Tubal Factor Infertility

Infertility is the inability to conceive after one year of regular unprotected sexual intercourse.

Tubal factors or diseases affecting the tubes continue to contribute immensely, particularly in Sub-Saharan Africa (KENYA) in this category, towards female factor infertility and overall causes of infertility.

• The fallopian tubes are thin, delicate, muscular, and membranous structures measuring between 7-14 cm in length.
• It is in the fallopian tube that “THE EGG MEETS THE SPERM=FERTILIZATION” happens. The fallopian tube performs a very crucial role by acting like an incubator. The fallopian tube’s condition is paramount for bringing forth life to occur in humans in vivo.
• Damage to the fallopian tubes may prevent fertilization from happening in various ways-obstruction/blockage, inefficient peri tubal movement function, destruction of the Endo salpinx, inadequate transfer of the fertilized embryo, egg selection, and  in cases of hydrosalpinx-the fluid may contain toxins that interfere with fertilization as well as endometrial receptivity

• Infections of the fallopian tubes play a leading role in the causation of tubal pathology by blockage. Most of these infections arise from sexually transmitted diseases like chlamydia and gonorrhea, Postpartum infections, and infections following abortions (septic abortions). Additional risk factors or conditions that affect the fallopian tubes include:
  1. Prior pelvic surgery
  2. Pelvic adhesions
  3. Previous abdominal surgery can predispose to tubal adhesions
  4. PID
  5. Endometriosis
  6. Other infections of nearby organs such as appendicitis or ruptured appendix and abscess; inflammatory bowel disease
  7. TB of the pelvis
  8. Prior ectopic pregnancy
  

• Your doctor is likely to request one of these three investigations to investigate tubal pathology:
  1. Hysterosalpingography (HSG). Read more here: https://www.nyalifewomensclinic.com/hysterosalpingography-hsg-test-procedure/
  2. HysteroSalpingo-Contrast Ultrasonography (HyCoSy)-such a mouthful-ever heard of this? This is whereby special contrast media or dye is injected into the uterus with the help of a thin cannula inserted into the cervix as a 3D transvaginal ultrasound scan is performed. Another test is sonohysterography whereby a similar procedure is performed but with saline
  3. Laparoscopic Chromopertubation- is considered the gold standard whereby laparoscopy is performed to check the movement and spill of a dye inserted into the uterine cavity through the cervix.

• If you have been trying to conceive for a duration of one year which means you having regular intercourse at least three times a week without contraception for a lady aged less than 35 years, be seen by a gynecologist doctor for evaluation
• If you have been unable to succeed with conception upon trying to conceive for a duration of six months which means having regular intercourse at least three times a week without contraception for a lady more than 35 years, be seen by a gynecologist doctor for evaluation
• If you have any reason that may be causing you to worry as regards fertility, maybe as a result of the risk factors listed up there as possible causes and you would like to be counseled and evaluated, it is time to see your gynecologist.

Good quality studies (Randomized Control Trials) that evaluate the outcomes of the different treatment options, for example, expectant management, tubal surgery, or In Vitro Fertilization (IVF), are unavailable at the time.
Considerations before treatment are individualized based on the cause of the tubal disease, the extent, the site, and the severity of the pathology.

However, the success rate of tuboplasty in our setting for instance is low.