by Corey Whelan
The Way It Should Be - Normal Tubal Function
The fallopian tubes are two conduits on either side of the uterus which extend down to the surface of each ovary. They are lined with actively motile ciliary cells, and a thin layer of fluid that to varying degrees actively transports the sperm, egg and embryos. The end of each tube that is closest to the ovary is flared open and contains delicate fringe like tissue, known as fimbriae. If the tubes are functioning normally, the fimbriae will pick up an egg upon its release from the ovary, and gently guide it into the tube. There, the egg is provided with nourishment by the lining of the tube. In addition, a good environment is maintained within the tube for sperm to reach the egg. Inside the tube, a fertilized egg can travel for up to five days prior to moving into the uterus and implanting itself upon the uterine wall. In order for pregnancy to occur naturally, this normal tubal function is required.
The Way It Might Be – Tubal Factor Infertility
Tubal factor infertility is defined as either being complete or partial blockage and/or scarring of the fallopian tubes. Tubal factor infertility causes a disruption of egg pick up and transport, fertilization, and also embryo transport from the fallopian tube down into the uterus where the embryo implants.
Tubal factor infertility can be caused by damage or disease. Approximately 25%1 of all diagnosed infertility in the United States includes a tubal factor; a really high statistic when you take into account that most cases of this type of infertility can be completely and easily avoided.
The Way It’s Caused
- Pelvic Inflammatory Disease (PID): PID typically results from exposure to sexually transmitted infections (STI’s), most notably, Gonorrhea and Chlamydia. PID can also be caused by bacteria that isn’t transmitted sexually or intestinal infections including appendicitis.
- Scar Tissue caused by Endometriosis. Endometriosis can cause tubal obstructions if there is scar tissue on or near the tubes.
- Scar Tissue caused by Surgery: This can result from surgeries of various kinds, including abdominal or gynecological surgery, caesarian section, ruptured appendix, bowel surgery, and fibroid surgery. Current trending towards minimally invasive surgical procedures, such as a laparoscopy utilizing a small incision instead of a laparotomy, where a large incision is made, has greatly reduced the incidence of tubal factor infertility through this cause.
- Tubal Ligation, also commonly referred to as “tying your tubes”: This procedure by definition, will render a woman infertile. Tubal ligation is an elective medical procedure whereby a woman’s tubes are severed and sealed, or pinched shut.
The Way You Can Avoid It
While pelvic infection with Gonorrhea is commonly painful, some women infected with Gonorrhea and most women infected with Chlamydia do not have symptoms and therefore, will not get tested or treated for these infections. This is not rare; 50% of all Gonorrhea cases and a whopping 70% of all Chlamydia cases2 are completely asymptomatic and the women infected simply do not know that they are. In some other women, the symptoms of PID may be subtle, and go unnoticed. Both scenarios unfortunately will result in a delay in treatment. And for women who do not regularly see a gynecologist the result may be devastating. It is important to note that the lack of symptoms does not mean that these infections will resolve on their own. And the subsequent lack of treatment unfortunately, increases risks for both tubal factor infertility and also for ectopic pregnancy.
Infections such as these if detected through medical screening and caught early, are curable with no long term consequences to either the woman or her infant.
Most importantly, PID as caused by sexually transmitted infections can largely be avoided completely if barrier protection such as condoms are used on a consistent basis.
The take home message is clear. For sexually active women, condoms should be used at all times. In addition, regular medical check ups and screenings should be conducted, as this will aid in the quick resolution of these infections, should one be contracted.