Tubal Disease

Patients trying to achieve a pregnancy may have difficulties because of abnormalities in their fallopian tubes. In some situations the tubes are not functioning well, possibly because the inside of the tube does not have good cilia (hair-like structures that move the egg down the tube), or due to scar tissue surrounding the tubes. Sometimes the tubes are actually blocked. This may result from a past infection that has damaged the tube, or may be due to scarring from previous operations or endometriosis. When a fallopian tube is blocked at the end of the tube it may accumulate fluid inside of it, and this is called a hydrosalpinx. Other times, the tubes may appear normal but not function. The presence and severity of tubal disease or damage can be evaluated by a hysterosalpingogram or at the time of laparoscopy.

Several studies in the past few years have shown that women with tubal disease or a hydrosalpinx may not conceive on their own. They may have a lower chance for a successful pregnancy when undergoing IVF than women with normal fallopian tubes. Some studies show that if the tubes are repaired surgically or the hydrosalpinx is surgically removed before an IVF cycle attempt that women can then expect similar pregnancy rates to women who have normal fallopian tubes when using the IVF technique. We may achieve a similar result without completely removing the hydrosalpinx by cauterizing or burning the tube surgically. These procedures can usually be done at the time of a laparoscopy.

Patients with a hydrosalpinx may have lower pregnancy rates after undergoing IVF because the fluid accumulates in the hydrosalpinx and can go back in to the uterus. This may diminish the chance for the embryo to implant. The fluid may also be toxic to the embryo, or may decrease the chance for implantation mechanically.

Women undergoing an IVF cycle with a hydrosalpinx in place will have half the chance of having a successful pregnancy that she would have if the hydrosalpinx was removed or cauterized before the IVF cycle. Based on these findings, we recommend that women undergoing an IVF cycle who have hydrosalpinx, strongly consider surgery to remove or cauterize the tubes before undergoing IVF. As an added benefit, the surgery would also decrease the small chance of having an ectopic (tubal) pregnancy after an IVF cycle.