without menstrual cycle disturbances.
The condition may remain unnoticed for years and may only be discovered during evaluation for prolonged infertility.
Diagnosis
Fallopian tube obstruction can be diagnosed using metrosalpingography or hysterosalpingography (HSG), an X-ray examination in which a contrast agent is introduced into the uterine cavity. The procedure is performed between days 5 and 12 of the menstrual cycle, most commonly on days 7–8.
Tubal obstruction may also be detected during diagnostic laparoscopy.
Treatment
Treatment depends on the location of the fallopian tube obstruction:
If the obstruction is located in the interstitial portion of the tube (the part closest to the uterus), IVF may be the only effective method for achieving pregnancy.
If the obstruction is located in the ampullary portion of the tube (the part farther from the uterus), surgical treatment may be possible. Laparoscopy with salpingostomy can be performed to restore an opening in the affected tube. If pregnancy does not occur naturally within six months, the tubes may have become obstructed again. In this case, IVF may be recommended to achieve pregnancy.
If the fallopian tubes are absent as a result of previous surgery, for example following an ectopic pregnancy or severe inflammatory disease, IVF is recommended as the method of achieving pregnancy.