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Once the doctor has assessed the damage and pinpointed the location of the blockages he will decide on treatment alternatives and how to proceed. The first choice in the past used to be an attempt at surgery to repair the tubal damage. However, because results with tubal surgery were not very encouraging, many patients with tubal damage are now advised to undergo IVF (in vitro fertilization) as their first treatment option.
In order to select between IVF and tubal surgery, we need to differentiate between intrinsic tubal damage and peritubal damage. If the tubes have been damaged because of a problem outside the fallopian tubes, such as peritubal adhesions or endometriosis, which have caused the tubes to get kinked, then surgery may be useful. However, surgery is not advisable for patients if the tubes have been blocked because of TB; the tubes are very badly damaged; if the tubes are blocked at multiple places; or if the tubes have been blocked because of intrinsic tubal disease.
The likelihood of surgical success (in terms of pregnancy) depends on the severity of the tubal damage. If a previous infectious process has caused scarring of the fallopian tube, the inner delicate lining may have become irreversibly damaged. Surgery can result in re-establishing patency in some cases but the main aim of the surgery is not to just open the tubes, but to achieve pregnancy - and the tubes have to become capable of capturing the egg and transporting it to the uterus for this to happen. Unfortunately, surgery cannot reverse tubal damage once this has occurred.
What if only one tube is blocked? One normal tube is sufficient to allow a pregnancy and most surgeons would not advise tubal surgery for these patients. Obviously, the chance of pregnancy for such patients is half that of normal women and therefore establishing a pregnancy may take twice as long. The danger of trying to surgically repair a single blocked tube is that adhesions because of the surgery may cause both the tubes to become blocked!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
