Infertility – tubal problems

Tubal factor is present in about 14% (1 in 7) of infertility. One or both Fallopian tube(s) is(are) blocked or damaged (due to pelvic infection) or distorted (due to adhesions) or absent. The commonest cause is pelvic infection, which is associated with multiple sexual partners, not using condom, termination of pregnancy, miscarriage, appendicitis etc. The commonest cause of pelvic infection is Chlamydia trachomatis (was Gonococcus* in the past). In practice, there are generally two tests to check tubal patency, laparoscopy & dye test and hysterosalpingogram or HSG (X-ray of the womb and the tubes). Laparoscopy & dye test is performed when the risk of tubal/pelvic diseases is high such as positive Chlamydia trachomatis antibody (IgG), history of pelvic infection, pelvic adhesions, abdominal/pelvic surgery, endometriosis, painful sexual intercourse, significantly painful periods, tubal (ectopic) pregnancy etc. Laparoscopy & dye test is superior to HSG as a test for tubal patency and detection of pelvic diseases. Other procedures to check tubal patency include Hysterosalpingo-contrast-sonography (HyCoSy), Saline infusion sonography, Fertiloscopy, Falloposcopy etc.

The management of tubal factor infertility includes:

Tubal surgery

â–º Cumulative success rate is about 40% (12-67%) in 3 years (about 1% per cycle) depending on the severity of the tubal damage, female partner’s age, duration of infertility and presence of other factors.

IVF

â–º Success rate is about 24% (10-27%) per cycle depending on the female partner’s age and presence of other factors.

Comparison of Tubal surgery with IVF in Tubal problems

Tubal surgery

â–ºCumulative success rate is about 40% (12-67%) in 3 years. Removal of ovarian endometrioma (cyst in endometriosis) and treatment of any endometriosis at the same time during laparoscopic surgery significantly improves the success rate.

â–ºThe cost is about Rs 35000

â–ºIf successful, the potential to have a pregnancy continues long-term

â–ºIf it fails the couple could still go for more expensive IVF treatment

â–ºRequires a Gynaecologist with skills in performing tubal surgery

â–ºNo increased risk of multiple pregnancies

â–ºNo increased risk of OHSS

â–ºEctopic pregnancy rate is about 5%

IVF in Tubal problems

â–ºThe success rate is about 24% (10-27%) per cycle. The success rate is lower in presence of ovarian endometrioma.

â–ºThe cost is about Rs 80000 per treatment

â–ºOne-off treatment

â–ºIf it fails the couple could still go for more IVF

â–ºRequires well equipped IVF centre

â–ºIncreased risk of multiple pregnancies (about 30%)

â–ºIncreased risk of OHSS (0.6- 10%)

â–ºEctopic pregnancy rate is about 8.95% (due to damaged tubes)