Fallopian tubes, also known as uterine tubes, are tubes in the human female reproductive system that run from the ovaries to the uterus. It allows the sperm to pass from the uterus to the tube at one end, and the egg released from the ovary to pass into the tube at the other end. Sperm and egg meet in the tube and fertilization occurs here. The fertilized egg is pushed into the uterus with the help of a tube and attaches to the uterus wall. Thus, pregnancy begins. Therefore, the tubes have a very important role in the formation of pregnancy.
2- DOES OBSTRUCTION CAUSE INFERTILITY?
If both tubes are blocked in a woman, the sperm and egg will never meet, and in this case, natural pregnancy will not be possible. Sometimes, even if the tubes are not clogged,
due to infections, it may be extremely enlarged and filled with inflamed fluid. In this case,
the tubes may not be able to function and pregnancy may not occur naturally.
3- WHY ?
Some of the causes that lead to blockage of the fallopian tubes are as follows:
Pelvic infection (PID) – Infectious diseases such as gonorrhea (or commonly known gonorrhea) and chlamydia can progress to reach the tubes and cause the tubes to become blocked. These infections are sometimes silent without causing a serious illness in the person and can cause infertility by blocking the tubes. · Endometriosis (chocolate cyst disease): In this disease, widespread adhesions may occur in the peritoneum and intra-abdominal organs. Depending on these adhesions, the tubes may become unable to function. History of abdominal surgery in the past: Free passage to the tubes due to adhesions that may develop due to abdominal surgery may break down.
Hydrosalpinx (It is the situation where the Fallopian tubes are completely filled with liquid, enlarged and become unable to function.): In this case, even if the tube is not clogged, pregnancy may not be achieved naturally due to the fact that it becomes unable to function.
4- WHAT CAN BE DONE TO KNOW IF THE TUBES ARE CLOGGED OR OPEN
There are several methods for testing tubal patency:
Hystero-salpingo-graphia: Also known as HSG or uterine film. It is usually performed under anesthesia. A radiopaque fluid is introduced into the uterine cavity and it is evaluated whether this fluid passes through the tubes and reaches the abdominal cavity easily. In this way, a possible blockage is detected. It is a very practical and successful method. However, pain occurs during the passage of fluid through the tubes. may come out. Therefore, the procedure is usually completed under anesthesia. After the uterine film, people can return to their working life on the same day.
Ultrasound: Ultrasound is only useful in detecting overgrown and fluid-filled tubes such as hydrosalpinx. However, if the tubes are of normal size, ultrasound alone will not be sufficient to detect a blockage in the tubes.
Evaluation of tubes with closed surgery (laparoscopy): In laparoscopy surgery, a camera is placed in the abdominal cavity with a 1 cm incision just below the navel. At the same time, a dye (methylene blue is often used for this purpose) is sent from the cervix to the uterus with the help of a catheter. If methylene blue fluid fills the uterine cavity and then passes the tubes and pours into the abdomen, this is observed with the camera placed on the abdomen and the tubes are determined to be open.
This method is the gold standard in evaluating the patency of the tubes and is more successful than HSG. In addition, if a blockage is detected in the tubes, the simultaneous opening of this blockage can be done by laparoscopy. However, this method is ultimately an operation and is more troublesome than HSG. After HSG, people can return to their working life immediately, but a one-day hospital stay is required after laparoscopy. For this reason, HSG is often the first option in evaluating whether the tubes are clogged. However, sometimes laparoscopy can be applied after HSG for further examination.
5- WHAT CAN BE DONE IF BOTH TUBES ARE CLOGGED?
In this method, it is aimed to open the tubes surgically. However, tubes should not be
thought of as immobile straight pipes with no function. The tubes must be in an activity that ensures the movement (transport) of the fertilized egg. Even if the obstruction in a tube is surgically opened, the transport activity of the tube may be impaired. Sometimes, even if the
tube is opened with surgery, an ectopic pregnancy may develop in that tube. In addition, the opening of clogged tubes with surgery is not always successful. If there is severe deformation in the tubes, the success of tube opening surgery is considerably reduced. For this reason, in vitro fertilization may sometimes be the first choice for people whose both tubes are blocked.
IVF (In vitro fertilization method), fertilization of the egg by the sperm outside the body (in the laboratory environment) and then fertilized
is the transfer of the egg (zygote) to the patient’s uterus for the purpose of a successful pregnancy. Thus, there is no need for tubes in this method.