Is fallopian tube surgery a required infertility treatment?

This article looked at the different surgical options available for women who have trouble conceiving due to fallopian tube dysfunction.

The fallopian tubes (FT) connect the ovaries to the uterus. For a normal pregnancy to occur, an egg released by the ovary needs to travel through its corresponding fallopian tube towards the uterus. At some point in this course, the egg encounters a sperm cell and fertilization occurs. Within a few days, the fertilized egg reaches the uterus and implants within its lining.

FT blockage is the cause of infertility in 25-35% of cases. It is often the result of an untreated pelvic infection (e.g. Chlamydia) or prior abdominal surgery. Tube ligation (a surgical procedure used for contraception) should be reversed in order to conceive.

Various types of surgery are available to repair FT defects. However, some women may opt to avoid surgery and skip to assisted pregnancy via in-vitro fertilization (IVF: the artificial joining of an egg and sperm in a laboratory dish).

This article summarized current data published in the medical literature regarding surgical FT repair.

In cases where the blockage of the FT was located close to the uterus (10-25% of cases), the authors recommend undergoing tubal cannulation. This is a minimally invasive procedure that uses small wires guided to the opening of the fallopian tubes to apply gentle pressure and overcome the blockage. Research showed an 85% success rate in overcoming the blockage using this technique, with about half of patients successfully conceiving.

FT blockage that is located closer to the ovaries rather than the uterus may be operated only under certain conditions (when the tube is intact, flexible and not severely enlarged). Pregnancy rates following surgery were between 58 to 77%. Severely enlarged FT may be removed to improve pregnancy rates following IVF.

For women who wish to regain fertility following tube ligation, microsurgical repair (using a microscope to operate) is a viable option. Success rates were found to be variable, depending on the patient's age and the experience of the surgical team.

There are several options available that may solve infertility problems caused by fallopian tube dysfunction. In some cases, these can be as effective as IVF, but the surgical risk, potential benefits and personal choice need to be carefully considered.

If you suffer from fallopian tube abnormalities causing infertility problems, you should carefully consider your options with your physician. Outcomes strongly depend on individual patient characteristics.