Understanding tubal occlusion

Dear Dr Mitchell,

I did a hysterosalpingogram which shows that I have tubal occlusion. What does this mean?

A hysterosalpingogram(HSG) is an X-ray that outlines the cavity of the uterus and the Fallopian tubes. It is an investigation that is usually done in a woman who is unable to conceive despite being sexually active two to three times per week for one year. The Fallopian tubes being occluded means that they are blocked and nothing can pass along the length of the tubes. The ends of the Fallopian tubes need to be healthy to pick up the egg once it is released from the ovary. It is then pulled into the cavity of the Fallopian tube. The sperm then travels up through the cervix and makes its way up to the Fallopian tube where it is fertilised and then travels back into the uterine cavity for implantation and development.

If the lumen of the Fallopian tube is blocked, then the egg cannot meet the sperm, and if it does, then the embryo gets stuck in the Fallopian tube because of the damaged lining of the tube.

The Fallopian tube can become blocked or occluded by pelvic inflammatory disease which is usually caused by gonorrhoea or chlamydia from sexual intercourse. Failure to treat these infections early can result in inflammation and damage to the tubes, causing them to become blocked. Occlusion of the Fallopian tube can result in infertility, and if pregnancy occurs the risk of ectopic pregnancy is very high. An ectopic pregnancy is a life-threatening emergency, since the Fallopian tubes can rupture and cause internal bleeding resulting in shock and death from blood loss.

Blocked tubes can sometimes be repaired by doing an operation to remove the blockage. If the tube is severely damaged, then it will have to be removed. In this case, in vitro fertilisation (IVF) has to be done. The egg is removed from the woman under ultrasound guidance, and then the sperm is removed from the male partner. They are then fertilised in the laboratory and put back into the uterine cavity, thus bypassing the blocked Fallopian tubes. This procedure is available locally at the Fertility Management Unit at the University Hospital of the West Indies. Tubal surgery and IVF can lead to a good outcome. Consult your doctor who will do the appropriate referral if this is necessary.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.