Treating Female Infertility and Fallopian Tube Blockage

For achieving your pregnancy naturally, one of the necessities is the passage where the woman’s egg meets the man’s sperm contained in the semen that penetrates and fertilizes it. This generally happens in one of the woman’s two Fallopian tubes.

While ascertaining the couple’s fertility, it is important to know whether the woman’s Fallopian tubes are open to facilitate the process. As for the symptoms of tubal blockage, there, actually, are no external signs that will indicate that your Fallopian tubes are blocked.

There is a high probability of your suffering from blocked Fallopian tubes, if you have had pelvic inflammatory disease in the past. The fertility experts estimate that three out of four women suffering from any kind of sexually transmitted diseases will have tubal blockage.

The main sign that indicates tubal blockage is that you become infertile, meaning, it prevents you to get pregnant. There are some medical tests that may identify any kind of irregularities or blockages.

If any kind of tubal blockage is evident, your treating doctor may perform some investigations using a laparoscope.  These investigations will help your doctor to look into the Fallopian tubes. Let us discuss how blocked Fallopian tubes can be diagnosed:

  • Hysterosalpingogram (HSG)

A hysterosalpingogram, or HSG is a significant test of a woman’s fertility potential. The HSG test is a radiology method performed in the radiology department of a Clinic or a diagnostic center.

  • It is, in fact, an X-ray examination wherein a contrast dye is used to examine any kind of occlusion in the Fallopian tubes.
  • The dye is placed through a slender tube, which is placed up through the vagina, into the uterus.
  • The filling of the dye in the womb with, thus, falls into the Fallopian tubes.
  • After this, X-rays are done to ascertain whether the uterus and the Fallopian tubes are injured and have gone unshapely or there exists any occlusion in the tubes.
  • The examination will also ascertain whether the blockage is at the proximal, mid-segment or the distal end of the tube.
  • The tubes are also inspected for other defects and to know whether the blockage is partial.
  • The doctors mostly rely on this test to know if there is an obstruction in the Fallopian tubes.
  • Besides examining the Fallopian Tube blockage, the uterine cavity is also examined to know the presence of congenital uterine anomalies, fibroid tumors, polyps and uterine scar tissue.
  • The examination is also done to know the presence of pelvic scar tissue in the abdominal cavity, and for evidence of pelvic scar tissue in the abdominal cavity close to the tube.

The hysterosalpingogram test can be performed in just 5 minutes. The test is generally done in the radiology department of the Clinic or the Diagnostic center.

So, there is extra time required to register at the Clinic/Diagnostic Center filling out the answers to the questionnaire like allergies to any kind of medicines etc. The examination is done in the following manner:

  • You will be asked to lie down on the examining table and bring your feet up into the frog-leg position.
  • Your treating doctor will put a speculum in your vagina to visualize the cervix.
  • Either a flexible and thin catheter is placed into your uterine cavity through your cervical opening, Or,
  • An apparatus called, tenaculum, is put on your cervix and then a slender metal cannula is introduced through your cervical opening.
  • Contrast dye is injected bit-by-bit either through the cannula or the catheter into your uterine cavity.
  • An X-ray image is taken as your uterine cavity is filled.
  • Extra contrast dye is introduced so that the tubes get filled and begin to fall into your abdominal cavity. And, more X-ray pictures are taken as this “filling and spilling” happens.
  • When both tubes begin spilling dye, you may be asked to roll to your both sides turn-by-turn or slightly so that some X-ray pictures can be taken in the oblique posture that will further explain the anatomy.
  • The process is now complete. The instruments that were placed in your vagina and cervix for conducting the test are carefully removed.
  • You may be asked to stay on the table in the supine position for a few minutes for recovering from the pain caused to you by injection of the contrast dye.
  • The test results are made available immediately. The X-ray images are generally reviewed after the procedure is accomplished.

It is important to know that it hysterosalpingogram is a diagnostic procedure and not the treatment process.  However, the pregnancy rate may increase during the first few months following this procedure.

This happens, believably, either because of the flushing of the tubes opening in case of minor blockages or some trash that was preventing the couple from conceiving gets cleaned during the procedure. Some studies and the fertility experts believe that using oil based contrast dye increases the pregnancy success rate if compared to water based contrast.

Yet, a majority of hysterosalplingogram tests is performed with water-based contrast dye. As for possible complications, there is a possibility of your catching allergic reaction to the contrast dye, although it is found to be uncommon. You may get rashes, but they are generally not serious. You may even catch infection in the pelvic area or uterine perforation but these are also uncommon.

Women, who have either multiple sexual partners or at a risk of catching sexually transmitted diseases or infections, such as Chlamydia and Gonorrhea,  might be additionally screened with cervical culture before performing the hysterosalplingogram test. In order to avoid some physicians may ask you to undergo an antibiotic course after the HSG test.

  • Chromotubation

Chromotubation is a surgical procedure which is performed with the help of a laparoscope. Besides examining the tubes for any kind of blockage, laparoscopy also helps in scrutinizing the efficacy of the other parts of your reproductive system including your uterus, ovaries and the surrounding areas.

It also helps in detecting the conditions such as endometriosis and adhesions. While the fine scar tissues are called adhesions, endometriosis consists of tissues similar to the lining inside the uterus that grow outside the womb, instead. It is pertinent to understand that it is a diagnostic course of action to ascertain any abnormality related to the reproductive system, which is obstructing your natural pregnancy. The procedure is not intended to be a treatment procedure.

While performing laparoscopy, a long and fine telescope, called a laparoscope, is inserted into your abdomen by making a small incision/cut in an area close to your umbilicus, known as the belly button in a layman language. The laparoscope instrument is as thick as an ordinary pen. Before inserting the laparoscope, the abdomen is inflated with the gas volume using a special fine needle.

This ensures availability of sufficient space in the abdomen to facilitate the laparoscope entry. One more incision (cut) is made on the upper portion of your pubic hairline to allow insertion of a slender probe.  This is meant to facilitate manipulation and easy movement of different organs of the pelvis so as to obtain a clearer view of the entire female reproductive system. Once the instrument is placed, the treating doctor can perform minute examination of the female reproductive organs such as uterus, ovaries, Fallopian tubes and their surrounding structures.

The doctor will take note of any anomalous findings. Polaroid photographs of abnormal features, if any, are taken to referring them in future. Besides examining the other organs, the procedure is also done to know the obstruction in your Fallopian tubes. It is popularly known as the dye test. In this simple test, a small quantity of light-colored blue fluid is injected into the uterus through a metal/plastic tube through your vagina and the cervix (neck of the uterus).

The objective of this examination is to aim of this test is to review if the Fallopian tubes are blocked or open. If the tubes are open, the blue fluid will go into them and spill out from the ending edges of the tubes into the pelvic area. The doctor will be able to witness this happening live from the laparoscopic view confirm the regularity of the tubes. And, if the fluid does not get into/or, gets into the Fallopian tubes, but does not fall out from the ending edges of the Fallopian tubes, tubal blockage is, thus, confirmed.

After completing all the procedures, the inflated abdomen is deflated to normalized by releasing the gas via one of the two incisions. After removing the instruments carefully, the incisions are stitched, which normally dissolve naturally in the due course of time.

  • Sonohysterography

It is a non-invasive method wherein ultrasound imaging is used to ascertain if there are any irregularities in the reproductive organs. This kind of examination is not considered reliable to ascertain Fallopian tube blockages as the tubes are very small. This examination is also known as Saline Infusion Sonohysterography or saline ultrasound. In this examination a small quantity of salt solution (saline) is inserted into the womb, thus, making the view of the endometrium clearer in the ultrasound scan. The test is also called Saline Ultrasound Uterine Scan.

Ultrasound is the process of taking images using high frequency sound waves. Sonohysterography helps in diagnosing the endometrium thickness in the uterus and the presence of polyps. Small growths of the endometrium are known as Polyps.  The test is also performed to assess the endometrium thickness that happens after the menopause or probable Asherman’s Syndrome.

The Asherman’s Syndrome is the condition that crops up with the presence of scar tissues in your uterine cavity. You do not need to make any special preparations for undergoing the sonohysterography examination.  This test is preferably done on the 8th or 9th day of your menstrual cycle.  And, it is advisable to fix your appointment with the doctor as per your menstruation dates. Prior to conducting the test, you will probably be asked to visit the ladies’ room for emptying your bladder.  In case you are wearing a tampon, you will be asked to remove it.  In case of urgency for the test, you can go in for it if your periods are about to end and the bleeding has become light.

The saline infusion sonohysterography is not performed on pregnant women and the women having a pelvic inflammatory disease. You must inform your doctor if you have any of these conditions. It will be nice if your dress is slightly loose and comfortable to allow easier access to the pelvic parts of your body. Once you have emptied your bladder, you will probably be asked to undress from your waist down and wear a clinic gown. After this, you may be asked to lie on the examination table. The doctor will insert a speculum into your vagina.

The speculum is an instrument that keeps your vagina open for facilitating easy examination.  A flexible catheter (a slender plastic tube) is softly inserted into the vagina and into the womb through your cervix (the uterus neck). A small quantity of saline (salt solution) is pushed into the uterine cavity through the catheter. The speculum is then removed to insert a transducer into your vagina.

The saline liquid within the womb stretches the uterus slightly and helps in imaging the lining of the womb understandable on the screen and any endometrial abnormality can be seen on it. The transducer is, somewhat, bigger than a tampon but specially manufactured to comfortably fit into your vagina. Over it, a protective cover is placed and lubricating gel is applied to it for making its insertion easy. It is gently moved around and pictures or images of the inside of the uterus are obtained. After the examination, you may notice fluid trickling from your vagina.

In fact, this is the saline fluid coming out that was inserted through the catheter. This fluid is generally stained with blood and may continue for the rest of the day after the examination. You may like using a sanitary pad.  But, mind it! Using tampons is prohibited for the rest of the day after the examination. Most often, patients feel comfortable after this examination showing no after effects. But, some women may feel pelvic discomfort similar to the one that is felt at the time of your menstruation or periods.

This kind of discomfort goes within an hour or so and is found to be uncommon. Some women may even feel mild dizziness, but this does not last long and goes off within minutes. Overall, you will generally be fine in a short while and can drive back home to resume your routine activities. The whole process of the examination generally takes about 30 minutes. And, most of the time is spent on scanning before and after placing the saline into your womb.

The actual time for inserting the saline in the womb takes only two-three minutes. The test is considered safe, excepting some risk of catching infection very rarely.  In case you get this infection, this can be treated with antibiotics. As for the benefits of SIS examination, inserting the salty solution (saline) into the womb stretches it and allows a clearer view of the ultrasound images on its screen to examine the uterine lining.

Irregularities like the endometrium thickening or the presence of polyps can also be easily seen. Based on the test results, your treating doctor will decide the further course of actions like prescribing you further investigations or the line of treatments.

The time taken by the Clinic for delivering test results will depend on:

  • The urgency of the test report
  • The complications and irregularities found during the examination
  • Whether additional information is required from your treating doctor before the tests are interpreted by the radiologist.
  • If you have had X-rays and ultrasound imagine done previously and you want your treating doctor to compare the earlier report with the newly results.  This is commonly done when you have the disease or the condition that is being pursued for assessing the treatment progress.
  • How the report is delivered to you or your treating doctor i.e. telephonically, by email, fax or electronically transferred.
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