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It is in the Fallopian tubes that ova are fertilised by spermatozoa.
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The tubes actively transport the ova to the uterine cavity by the coordinated action of tiny fine hair-like structures called cilia.
- During their passage along the tubes, ova are nourished.
Approximately 14% of infertility is attributable to the 'tubal factor'.
Infection ascending to the Fallopian tubes following pregnancy or through sexual transmission accounts for the majority of patients with Fallopian tube problems (pelvic inflammatory disease).
How can we assess whether the fallopian tubes are functioning?
Tubal function tests generally provide evidence of patency only. We wish to
know if there are blocked fallopian tubes.
The arrival of fibroptic light technology and the first reports of the laparoscope (Q23.24) into the English literature opened the world of direct visualisation of the pelvic organs. When combined with methylene blue dye insufflation (the dye is passed through the cervix), a new technique for assessing tubal patency became available (laparoscopy with dye insufflation). Often hysterosalpingography and laparoscopy provide differing evidence on tubal patency.
Diagram of Laparoscopy and Dye Insufflation.
Picture at laparoscopy and dye showing spill of the blue dye and hence
confirming tubal patency.
In a study of 104 infertile couples, the women had both hysterosalpingography and laparoscopy with dye insufflation. There was an overall agreement between the two techniques in 62.5% of cases. It was concluded that whenever the HSG demonstrated tubal patency with free flow of dye, laparoscopic may not be necessary. At one time it was argued that laparoscopy had the advantage as it would allow a diagnosis of minimal endometriosis. This no longer seems relevant as such findings are of no clinical relevance (Q9.11). Several experts have come to the conclusion that in the absence of clinical indicators of significant pelvic disease and a normal hysterosalpingogram there is little to be gained by submitting infertile women to laparoscopy.
Related Medical Abstracts - Click on the paper title:-
Making Babies the Hard Way: Living with Infertility and Treatment
Tubal Surgery for Tubal Factor
Infertility
The success rates following tubal surgery will depend on the severity of the disease. Careful pre-operative assessment, including semen analysis and often hysterosalpingography and laparoscopy, is required.
The commonest site of tubal damage is at the fimbrial end (opening near the ovaries –Figure 9.1), with birth rates after surgery in the order of 25 per cent. Surgery for proximal tubal occlusion (the blockage is close to the uterus) is more successful, with live birth rates of 50% and ectopic rates of 10%. Just over a half of intrauterine pregnancies following tubal surgery may occur more than one year after surgery. Reversal of sterilisation, with removal of clips and re-anastomosis (reconnection), carries a relatively high success rate of up to 80%.
Tubal microsurgery involves the use of magnification as well as the adoption of a set of techniques including the use of special instruments, minimal handling of the Fallopian tubes and fine non-reactive suture material. There have been no controlled trials to prove conclusively an advantage over conventional surgical techniques but several surgical teams have reported improved success rates. It is technically possible to transplant Fallopian tubes and large numbers of these organs would undoubtedly be donated by women undergoing sterilisation or hysterectomy
(hysterectomy). Research interest in this area seems to have diminished following the development of IVF (Q10.24).
IVF
Introducing IVF - In Vitro Fertilisation (USA Fertilization)
IVF literally means fertilisation outside
the body. IVF was initially developed for women who had severe tubal disease or who had their Fallopian tubes removed but this treatment has also proved successful for unexplained
infertility and male factor infertility.
IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. A typical IVF treatment cycle is outlined in (Figure 10.3). Originally, eggs were collected laparoscopically (laparoscopy) but we now collect the eggs by ultrasound guidance usually through the vagina.
Please see
or
Egg Donation and Egg Sharing
Some women are unable to produce healthy eggs either because they have reached their menopause early, they are approaching their menopause (Figure 10.7) or because their eggs carry abnormal genes. The only realistic chance of a successful pregnancy in these circumstances is if another woman donates some of her eggs. There are some remarkable women who, for altruistic reasons, come forward voluntarily and go through the regimen for IVF egg collection and donation. Egg donors should usually be aged 35 years or less.
The demand for egg donation greatly exceeds supplies. There are many women who have healthy eggs and need IVF but for economic reasons IVF is beyond them. The combined requirements of funding for IVF for the less privileged and of others for egg donors has led to the development of eggs sharing. If a woman requiring egg donation will fund the two treatments, she may receive perhaps half the eggs provided by the woman who hasQuality eggs but cannot afford the treatment.
Tubal Surgery and IVF Compared
Information about success rates is essential for couples to make informed decisions. In vitro fertilization (IVF) provides an alternative to tubal surgery. For mild tubal disease and previous sterilisation, tubal surgery is probably the treatment of first choice. With severe tubal disease, IVF carries the better success rate. For intermediate disease, the optimum method in terms of success is less certain. IVF is becoming increasingly successful (Figure 10.5) and appropriately more popular (Figure 10.6).
The merits of tubal surgery and assisted reproduction (Assisted Reproductive Technology ART) need careful comparison. In-vitro fertilisation is becoming more readily available with a corresponding reduction in the use of tubal surgery.
IVF is associated with a higher incidence of multiple pregnancy. Perinatal mortality rates following assisted conception procedures are treble that of spontaneous conception although most of the increase is related to multiple pregnancy. There is a five-fold increase in perinatal mortality (stillbirths and first week losses) with triplets compared with singletons. The predicted costs associated with delivery of each baby for a singleton pregnancy in the USA in 1991 was $9,845, for a twin pregnancy $18,974 and for triplets $36,588. Between 1986 and 1991, assisted reproduction techniques were found to be responsible for 35% of twins and 77% of higher order pregnancies.
In the NHS only about 25% of purchasing authorities are currently supporting IVF treatment and the number is falling. There can be little doubt, that from a purely economic point of view, a greater number of pregnancies could be achieved with a given amount of funding using low tech treatments. Many couples would prefer tubal surgery in the first instance and the opportunity to conceive naturally, only resorting to IVF if this fails.
Tubal Surgery for Tubal Factor Infertility
Egg Donation and Egg Sharing
IVF and Tubal Surgery Compared
Infertility Support Groups
Members of a support group, provide each other with various types of help
for a particular shared difficulty. The support may take the form of
providing relevant information, relating personal experiences, listening to
others' experiences, providing sympathetic understanding and establishing
social networks. A support group may also provide ancillary support, such as
serving as a voice for the public or engaging in advocacy. Support groups
maintain interpersonal contact among their members in a variety of ways.
Support groups also maintain contact through printed newsletters, telephone
chains, internet forums, and mailing lists.
Support groups offer companionship and information for people coping
with diseases or disabilities. Support groups may not be appropriate for
everyone, and some find that a support group actually adds to their stress
rather than relieving it.
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http://www. Asrm.org/ |
The
American Society for Reproductive Medicine is a
voluntary, non-profit organization devoted to
advancing knowledge and expertise in reproductive
medicine, including infertility, menopause,
contraception, and sexuality. |
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http://www.nor.com. Au/community/aisg/ |
The Australian
Infertility Support Group |
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http://www. Theafa.org/ |
American Fertility Association |
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http://www.epigee.org/guide/infert.html |
Epigee - Natural Fertility |
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http://www.fertilethoughts.net/ |
Infertility Pregnancy Adoption Parenting
Surrogacy |
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http://www. Inciid.org/ |
International Council on
Infertility Information
Dissemination |
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http://www. Indiaparenting.com |
India Fertility Issues, Preconception, Adoption,
Baby Names |
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http://www. Infertility-info.com |
Tim Appleton - doctorates in cell biology, is an
ordained Anglican Priest, and has been an
independent Fertility Counsellor |
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http://www.noah-health.org |
Fertilty,
Infertility, Surrogacy |
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http://www.resolve.org |
The National
Infertility Association |
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http://www.fertilitynetwork.com |
Find
Infertility specialists,
fertility doctors, who perform advanced Infertility
treatment, like IVF and ICSI, |
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http://www.hfea.gov.uk |
The Human Fertilisation and Embryology Authority
is the UK's independent regulator overseeing safe
and appropriate practice in fertility treatment and
embryo research. |
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http://www. Infertilitynetworkuk.com |
Infertility Network UK - Advice, Support and
Understanding |
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http://www. Ivfglossary.org.uk |
Glossary of
Infertility and IVF Terminology |
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http://www.dcnetwork.org/ |
A self-help network of
over 1,000 families created with the help of donated
eggs, sperm or embryos; couples and individuals
seeking to found a family this way; and adults
conceived using a donor. |
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http://www.ngdt.co.uk/ |
Clear and practical information mainly for those
considering becoming an egg or sperm donor but also
for health professionals and those requiring
treatment with donor eggs or sperm. |
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http://www. Acebabes.co.uk/ |
ACeBabes was established as a UK charity in 1998
to support the growing number of people who were
using assisted conception as a way to bring about
their longed for family |
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Do you have an unanswered women's health question?
Please let us have your general question on our
NEW FORUM
/ MESSAGE BOARDS facility and we will try
to answer it for you. I am sure that you will appreciate that we cannot offer advice on the management of an individual's specific problem.
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