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Blockage of the fallopian tubes may be due to various causes, including prior tubal ligation surgery, prior infection with infective agents such as chlamydia or gonorrhea, or from endometriosis or other pelvic adhesions caused by surgery, such as myomectomy, appendectomy, or removal of cysts.
Tubal reanastomosis is a surgery which is performed to reverse tubal ligation. The procedure is performed as follows. A small incision is made into the bikini line of the abdomen. The two portions of the tube which were previously ligated with the tubal ligation procedure, or burned by the tubal fulguration procedure, are then examined under the microscope. The ligated or burned portion of the tube is then removed under the microscope with microscissors, and the two ends of the tubes are placed back with very fine sutures.
A reproductive specialist is the most qualified physician to perform this surgery. This surgery requires extra care, because success of the procedure depends on the technique used during the surgery. By using adhesion prevention techniques and microsurgical techniques the surgeon may improve the success of the procedure by up to 50%.
Other tubal blockages may also be repaired using a laparoscopic tuboplasty procedure. This procedure is performed by placing a camera through the belly button and, using minimally invasive surgery, the portion of the tube that is blocked because of prior infection or endometriosis can be surgically opened. Successful pregnancies have been reported after repair of tubes using this technique.
The success of the procedure depends on multiple factors. The age of the female who is undergoing treatment, the extent of scar tissue and adhesions formed next to the tube, the nature of the adhesions that are formed, the diameter of hydrosalpinx (hydrosalpinx is the presence of water in the tube), appearance of the endosalpinx and the thickness of the tube wall. When the tubes are blocked, the endosalpinx, which is the lining of the tubes, is damaged. The longer the tubes are blocked, the lower the chance of pregnancy post tubal reversal surgery.
Tubes may also be blocked next to the uterus (proximal tubal blockage). If the tubes are blocked proximally or next to the uterus, a technique called hysteroscopic cannulation may be performed to open the tubes. Hysteroscopic cannulation of the tube is a relatively simple procedure to perform. It is usually performed as an outpatient procedure. The success rate of opening the tube with proximal cannulation is as high as 90%, with pregnancy rates ranging from 50-90% post surgically.
In cases of extensive damage of the tubes, the in vitro fertilization (link) procedure is the most effective way to achieve pregnancy. In addition, in order to enhance the chances of IVF, for patients with hydrosalpinx (water in their tubes), removal of the tubes may be recommended.
