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Tubal infertility

Mr Amit Shah, Mr Anil Gudi & Prof Roy Homburg

Normal conception requires a fertile sperm and an egg to come together in the fallopian tubes and carry on the journey to the cavity of the uterus in order for an embryo to implant there. Blockage or damage to the tubes can prevent this happening and so cause infertility. Tubal damage underlies infertility in about 15% of couples.

The fallopian tube is not just a simple tube but contains hair like structures called cilia that help in transport with wafting movements. That means that the tube may still be open but damage to it may prevent its proper functioning.

The main causes of tubal disease are infections that may start in the tubes themselves, in the uterus or indeed anywhere in the pelvis. Common causes include an infected intra-uterine contraceptive device, an infected abortion or miscarriage, pelvic inflammatory disease, endometriosis, appendicitis or a previous operation in the area of the pelvis. Blockage of the tube usually occurs at the far end of the tube or at the junction of the tube with the uterus. If the tube is blocked in two places the secretions of the tube may cause it to swell up like a balloon (hydrosalpinx). A sterilization procedure to close the tubes will obviously cause the same problem.

Except in the case of a previous sterilization procedure, surgical repair of the tubes is largely unsuccessful and in-vitro fertilization (IVF) is far and away the most successful option. In fact, tubal blockage was the very reason why IVF was invented as this procedure bypasses the blocked tubes.

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