TUBAL BLOCKAGE: IVF BETTER THAN SURGERY

The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, according to Consultant Gynecologist and Invitro-fertilization (IVF) expert, Dr Abayomi Ajayi, the success rate is very poor in the range of between 10-15 per cent. There is also the risk of tubal or ectopic pregnancy following tubal surgery.

He disclosed that in IVF, you can avoid surgery and pregnancy rates are in the range of 25-30 per cent.Dr Ajayi spoke on this and other issues.Tubal surgery vs lVF The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, its success rate is poor in the range of between 10-15 per cent. There is also the risk of tubal pregnancy (Ectopic) following tubal surgery and this may be life-threatening if rupture occurs. In-Vitro-Fertilization (IVF) has the advantages; you can avoid major surgery and pregnancy rates are in the range of 25-30 per cent. Complications following IVF are also minor. IVF however is more expensive than tubal surgery as it involves the use of hormonal preparations, there is also an increased risk of multiple gestation following IVF.

Various factors affect the success of IVF and the single most important is the age of the woman, the younger in age, the better the outcome. Older women however can benefit from IVF by using donor oocytes from younger women. IVF also has the advantage of overcoming male infertility through a process called Intra-cytoplasmic sperm injection for men with low sperm count (oligospermia). It is therefore imperative that tubal fertility problems be promptly referred to assisted conception units for care. Undertaking tubal surgery may not be the best option and it involves a lot of risks.

In-Vitro Fertilization and Embryo Transfer remains the most acceptable means of passing tubal factor infertility.Ectopic pregnancy The tubes may develop adhesions and thickened walls and close off completely. In that case, a woman’s hormones can be fine, her eggs can mature and she can even release healthy eggs every month, but the sperm may not be able to reach them. If the tubes are opened enough to allow the sperm through, fertilization may occur in the fallopian tubes. Then, when the growing zygote is traveling through the tube to reach its destination in the uterus, it may get stuck and implant in the partially-obstructed tube, resulting in an ectopic pregnancy, which may cause further tubal damage and even loss. There is a risk of recurrence of ectopic pregnancy and when both tubes are affected, the woman is unable to conceive by natural means.

Treatment
There are two basic approaches to treat infertility due to tubal blockage viz: Tubal Surgery and In Vitro Fertilization (IVF).

Tubal surgery involves techniques aimed at re- opening blocked tubes, while IVF replaces the functions of the fallopian tube with laboratory and minor surgical procedures that result in fertilization and transfer of fertilized eggs or embryos into the uterine cavity.

Since the advent of In Vitro Fertilization (IVF), reconstructive tubal surgery is becoming a lost skill. IVF is more popular than tubal surgery due to the better pregnancy outcome using assisted conception procedures. Sometimes, a woman’s inability to conceive is because the pathway from her ovaries to her uterus is compromised. The ovaries could be covered with adhesions that obstruct entry of eggs into the pelvic cavity. The fallopian tubes could be narrowed or even completely obstructed or perhaps the uterus is bound up with scar tissue that keeps it from holding the fertilized egg successfully. Blockages such as these may be caused by congenital defects, by scarring from past infections, by surgical procedures like tubal ligation. A blocked tube prevents sperm from being able to reach an egg and also prevents embryos from being able to reach the uterus. Tubal block can be intentional (such as in tubal sterilization) or unintentional (due to disease conditions that result in involuntary infertility).

Whether intentional or resulting from disease, tubal blockage may be corrected with reconstructive tubal surgery. Prevalence and causes An estimated five million women in Nigeria have had a tubal sterilization for one reason or the other. Approximately one-sixth of the cases of infertility in the country are due to tubal disease. Most of these cases are caused by pelvic inflammatory disease (PID) - an inflamatory condition of the fallopian tubes (salpingitis) and may also involve the ovaries (oophoritis), and pelvic peritoneum (peritonitis). In many, perhaps the majority of cases, PID is unrecognized or ‘silent’ and/or misdiagnosed. Endometriosis is another condition that can cause tubal blockage and is sometimes confused clinically with PID. Congenital abnormalities or malformations of the uterus and fallopian tubes may also result in tubal blockage. In these cases, the blockage is usually at the uterine, or proximal, end of the tube rather than at the fimbrial end as occurs with PID. Symptoms Most fallopian tube obstructions produce no overt symptoms other than infertility. Adhesions and scar tissue may cause pain and limit mobility.

Many women discover blocked fallopian tubes only after experiencing infertility and as a result of one or more diagnostic procedures, including a hysterosalpingogram (where dye is injected into the uterus and examined via x-rays to see if it spills into the pelvic cavity), laparoscopy or laparotomy. Mechanical Infertility Perhaps the most heartbreaking causes of mechanical infertility known to mankind is Pelvic Inflammatory Disease (PID). This infection is being singled out because it can destroy a woman’s fertility without warning, long before the woman even considers getting pregnant. PID is usually the result of bacterial infection that can involve the ovaries, fallopian tubes, uterus and cervix. The bacteria commonly enters the body through the vagina and cervix and spread from there throughout the pelvic cavity. Many women in their teens and 20s are routinely diagnosed with acute pelvic inflammatory disease (PID). The most common cause of PID is sexually transmitted diseases, especially Chlamydia and Gonorrhea. PID can also result from using an intrauterine device (IUD), complication from earlier pregnancy or infection following surgery of the reproductive tract. Depending on the infectious organism and the severity of infection, the acute phase of the disease may be characterized by lower abdominal pain, fever, painful sexual intercourse, irregular bleeding and profuse vaginal discharge. As with any bacterial infection, signs such as these should be treated as quickly as possible with antibiotics. On the other hand, some pelvic infections involving Chlamydia species, may not have symptoms of any kind, yet can cause extensive damage to the reproductive organs, especially the fallopian tubes. Most fertility problems associated with PID are not caused by active infection, but instead by scarring from past infections. Untreated, chronic PID creates a condition of long-standing inflammation within the pelvic cavity, and this sets up a reactionary environment within the reproductive organs, especially the fallopian tubes. One of the most common outcomes of PID is fallopian tube obstruction. The fallopian tube is the ‘golden path’ that the embryo must travel to reach the uterus. It is also the location for fertilization of the egg (oocyte). The tubes contain two specialized kinds of cells viz: those that produce mucus, glucose and other substances needed to nourish the egg (both before and after fertilization) and tiny hair-like structures that move the embryo through the tube and into the uterus. Unfortunately, the fallopian tubes are often the first locations attacked by the opportunistic bacteria. And because they have such narrow structures, it doesn’t take much to obstruct them. The tubes can become inflamed within (salpingitis), become filled with fluid (hydrosalpinx) or pus (pyosalpinx), creating a bulge and/or possibly destroying the lining and musculature needed to nurture the egg and move it along. Fluid from a hydrosalpinx can drain into the uterus and have an adverse effect on implantation.
SOURCE: SUNNEWSONLINE