Options for blocked tubes

Dear Dr Mitchell,

I’m 35 (a bit old) and I’ve been trying to get pregnant for more than six years now. One day I decided to visit a gynaecologist and she sent me to do a HSG test, which I did, and the result confirmed that I have blocked tubes — the right side is completely blocked.

My question is, can I get it clear without doing surgery? Will I be able to have another child?

The presence of blocked tubes on a hysterosalpingogram (HSG) is a significant factor that would have definitely contributed to your inability to conceive for the past six years. It is also important to rule out other causes of infertility such as infrequent ovulation. At 35, fertility starts to decline due to infrequent ovulation in some women and a hormone profile should be done to establish that you are in fact ovulating.

Male infertility is also a problem that can contribute to your inability to conceive. Your partner could also have low sperm count or decreased motility of the sperm which prevents fertilisation from occurring. The finding of blocked Fallopian tubes does not necessarily mean that this is the only problem and so it is important to rule out other problems that interfere with your ability to conceive.

If both Fallopian tubes are blocked then this is most likely due to an infection that caused the tubes to be subsequently damaged. Gonorrhoea and chlamydia are common sexually transmitted infections that result in significant damage to the Fallopian tubes if there is failure to diagnose and treat these infections early. Surgery can sometimes be done to clear the blockage in the Fallopian tubes but this is not always possible especially if the damage is severe. In some cases pregnancy occurs but this results in the implantation of the embryo in the Fallopian tube (ectopic pregnancy). This is because the lining of the tube is damaged and the embryo is not carried along the length of the tube into the lining of the uterus. This is a surgical emergency and can result in rupture of the Fallopian tube, shock, and even death in severe cases.

You need to have a proper evaluation done to see how badly damaged the Fallopian tubes are and to determine whether it is possible to do surgery. In some women it might be recommended to remove both damaged Fallopian tubes and then do invitro-fertilisation (IVF). This is a procedure where the ovaries are stimulated to procure several eggs which are then removed and fertilised with the sperm from your partner or a donor and then put directly into the uterine cavity. The results with this procedure are reasonably good and will definitely help you to achieve a successful pregnancy. IVF is available widely in the Caribbean and also at the Hugh Wynter Fertility Management Unit at the University Hospital of the West Indies.

Consult your doctor who will advise you further and do all the baseline investigations to determine what is appropriate for you.

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 Avenue, Kingston 5; or fax to 876-968-2025. 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.