Tubal Factor Infertility and Reversing Tubal Sterilization

Once the follicles reach maturity, the LH surge occurs, which causes ovulation thirty-six hours later. The egg(s) is ovulated into the end of the fallopian tube and travels to the distal end where fertilization occurs. Any condition that impedes, or blocks, egg transport through the tubes can cause tubal factor infertility. In many of these cases IVF is the treatment of first choice.

Sometimes endometriosis will attach to the fallopian tubes causing scarring and/or adhesions "on" the tubes leading to obstruction. In addition, severe pelvic infections (pelvic inflammatory disease), caused by a variety of microorganisms including Chlamydia, can severely damage the fallopian tubes.

In other cases, women who previously had their tubes tied, seek to have the procedure reversed. While this is sometimes possible, tubal sterilization should be considered a permanent form of birth control.

To begin the evaluation of the tubes and uterus, the specialist orders a hysterosalpingogram (HSG). In this test, dye is inserted into the uterus and x-rays are taken as it flows back through the tubes. Blockages are seen as concentrations of dye.

The physician may recommend surgery if the tubal blockage is not severe. This is dependent upon a number of patient specific variables including age, where, and how, the tubes were "cut" or damaged, other underlying causes of infertility, etc. Data clearly demonstrates that in vitro fertilization (IVF) produces higher per cycle success rates than does tubal reconstruction.

A patient with tubal sterilization may opt for a tubal reversal if she is young and has no other factors contributing to her infertility. The advantage to tubal reversal, in appropriately screened cases, is that even though the per cycle success rates are lower than IVF; numerous natural intercourse cycles can be attempted. Moreover, the patient may not be able to afford multiple IVF attempts.

IVF is usually recommended as a first line treatment when moderate to severe tubal damage is present.