What Is Tubal Blockage?

Tubal blockage, or tubal occlusion, is the mechanism by which tubal ligation procedures prevent pregnancy. It blocks sperm from reaching the egg and prevents eggs from reaching the uterus.

When tubal sterilization is performed, tubal blockage is intentional. It can also occur due to diseases, resulting in involuntary infertility. Whether intentional or caused by disease, tubal blockage can often be corrected with reconstructive tubal surgery.

Causes of Tubal Blockage

• Tubal sterilization
• Pelvic inflammatory disease (PID): Inflammation of fallopian tubes (salpingitis), possibly involving ovaries (oophoritis) and pelvic peritoneum (peritonitis)
• Endometriosis
• Congenital abnormalities: Malformations of uterus and fallopian tubes, usually causing blockage near the uterine end

Treatments for Tubal Blockage

There are two primary approaches to treating infertility due to tubal blockage:

• Tubal Surgery: Best performed by specialized gynecologic reproductive surgeons.
• In Vitro Fertilization (IVF): Replaces fallopian tube functions with laboratory fertilization and embryo transfer.

Since IVF’s advent, reconstructive tubal surgery skills have declined, with IVF becoming more popular among reproductive endocrinologists.

Tubal Surgery to Correct Tubal Blockage

There are three main surgical techniques:

• Tubal Anastomosis: Removing blocked segments and reconnecting the open ends. Used when blockage is between uterus and fimbrial end.
• Tubal Implantation: Bypasses proximal blockage by creating a new uterine opening and inserting healthy tube segment.
• Salpingostomy: Creating a new opening near the fimbrial end to correct distal blockage caused by PID or endometriosis.

Benefits and Risks of Tubal Surgery vs. IVF

Benefits of tubal surgery: Usually done once, allowing pregnancy at any time after. Main risk: increased tubal (ectopic) pregnancy.

IVF advantages: Avoids surgery, though expensive and requires ovarian stimulation hormones. Risks include ovarian hyperstimulation and multiple pregnancies. There is also a small risk of tubal pregnancy if tubes are open.

Tubal Clipping or Removal (Salpingectomy) Before IVF

Performed to prevent harmful tubal fluid from flowing into the uterus during IVF, especially in cases of severe hydrosalpinx. It can improve pregnancy rates but may compromise ovarian blood supply and be complicated by pelvic adhesions.

Polycystic Ovarian Syndrome (PCOS)

PCOS is a common reproductive disorder marked by irregular menstrual cycles, excessive body hair, acne, oily skin, weight problems, and infertility. It’s linked to high insulin levels and excess testosterone, causing ovulation disorders.

Women with PCOS are also at risk for conditions like Type 2 diabetes. Managing insulin levels can restore menstruation and reproductive function.

What Does PCOS Mean?

PCOS is an endocrine disorder with symptoms including irregular or late periods, lack of ovulation, acne, oily skin, excess body hair (face, chest, below navel), and weight gain. Some also develop dark patches on the skin (acanthosis nigricans) due to high insulin.

What Happens in PCOS?

Women normally have small amounts of androgens (male hormones). PCOS causes excess androgen production by the ovaries, increasing free testosterone and leading to non-ovulation and related issues.

PCOS affects 5-10% of women of childbearing age and is a leading cause of infertility. About 20% of women with normal cycles may have polycystic ovaries on ultrasound.

How Is PCOS Diagnosed?

Diagnosis involves physical examination for symptoms, ultrasound to detect polycystic ovaries, and blood tests to measure hormone levels and insulin resistance.

Excessive or Prolonged Bleeding Causes

Due to lack of ovulation, continuous estrogen exposure thickens the uterine lining, causing heavy irregular bleeding.

Follow-Up After Delivery

Women with PCOS should continue medical follow-up due to risks of heart disease, diabetes, abnormal lipid profiles, and uterine cancer.

Weight and PCOS

Weight loss improves ovulation, fertility, and lowers diabetes risk. Lifestyle changes including reducing fat and sugar intake, and exercising (e.g., 40 minutes brisk walking daily) are recommended.

PCOS Treatment Options

Treatment depends on your goals: fertility or symptom management.

If Fertility Is a Concern

• Clomiphene citrate to induce ovulation
• Insulin sensitizers (e.g., metformin) for better ovulation
• Gonadotropins (injectable hormones) if oral treatments fail
• Laparoscopic ovarian drilling to improve ovulation

Metformin Use in PCOS

Metformin lowers insulin and improves egg development, especially in women with high insulin or diabetes. It’s recommended only for select patients, not as blanket therapy.

If Fertility Is Not a Concern

Hormonal therapy regulates menstrual cycles, and antiandrogens treat excess hair and acne. Lifestyle modifications are essential for overall improvement.

Top 10 FAQs About Tubal Blockage