Sunday, February 13, 2011

Blocked Fallopian Tubes

Fallopian tubes can become blocked without you knowing or feeling it.  Women with blocked tubes still ovulate and get their periods.  Although sometimes blocked tubes can cause pain, usually you can't feel it at all.  Therefore your doctor will need to order a test, if you want to find out whether your tubes are blocked.  

The traditional gold-standard test for determining whether tubes are blocked is called a hysterosalpingogram or HSG.  A small tube, or catheter, with a balloon on the end or a stopper-like device is placed into the canal of the cervix.   A special liquid called contrast, which shows up white on x-rays, is then infused through the catheter into the uterus and out the fallopian tubes.  X-rays are used to watch this happen.  It can tell you about the cavity of the uterus as well as whether the tubes are open.  It is definitely uncomfortable as the contrast is infused.  Usually, it feels like strong menstrual cramps and only lasts a few minutes.  Taking some ibuprofen or naproxen sodium beforehand can help, as both of these medications help keep the uterus from cramping.  Check with you doctor before taking them, of course.  After the HSG, you will have a sticky discharge as that contrast comes back out, so you may want to bring a pad along with you (the ones the x-ray department gives you may be humongous!).  The risks to the procedure include infection (rarely, bacteria form the vagina will come along for the ride), allergic reactions to the contrast (tell your doctor about any shellfish, iodine or contrast allergies), and the risk from the small amount of radiation from the x-rays.  Sometimes you can get spasms of the tubes that make them look like they are blocked, when the actually are not, too.  The test should be done right after your period ends.  This way you won't be pregnant when the test is done, and the lining inside the uterus is nice and thin.  This helps with being able to visualize the cavity of the uterus well.

Normally, you can't see the fallopian tubes on ultrasound.  Mixing something like protein or air, which  shows up well on ultrasound, can make the tubes visible, however.  Recently, a device called FemVue has made it fairly simple to infuse a mixture of saline with tiny little air bubbles into the uterus and watch it flow out the tubes on ultrasound.  This has a few advantages.  First of all, there is no radiation like you get with x-rays.  Secondly, you can take a look at the walls of the uterus and the ovaries, which you cannot see on an x-ray.  It appears to be less uncomfortable too, perhaps because the saline is so much thinner than the contrast used in an HSG.  The disadvantage is that you need a doctor who is trained in how to use the device.  It has the same risk of infection (rare) as the HSG too.

Finally, the patency of the tubes can be tested at the time of surgery.  Saline with a little blue dye can be infused in the same way as it is in the HSG.  The surgeon is watching the ends of the fallopian tubes to see if the blue dye comes through.

Some women may not need any of the above tests, though, at least not right away.  It has been shown that you can predict most of the women who are going to have blocked tubes by looking at their medical history and doing a blood test for an infection called Chlamydia trachomatis.  If a woman has never had any surgery in her pelvis, never had her appendix out, does not have moderate to severe menstrual cramps (signs of endometriosis), and has never had a sexually-transmitted infection or pelvic inflammatory disease (PID);  then she is at low risk for tubal blockage.  Chlamydia often has no symptoms, and so a blood test should be done to see if she has ever been exposed to Chlamydia trachomatis.  If not, then studies show that her risk of having blocked tubes is less than 10%.  At that point, both the patient and her doctor can decide whether the doing further testing is worth it.

If your tubes are blocked, then there are several options.  If only one tube is blocked, then sometimes just getting you ovulating on the side that is open is all it takes.  This will happen about 50% of the time without any intervention, but it is impossible to predict the pattern.  Clomiphene citrate (a mild fertility medicine) is often used to get 2 eggs ovulating instead of one.  This will increase the chances that at least one of those eggs is on the side that is open.  

If both tubes are blocked, then the choice is either to open the tubes or perform IVF (in vitro fertilization or the "test-tube baby" procedure).  Because eggs are taken out of the ovaries and then fertilized embryos are placed into the uterus with IVF, the tubes do not need to be open.  Unblocking the tubes may or may not be possible.  If the tubes are blocked right where they enter the uterus, then it may be possible to open them.  Small guidewires can be placed through the blockage to open it up.  This can be done under x-ray or with a scope that is placed into the uterus.  If the tubes are blocked at the other end, near the ovary, then it also may be possible to open them.  This is done by placing a scope and other instruments through small incisions in the bellybutton and down near the pubic bone.  The delicate fingers at the ends of the tubes are teased apart.  Oftentimes, they are too damaged and scarred together, however, to get apart.  

If a woman has had her tubes tied and now wants more children, then the options are also surgery or IVF.  The tubes can be sewn back together with very fine suture, if there is enough tube left.  The best tubes are ones that were tied at the time of c-section or had a ring or clip put on them.  Tubes that were cauterized or "burned" can have severe damage.  Many times they cannot be put back together.  In that case, IVF is still an option.

No matter how a fallopian tube is opened, doing so puts the patient at risk for a tubal pregnancy.  This is when a pregnancy implants in the fallopian tube rather than in the uterus.  This can be very dangerous, because there is not nearly enough room inside a fallopian tube for a pregnancy to grow.  If not caught in time, the fallopian tube will eventually rupture and the patient will start bleeding into her belly.  At this point, it becomes a life-threatening situation.  Therefore, women who have had surgery on the tubes or have blocked tubes need to be followed very closely at the beginning of pregnancy.  If caught in time, it can be treated with medication.

Sometimes, when the tubes are blocked down near the ovaries, they will fill up with fluid.  This is called a hydrosalpinx.  The fluid backs up into the uterus and it is very toxic to embryos.  If a woman has a hydrosalpinx, then it should be removed.  Even if the other tube is open or IVF is planned, removing the hydrosalpinx will keep the toxic fluid from entering the uterus and killing any embryos there.

Fortunately, blocked fallopian tubes make up only a small portion of infertility cases.  There is testing that can be done to determine whether a woman's tubes are blocked, for those who are at risk of tubal damage.  If one or both fallopian tubes are blocked, there are options.  So talk to your doctor!

26 comments:

  1. Thanks so much for such a detailed description of the HSG/Femvue procedure.

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    2. Oops! Unknowingly I had deleted my own comment. However, I was writing about a therapy that helped me in conception. It was called the pregnancy Miracle. I had both tubes blocked but the therapy which consists of wide range of natural treatments helped me get pregnant.
      It is dead cheap like $37. If you were like me, desperate in conceiving then I strongly recommend it.
      I know it sounds crazy. Even I was skeptic at first. BTW I am not forcing anyone. Just thought of sharing and nothing else http://www.fallopiantubeblockage.com/pregnancy-miracle-dr-lisa-olson/

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  2. How do you know if someone has hydrosalpinx? Both of my tubes are blocked and I had an hsg test. I am having femvue next month to confirm because I was having muscle spasms during the test. I was curious about this fluid killing embryos because I had a miscarriage with an ivf cycle and the next cycle I had a BFN pregnancy test. I have never heard of hydrosalpinx nor has my ivf doctor even mentioned it to me. Fyi I am 43.

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  3. hi iam a 46 year old women and had eight normal pregnace and one ivf baby i have just been through 19 ivf attempts and was not successful i was just wondering if it would be possible to have a tuble reversal seing i had my tube clamped about 13 years ago and had a reversal but it did not work and was wondering if there was anything i could do i just want one more baby

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  4. Great Post KEEP IT UP
    I've been using HOME CHECK OVULATION TEST KIT for a long time and I still get butterflies when that little smiley shows his face. :) I got one from the internet by searching on Google HOME CHECK OVULATION KIT it was great! You can check my profile if you want to more information

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  5. Wow congratulation Great Post KEEP IT UP
    With regards
    Sammy
    Home Check Ovulation Kit
    You can find me by searching on Google HOME CHECK or check my profile

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  7. Thank you Dr. Trout for such an explicit and comprehensive explanation of blocked fertility tubes. I found out a few days ago that my tubes were blocked I began my research yesterday and today and this is the best site by far. Having a medical background, the other sites were information overload and overwhelming to say the least. Fantastic job Dr. Trout!

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  8. Thank you for the advice, I am 29 I have 3 children from a previous relationship and I have remarried, we have tried to get pregnant for 18 months and I've finally been diagnosed with PID and my tubes are blocked, these site has been most helpful and I'm hoping that there are many things we can try so we can successfully have a baby together this has given me hope x

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  9. Hi im 30 been with my partner 11 years we been trying for kids for 6 yrs now still no luck I'm having the hsg tomorrow very nervous about it in worried i have blocked tubes and theres nothing can be done me and m partner want children so badly I cldnt bear bad news

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  10. Nice Posting!! Keep it up!!Main problem faced by women trying to conceive. It is necessary to know the RIGHT Day, RIGHT Time and RIGHT Way for conception…Now you can plan your pregnancy and you can choose your date and time of pregnancy as you like with Ovulation Kit.

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  11. hi i am 25 and at the age of 20 was told that my tubes are blocked, the conversation i had with my doctor is now very vague since it was such a long time ago, i had a laparoscopy and was told that i had a very low chance of falling pregnant naturally so at the age of 24 went though an ivf cycle and now have a 10 month old son :) but now im wanting more kids but ivf is very stressful and expensive and want to know if there is any doctors in sydney that specialise in fallopian tube blockage/scarring. I had an appointment with a "specialist" last month but she just shut me down and said there was NOTHING i could do about it, but i have read different on the internet , please help me this is very frustrating! If you could please email me information to brax1002@hotmail.com

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  12. I got told too (I'm in Brisbane) that there is "No such surgery to unblock fallopian tubes". That just is not true. Either Australia's OBGYN's are medically backwards or there is a skills shortage and they don't know how to perform the surgery thus deny it's existence. Any other Australian women got told this or have actually had this type of surgery here? I mean, for christ sake- Australia isn't a 3rd world country. And it's really sad we are being told that there is "No such surgery to unblock fallopian tubes" and being sent away- when there is. Do they mean there are no surgeons in Australia that perform it? Or they really belive there is none?

    Can any experts out there let me know??? :-(

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  14. Hi i'm 37 & got the same issue too & was diagnosed with blocked left tube. I underwent MRI & some other test prior to laparoscopy likely 3yrs ago. My gynecologist tried to fix & unblock my tube. AFter the procedure, she said i only have a very small chance of getting pregnant or conceiving. Obviously laparoscopy did not help fix my problem. I have been referred to a fertility specialist though & was adviced by the specialist to undergo blood test, ultrasound & HSG before ivf procedure begins. I hope once i am done w/ these 3 tests, everything turn out ok so we can start with ivf. I would like to have a child/children. I am praying hard.

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  15. There are no two ways that India is the world leader in attracting patients from across the borders for medical treatment in India like Surrogate mothers in India, Infertility Treatment in Delhi, Surrogacy India, Gestational Surrogacy India, IVF Hospital in Delhi, Best IVF Doctor in Mumbai, brain surgery at best hospitals in India.

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  16. Hsg done today said left fallopian tube flowed great right side looks blocked . Been taking clomid since march. been trying for a while now

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  17. I have my both fallopian tubes blocked due to appendicitis operation. Can I become pregnant?

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  18. I have been married for four and a half years and having intercourse without protection. I have not gotten pregnant once. Before marriage, I purchased after morning pills (one fell and could not be located so only swallowed one), turned out some remnants were left in me and I wasnt aware causing my ovaries to become inflamed. Upon discovering this, I had a DNC. Truth is my husband has 2 children and does not care for more but that is based on the present behaviour of children (which is selfish). I have always wanted a child but I believe I have dismissed it because of him. Yesterday my pastor's wife encouraged me to get checked to see if tubes are blocked. I have read this article and although willing I am now teriffied of the 1. Possible infection 2. Tubal pregnancy. However, I must commend the writer....detailed and quite easy to read. I need advice please. How do I say to my husband I need a child and also how do I get over being terrified of the pricedure?

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  19. My wife had blocked fallopian tubes and we both struggled hard to conceive. We tried almost every treatment and spent half of our fortune. Then I came across this site http://www.fallopiantubeblockage.com which recommended a natural treatment called pregnancy miracle. The therapy promised to conceive within 2 months but it never helped for more than 4 months.
    Interestingly in the 5th month my wife conceived. Now, we have a beautiful daughter named Sarah. If you have tried every treatment or looking for a natural therapy I recommend to take a look at the website.

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  20. i have a question. what if u cant see ur left fallopian tube when u get a hsg done? what do that mean?

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  21. hi im 24 and i found out both of my fallopian tubes are blocked this really suck being ttc for 3years and this is why my im getting tubal surg done April 14th and im so scared you ladies have giving me hope you are not alone i wish it can happen the easy way but this will just make our babies special remember god does not short anyone a blessing and placing a baby in your womb is a gift from god

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  22. tay it may either be blocked are some times they may not show because of spasm

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