Unilateral tubal blockage, unilateral tubal obstruction
Unilateral fallopian tube blockage represents the occlusion of one of the Fallopian tubes with the other one remaining patent. Fallopian tube blockage is one of the common causes of female infertility. In patients with one fallopian tube blocked and the other one patent, fertility may be only decreased with the patent tube still alowing for the sperm and egg to converge, but infertility may also result.
Depending on the portion of fallopian tube affected, three types of tubal blockage can be identified.
affects the end towards the ovary and the fimbriae (finger-like protrusions lining the opening of the fallopian tube into the abdominal cavity),
occlusion affects the middle part and
affects the part close to the uterine cavity. Distal obstruction is commonly associated with the development of hydrosalpinx – collection of fluid in the fallopian tube, which causes it to dilate a sometimes compress other organs.
Fertility may vary in patients with only one patent Fallopian tube. Generally, pregnancy with unilateral tubal obstruction is possible, if the other Fallopian tube is still patent. Passage through the tube may be influenced by changes to its lumen, surrounding fibrous adhesions, its blood circulation and the ability of the adjacent ovary to ovulate. Some patients may require assisted reproduction treatment to achieve a pregnancy although the remaining Fallopian tube is seemingly unobstructed.
The most effective way to prevent unilateral tubal obstruction is an effective prevention and treatment of sexually transmitted infections, which are the leading cause of tubal obstruction. To avoid these infections, such as Chlamydia or Gonorrhoea, it is advised to use barrier contraceptive methods, such as a condom, during sexual intercourse, and to limit the number of sexual partners. If the patient has already contracted a sexually transmitted infection, antibiotic treatment should be administered as soon as possible to avoid pelvic inflammation and scarring in the Fallopian tubes.
For fallopian tube obstruction, alternative medicine has been used as a form of fertility treatment. A number of various approaches is available
Fallopian tube obstruction has traditionally been treated with fallopian tubal surgery (tuboplasty) with a goal of restoring patency to the tubes and thus possibly normal function. A common modern day method of treatment is in vitro fertilization as it is more cost-effective, less invasive, and results are immediate. Treatments such as assisted reproductive technologies are used more often than surgery. Pharmacotherapy is of limited use in the treatment of already existent Fallopian tube obstruction, but especially in the case of pelvic inflammatory disease, treatment with antibiotics can be used effectively to prevent the occlusion from forming.
Pharmacotherapy is generally not used to treat congenital tubal obstruction, as by the time of the diagnosis ,there is usually no process that can be pharmacologically averted. Treatment with antibiotics can, however, be used in women with the risk of developing tubal obstruction due to Pelvic inflammatory disorder.
Tuboplasty refers to a number of surgical operations that attempt to restore patency and functioning of the Fallopian tube(s) so that a pregnancy could be achieved. As tubal infertility is a common cause of infertility, tuboplasties were commonly performed prior to the development of effective in vitro fertilization (IVF).
Different types of tuboplasty have been developed and can be applied by laparoscopy (via small punctures in the abdominal wall) or laparotomy (via an incision in the abdominal wall). They include lysis of adhesions (fibrous tissue inside the fallopian tube, or attaching it to other structures), fimbrioplasty (repairing the fimbriated end of the tubes), salpinostomy (creating an opening for the tube), resection and reananstomosis (removing a piece of blocked tube and reuniting the remaining patent parts of the tube), and tubal reimplantation (reconnecting the tube to the uterus).
Further, proximal tubal occlusion (closer to the uterine opening of the tube) can be overcome by unilateral (on one side) or bilateral (on both sides) selective tubal cannulation, a procedure where a thin catheter is advanced through the proximal portion of the Fallopian tube to examine and possibly restore tubal patency, salpinostomy (creating an opening for the tube) or falloposcopy (inspection of the Fallopian tubes through a micro-endoscope).
If conservative medical treatments fail to achieve a pregnancy, the physician may suggest the patient to use the methods of assisted reproduction. Assisted reproduction technologies (ART) are today used more often than surgery, as they are less invasive and more reliable. In case of unilateral tubal obstruction, intrauterine insemination (IUI) may be used to treat infertility, however its outcomes are subject to discussion. In vitro fertilization (IVF) with the patient´s own ova (eggs) is a reliable method of achieving pregnancy in infertile women with unilateral tubal blockage.
IVF and ART generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
An obstruction prevents the egg or sperm from traveling down the tube, thus making fertilization impossible.
The finger like overgrowths attached to the inner wall of the uterus that extend into the uterine cavity which are made of endometrial tissue
A state in which pieces of the tissue alike to the lining of the uterus (endometrium) grow in other parts of the body.
Hematosalpinx is a medical condition involving bleeding into the fallopian tube.
A hydrosalpinx is an abnormal pouch containing liquid in a fallopian tube.
A distally blocked Fallopian tube filled with pus.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
Surgical removal of a Fallopian tube(s).
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
An advanced therapy with drugs triggering the ovulation, which is used in cases of fallopian tube blockage on one side.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.