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Monday, 10 February 2014

What can go wrong with the tubes?

Normal Fallopian tube

What can go wrong with the tubes? Well they can be blocked, or even if they are not blocked, the inside of the tube can be damaged to an extent that it is no longer able to do its function. Sometimes when the ends of the tubes get blocked, the fluid that is secreted by the cells lining the inside of the tube cannot drain and the fluid gets accumulated, this condition is called hydrosalpinx. Intermittently this stale fluid can get discharged into the uterus. So while swollen tubes can be seen on ultrasound scan, these same tubes may not be seen if they have emptied the retained fluid!

Hydrosalpinx (Swollen fallopian tube)

The tubes get damaged because of infections such as those caused by Chlamydia, Gonorrhoea, Tuberculosis and other pelvic infections.The tubes can also get damaged as a result of endometriosis. The degree of damage varies and sometimes the damage is so subtle that the tubes can look apparently normal on the evaluation tests that are available. If you have had an ectopic pregnancy wherein the pregnancy settles in the tube, it is likely that there may have been a damage to the tube. It is also probable that what has caused damage to one tube may have affected the other as well!

To fully evaluate tubes is not possible. Normal tubes cannot be seen at ultrasound scan. All that can be done is to check whether they are open or not. This can be done either by x-ray or ultrasound. In both procedures solutions that can be 'seen' on the x-ray or ultrasound are injected through the neck of the womb (cervix) and simultaneously x-ray or ultrasound is done to check whether this fluid is passing through the uterus and through each of the tubes into the cavity of the tummy. The x-ray test is called hysterosalpingogram (HSG) and the ultrasound test is called Sonosalpingography (SSG). These tests are not always foolproof. Sometimes the tubes can go into a spasm and the dye therefore doesn't go through giving the impression of blockage in the tubes. If the HSG or SSG findings are anything but normal, it is recommended that laparoscopy is done to examine the tubes before any further fertility treatment.

If there are any indications that the tube/s may have a problem, in my opinion it would be prudent to move on to IVF or test tube baby after a short trial (if at all) of natural conception or intrauterine inseminations (IUI). In case of hydrosalpinx, the swollen tube should either be removed or at least delinked from the uterus to enable best outcome with IVF.

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