Why do Fallopian tube obstructions prevent or complicate pregnancy?

Inflammations, infections, surgeries and scars don't just affect Fallopian tube permeability, causing an obstruction in one or both, but also harm the cilia and their capacity to transport. The cells that coat the inside of the Fallopian tubes also secrete a nutritious mucous which is responsible for nurturing the embryo in the first days after fertilization. This function is often jeopardized. Another problem is the loss of the end of the Fallopian tubes’ ability to go back to the ovary and "embrace it", making it unable to receive the ova it releases. What we often see are Fallopian tubes that are stuck far away from the ovaries, facing in the opposite direction. The issues can be moderate and simply lead to a further delay in getting pregnant. Unfortunately, the lesions are frequently severe and can completely prevent pregnancy.

What are the Fallopian tubes and what are their functions?

Fallopian Tubes are two thin, delicate structures located in the upper region of the uterus. Their purpose is to receive the ova released during ovulation and allow it to unite with a sperm. This means that natural fertilization occurs in the Fallopian tubes (in vivo). During the fertile period they must collaborate to make the sperm rise, and after fertilization the fertilized embryo must be nurtured and rolled toward the cavity of the uterus by the movement of thousands of cilia that line the internal walls.

I have a friend who also has a problem with her Fallopian tubes. Is this common?

Nearly 35% of female infertility cases are due to Fallopian tube issues.

What makes Fallopian tubes become obstructed?

Most couples who seek medical help to get pregnant receive a diagnosis that names Fallopian tubes as the problem. Fallopian tube obstruction is commonly caused by endometriosis through the formation of adhesions (scars) after surgeries, pelvic infections caused by microorganisms such as chlamydia or by a tubal ligation (sterilization). For the past few years in Brazil, there has been an increase in the number of women who undergo tubal ligation surgeries, and for various reasons, decide they would like to have another baby.

How are the Fallopian tubes assessed?

There are basically two diagnostic methods that can identify the functionality of the Fallopian tubes. The first is hysterosalpingography, diagnostic imaging done with radiology at hospitals and clinics. After a radiocontrast agent is introduced, this test allows for the visualization and documentation of the reproductive tract, simulating the path traveled by semen. The hysterosalpingography aids in analyzing the cervical canal, uterine cavity, Fallopian tube permeability and dispersion of contrast in the abdomen. It is a test that is very hard to interpret, and it can generate varying diagnoses. In addition, it is unreliable when the appropriate technical requirements are not followed while the test is being performed. Many patients complain of pain or discomfort caused by this test. Nevertheless, it is still very commonly used to evaluate the Fallopian tubes. Videolaparoscopy is a test done at a hospital under general anesthesia, which provides images of the inside of the abdomen and helps identify the anatomy of the reproductive system. This is the most precise test to evaluate the integrity of the Fallopian tubes and diagnose a series of abnormalities, such as endometriosis.

Is surgery on the Fallopian tubes worth it?

After the surgery, the Fallopian tubes often become permeable again, but they do not return to their previous levels of performance (anatomical and functional normality). This is why it is common for the Fallopian tubes to be unable to sustain a pregnancy afterwards. The surgery can also create a new obstruction due to fibrosis (scarring) and increase the risk of an ectopic pregnancy (in the Fallopian tube). In the past, when the success rates for in vitro fertilization (IVF) were lower, many women opted for surgery. Today, with better results through IVF, fewer Fallopian tube surgeries are performed. This is still an option in cases where the female is very young and the couple cannot afford IVF. It is important to note that after this surgery patients will have to wait many months or even a few years to verify whether or not a pregnancy is possible. A pregnancy is the only effective proof that the surgery successfully cleared the Fallopian tubes.

I had a tubal ligation done a few years ago. What steps must I take to get pregnant again?

Many women who undergo tubal ligations end up wanting to get pregnant again a few years later. This change is usually motivated by three things: regret and resurgence of the desire to be a mother, loss of a child, or most frequently: the beginning of a new relationship. In these cases, the recommended technique is in vitro fertilization (IVF). The chances of the treatment working depend on a series of factors, the main one being the woman's age. The rule for IVF is the younger, the better. After women turn 40 years old, even they are healthy and already have children; the chances of getting pregnant are significantly lower.