The egg is released from the ovary by the process of ovulation. This egg then enters the Fallopian tubes where it is fertilized by the ascending motile sperm to give rise to the embryo. After 5 days the 150-cell blastocyst enters the uterine cavity and gets implanted in upper part of the cavity where it grows further. After 9 months the labour starts and the foetus gets delivered. At least one functional open tube is needed for natural or artificial pregnancy through insemination.
In cases of bilateral tubal blocks, the most important infection which is needed to be ruled out includes genital tuberculosis, which if present should be treated with 6 to 9 months of anti-tubercular treatment under physician’s supervision. Following this the patient should be treated by IVF/ICSI. Sometimes the fallopian tubes get blocked by debris or secretions. These types of blockages can be opened using tubal cannulation with a terumo guide wire under laparoscopic – hysteroscopic control or under fluoroscopic control. Patient who opt for fallopian tubal recanalization surgery (FTR), may have a spontaneous pregnancy conception success rates which are variable from 30 to 50 % depending on which part of tube is involved. If the patient fails to conceive with FTR, or if the tubes are very diseased, it is best to opt for IVF/ICSI procedure Many times the fallopian tubes are severely diseased and swollen. This is known as hydrosalpinx. This can be diagnosed by ultrasound or hysterosalpingography, which is done by Xray of the pelvis while pushing a radiopaque dye through the cervix. If a hydrosalpinx is present and is > 2 cm thick or is visible on ultrasound, it is best to remove it prior to IVF. This is because the hydrosolic keeps on discharging its secretions into the uterine cavity, thus hampering implantation .Sometimes due to severe adhesions to surrounding structures such as bowels , it is very difficult to remove the hydrosalpinx. Also, if one tries to remove such difficult hydrosalpinxes, the blood supply of the ovary can get hampered, resulting in depletion of ovarian reserve. In such condition, it is better to disconnect the hydrosalpinx using cautery, ligasure or harmonic scalpel. One can also block the hydrosalpinx by applying a clip at the junction of fallopian tube and uterus. There is an improvement of pregnancy rate by as much as 50 % if the hydrosalpinx is tackled prior to IVF.
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