Having difficulty conceiving?
GENESIS 9:7: “As for you, be fruitful and multiply; populate the earth abundantly and multiply in it.”
Procreation is a natural process and most women have a natural desire to accomplish same. When this does not occur, it can be very frustrating to the woman and her partner. On a weekly basis, patients present to their OBGYNS because their tubes are obstructed and they are unable to conceive and are in dire need of an intervention.
The Fallopian tubes are tubular structures which originate from either side of the uterus. They are around 10 centimetres in length and one centimetre in diameter and are extremely mobile. They have an end called the fimbriae which has finger like projections and acts like a net to catch the egg released from the ovary when ovulation occurs monthly. The egg is transported to the uterus via small hairlike particles within the tube called cilia. Fertilisation (when the egg and the sperm meet) occurs in the Fallopian tube. Thus if there is a blockage of the tube, then fertilisation may not occur or may be abnormal (ectopic pregnancy or pregnancy within the tube).
Types and causes
Twenty per cent of infertility can be attributed to tubal problems. Obstruction can occur where the tube meets the uterus (proximal obstruction), in the midsegment of the tube, and at the fimbrael end of the tube (distal obstruction). The majority of tubal obstruction is due to Pelvic Inflammatory Disease (PID) which usually is a result of chlamydia and gonorrohoea and normally affects the fimbriael end of the tube. These infections are acquired during sexual intercourse. They ascend the uterus and cause inflammation of the tubes which if not treated results in scarring of the tube causing tubal obstruction. The more frequently a woman acquires PID, is the more likely she is to have tubal obstruction. Sometimes this infection causes inflammatory fluid formation within the tube — hydrosalpinx. When this becomes infected, an abscess can form which is more detrimental to the function of the tube.
Tubal obstruction in the midsegment of the tube is usually as a result of sterilisation procedures (tubal ligation), which is usually a permanent intentional intervention. However, some women may want reversal of this obstruction and present to their OBGYN. This can prove to be quite challenging at times especially if the tube has been cut and is shortened. Proximal obstruction usually results from a miscarriage which has become infected, leading to scarring of the proximal end of the tube. Other causes of tubal obstruction include intra-abdominal infection secondary to appendicitis or endometritis (infection of the uterus usually after childbirth) which indirectly leads to scar tissue formation. Smoking and HIV infection have been associated with affecting tubal function at the microscopic level and causing the tube to be non-functional by affecting the cilia.
Evaluation
The tubes can be evaluated via a HSG (hysterosalpingogram), laparoscopy and dye test or an in-office tubal hydro insufflation. A radio opaque dye is inserted through the cervix and an X-ray film is taken as the fluid enters the uterus. Obstruction can be shown on the X-ray if the dye does not enter the abdominal cavity. This is usually done in the first week of the menstrual cycle to avoid a pregnancy.
Laparoscopy involves the use of cameras within the abdomen. Dye is inserted through the cervix in a similar manner and fluid can actually be seen coming out of the tubes if they are patent. In-office hydro insufflation involves using normal saline and inflating the uterine cavity. If the tubes are obstructed, fluid will come back through the vagina. If they are clear, there will be no resistance to the fluid and no fluid will come back.
