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If the tubes have been severely damaged and have formed a hydrosalpinx (in which the fimbriae stick to one another and the tube is closed off) the surgery required is called neosalpingostomy, in which the surgeon opens the hydrosalpinx and creates a new opening for the repaired tube. While this is technically easy, success rates are very poor (about 20%) because the physiologic functioning of the fimbriae rarely returns to normal.
If the damage is less severe (fimbrial agglutination, in which the fimbriae are stuck to one another; or phimosis, in which the tube is narrowed, but open), then surgical repair is more successful, with pregnancy rates being about 50%.
The risk of having an ectopic (tubal) pregnancy is increased following tubal surgery. Fallopian tubes that have been operated on may have a damaged inner lining, and this can impair the movement of the embryo down the tube. This is why, in patients who have had tubal surgery, the diagnosis of a pregnancy should be made as soon as possible (preferably within a few days of missing a menstrual period), to rule out the possibility of an ectopic pregnancy.
The best chance of success is with the first surgical operation; therefore, you need to go to a specialized center. The chances of success will depend upon the extent of tubal damage and also on the skill of the surgeon. The best chance of achieving a pregnancy is in the first few months after surgery, and most women who are going to get pregnant after tubal surgery will conceive within this time. Some doctors believe that using ovulation induction and / or intrauterine insemination after tubal surgery helps to maximize the chances of a pregnancy.
If the patient has not conceived within one year after the surgery, then follow-up testing in the form of an HSG and / or laparoscopy is advisable, to determine whether the fallopian tubes are still open.
If the first surgery has been unsuccessful, the chance of success as a result of a second operation is very low, and IVF is the only treatment choice for such patients.
In the future, it is possible that tubal transplants may become a reality and that scientists may also develop artificial synthetic tubes to replace damaged ones.
With operative laparoscopy, it is now possible to open damaged tubes through the laparoscope, thus saving the patient major surgery. A hydrosalpinx can be repaired by opening it with a laser or cautery and then keeping it open with sutures: and even the complicated operation of tubal reanastomosis has been performed by experienced surgeons through the laparoscope (using sutures or special adhensive glue). Advances in operative laparoscopy may soon make conventional tubal microsurgery obsolete.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
