Infertility, the inability of a couple to conceive and reproduce. It is defined as the failure to conceive after one year of regular intercourse without contraception or the inability of a woman to carry a pregnancy to a live birth. Infertility can affect either the male or the female and can result from a number of causes.
Fertility depends on the production of a sufficient number of healthy, motile Sperm by the male, delivery of those cells into the Vagina, successful passage of the Sperm through the Uterus and into the fallopian tubes, and penetration of a normal Ovum (egg) by one of the sperm. A successful Pregnancy also requires that the fertilized ovum subsequently become implanted in the lining of the female uterus. A problem at any one of these stages can result in a couple’s infertility.
What are fallopian tubes? How do they help achieve pregnancy?
The female reproductive system includes two fallopian tubes, one on each side of the uterus. These flexible, trumpet-shaped tubes extend to the surface of each ovary. When the ovary releases an egg, finger-like projections at the flared end of the tube catch the egg. It is there, in the tube, that conception occurs if the egg meets sperm and becomes fertilized. Tiny hairs inside the tube’s lining push the resulting embryo (fertilized egg) out of the tube and into the uterus where it implants and grows
There are two types of cells within the fallopian tubes. Ciliated cells are most abundant in the infundibulum and ampullary. Estrogen increases the production of cilia cells in the fallopian tubes. Scattered between the ciliated cells are peg cells which produce tubular fluid. This fluid contains important nutrients for both sperm, oocytes (ova), and zygotes (fertilized ova). The secretions also promote capacitation of the sperm. Progesterone increases the number of peg cells. Estrogen increases the height and secretory activity of the peg cells. In addition, tubal fluid flows against the action of the cilia, near the fimbriated end. Not only is progesterone and estrogen balance vital to the menstrual cycle overall, but it is vital to the health and proper function of the fallopian tubes as well.
A fallopian tube blockage typically prevents successful passage of egg to the Sperm, or the fertilized egg to the Uterus. When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus
Damaged tubes may present in the following ways:
- Distorted tubes – tubes which are pulled to one side or the other and may be kinked
- Beaded tubes (appearing as beads of a necklace) as seen on xray (hysterosalpingogram)
- Blocked tubes – may be blocked near the uterus, in the mid-portion or at the far end
- Dilated tubes – collection of fluid or pus/blood (rare)
Causes of Blocked Fallopian Tubes
There are different types of fallopian tube blockages. Because the fallopian tubes have different parts and are a tube, there may be different parts of the tube blocked.
- Proximal tubal occlusion involves the isthmus This can occur after infection such as complications from abortion, missed miscarriage, cesarean section or PID. Permanent birth control procedures like Essure block the isthmus.
- Midsegment tubal obstruction This is most often due to tubal ligation damage . Tubal ligation is a surgical procedure to permanently prevent pregnancy. Some women who have had tubal ligation change their mind later in life and choose to have this procedure reversed. This can be done surgically and has a 75% pregnancy success rate. Tubal ligation removal comes with its own risk for development of more scar tissue on top of scar tissue already present from the initial tubal ligation procedure.
- Distal tubal occlusion This is the type of blockage that affects the part of the fallopian tube end towards the ovary. This type of blockage is typically associated with hydrosalpinx. Hydrosalpinx is often caused by Chlamydia trachomatis infection, which is a sexually transmitted disease. Untreated Chlamydia is known to cause both pelvic and fallopian tube adhesions.
- Pelvic Inflammatory Disease (PID)
- Uterine Fibroids
- Ectopic pregnancy
- Tubal Ligation Removal
- Complications from lower abdominal surgery such as Cesarean section
- Genital Tuberculosis (still common in developing countries, especially India)
There are both Surgical and Natural ways to improve the fallopian tubes’ functionality. For better suggestion and appropriate treatment, please contact Dr. Sarah Hussain, who specializes in treating such disorders and to identify potential causes and possible treatments — for infertility.