The fallopian tubes connect the ovaries (where the eggs are released) to the uterus, where the fertilized egg develops into a fetus. The egg is generally fertilized in the fallopian tubes by the sperm swimming upward from the vagina, through the cervix, through the uterus, into the fallopian tubes. If a doctor suspects that the fallopian tubes are the reason a woman cannot get pregnant, surgery is one option.
Infections, abdominal surgery, and other diseases, such as endometriosis, can cause scars to form between the end of the tube and the ovary. The insides of the tubes themselves may also become damaged with adhesions or scar tissue or can become completely blocked. Two common sexually transmitted infections that may cause tubal blockages are Chlamydia and gonorrhea. Tuberculosis, very uncommon in North America, may cause tubal disease. The infections resulting from appendix ruptures also cause blocked tubes. Surgery or endometriosis can also damage fallopian tubes.
If the fallopian tubes have been purposely blocked, by a procedure called tubal ligation, which is the intentional cutting or tying of the tubes, this blockage may be reversed in a procedure called tubal ligation reversal.
Before you have surgery, your doctor will check your tubes by hysterosalpingogram or by ultrasound for damage and decide what kind of surgery you need. The doctor injects a special liquid into your womb and looks at the x-ray or ultrasound to see if the liquid travels all the way through the tube. If the liquid does not travel completely through the tubes, there may be blockage.
Surgery is almost always performed via laparoscopy – a non-invasive procedure – rather than major surgery or laparotomy. The surgeon will cut the scars between the fallopian tubes and ovaries. If one or both tubes are completely blocked, the surgeon can attempt to open the tube. If extensive repair is required, then major surgery may be necessary. If the tubes are blocked near the ovary, surgery is unlikely to succeed. In the case of severe pelvic adhesions, IVF is the route to success for many couples.
If the tubes are not badly damaged, surgery might help promote natural pregnancy. Women with badly damaged tubes may need the expertise of fertility specialists to help you get pregnant. In vitro fertilization (IVF) is one treatment that is used.
The biggest risk after tubal surgery is the possible development of a tubal (ectopic) pregnancy. In tubal or ectopic pregnancy, the fertilized egg does not travel to the uterus. Instead, it stays in the fallopian tube and begins to grow there. The tube is too small to hold a baby, and the tube will burst if the pregnancy continues, causing internal bleeding and in rare cases, becomes a life threatening emergency situation. Therefore, women who have had tubal surgery or tubal disease should tell their doctors as soon as they think they are pregnant or have missed a period. Irregular vaginal bleeding and lower abdominal pain are common symptoms associated with tubal pregnancy.
Other risks of tubal surgery include the possibility of bleeding, damage to other organs, or a reaction to the anesthesia. In addition, it is common for scar tissue to grow back, and thus surgery success may be limited.
|If you have…||Your chance of getting pregnant after surgery is…|
|Very Few adhesions between your tubes and ovaries||Much better|
|Lots of thick adhesions between your tubes and ovaries||Not good, so you might need IVF|
|Lots of thick adhesions between your tubes and ovaries||About 20% to 30%|
|A blocked tube that is filled with fluid (called hydrosalpinx)||Not very good. IVF may work but the tubes will need to be removed or surgically blocked to increase your chances of success|