Bilateral Fallopian Tube Obstruction

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ilatereal fallopian tube obstruction is a major cause of female infertility.





Causes of Bilateral fallopian tube obstruction –

1.    Pelvic Inflammatory disease (PID)

2.    Endometriosis

3.    Intra-abdominal infections and formation of adhesions, etc

Evaluation –

1.    HSG (Hysterosalpingography) will demonstrate that tubes are open when radio-opaque dye spills into the abdominal cavity.

2.    Sonography can demonstrate tubal abnormalities such as hydrosalpinx indicative of tubal occlusion.

3.    During surgery, typically laparoscopy, status of the tubes can be inspected and a dye such as methylene blue can be injected in a process called as CHROMOTUBATION.

4.    Laparoscopic Chromotubation has been prescribed as the gold standard of tubal evaluation.

5.    Tubal insufflation is only of historic interest as an older office method to indicate patency; it was used prior to laparoscopic evaluation of pelvic organs.

Chromotubation (the blue dye can be seen coming out of the fallopian tube into the cavity indicating its patency)

 


Normal HSG (The dye can be seen coming out of the fallopian tubes and going into the cavity. The fallopian tubes are the thin hair like structures coming out of the central big inverted pyramid{uterus})

Treatment –

1.    Proximal Tubal Obstruction – Reconstructive surgery is done for proximal tubal obstruction. This procedure is called as Tubocornual Anastomosis. In this procedure, the cornual portion of the tube is resected followed by anastomosis. Reconstructive surgery for proximal tubal occlusion is not very effective and risk of subsequent ectopic pregnancy is very high, therefore IVF is preferable if available. (IVF = In-Vitro Fertilization).

2.    Distal Tubal Obstruction – In contrast to patients with proximal tubal obstruction where findings from HSG are often false positive, the HSG findings and laparoscopic tubal lavage are typically similar. Surgery for the treatment of tubal factor infertility is most successful in women with distal tubal obstruction. The surgical procedures carried out are “Fimbrioplasty and Neosalpingostomy”


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