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Infertility and Tubal Disease, Tubal Reversal
Once the eggs mature and are ovulated, they
travel to the fallopian tubes from the ovaries to the
distal end (end away from the uterus) of the tube  where
fertilization occurs. If the tubes are obstructed,
the eggs may not be able to make their passage resulting
in infertility.
Tubal disease can be caused by
endometriosis when endometrial cells implant on the
tubes eventually penetrating and obstructing them.
Tubal disease can also result from an infection causing scarring,
and can be caused by many different microorganisms such
as Chlamydia or sexually transmitted diseases including
gonorrhea and syphilis.
The condition of the fallopian tubes is usually assessed
with the
hysterosalpingogram (HSG). In this test, radiopaque
dye is injected into the uterus
and x-ray images are taken as it passes through the fallopian
tubes. Tubal damage and blockages show as collections of dye at the
area of the tubal obstruction.
Many women choose to have a tubal ligation (or
tubes tied) as a means of birth control. Oftentimes women seek to have tubal sterilization reversed. Tubal reversal surgery is often sought because of unforeseen
changes in their life situation, such as remarriage, loss
of a child, etc.
Tubal reversal, or "reconnecting" the tubes, is delicate surgery . Dr. Deaton
is a highly skilled microsurgeon and can often successfully
reconnect the tubes. Success depends upon many factors
including how the tubes were cut (laser, electrocautery,
etc.), the lengths of the fallopian tubes that remain, scarring,
and many other factors. However, any women considering
tubal sterilization should be counseled that this is a
permanent means of birth control.
Oftentimes in
vitro fertilization (IVF) is the treatment of choice
for tubal disease or for tubal reversal. In IVF, the eggs are withdrawn from
the ovaries and fertilized in a Petri dish. Since
the eggs are retrieved, they do not have to pass through
the fallopian tubes.
IVF per cycle success rates are higher than those with tubal surgery. However, once the tubes are reconnected there is no limit to the number of natural cycles that can be attempted whereas the number of IVF cycles may be limited by cost.
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