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Tuesday, 7 October 2014

Tuboplasty: assumptions versus reality

 When there is a block in the tubes, tubal surgery is offered as an alternative to patients for treatment of infertility. The usual assumption is that tuboplasty should be the first option as it "corrects" what is wrong. Unfortunately it is not as simple as this. I have described the sophistication which is integral to function of the tubes in my earlier post.  

The efficacy with which tubal surgery would work really depends on the extent of damage that has already occurred. If the cells lining the tubes are extensively damaged and the cilia (the hair like structures that assist in moving the egg/embryo towards the uterus) are non-functional or absent the woman would be at a risk of a pregnancy settling in the tube. This condition is called Ectopic Pregnancy and it is potentially life-threatening. Similarly, if the cells that are responsible for secretions that nurture the egg/sperms/embryo and create an environment that allows an embryo to develop are spoiled, the chances of embryo formation fall. How then would tubal surgery done by the best surgeon in the world help?

With the advances in IVF, the chances of pregnancy now are superior to those after tuboplasty. Without a doubt there is a place for tubal surgery and indeed, there have been women who have conceived after a surgery to repair the tubes. Tuboplasty has a role in cases where the damage is minimal to mild and impact on fertility is essentially due to obstruction and so by removing the obstruction, the woman chances of natural conception are restored. The best advantage of surgery is that the effect usually lasts longer term unlike an IVF cycle which is only offering a chance of conception in the treatment cycle. It may be the only option available to couples who have religious or ethical objections to IVF. The major drawback is the uncertainty pertaining the fertility renewal and the very real risk of ectopic pregnancy as a result of tuboplasty. Women who fail to conceive should move on to IVF if no pregnancy occurs within 6-12 months. There is also clear evidence that women with severely damaged tubes that are swollen (called Hydrosalpinx) would benefit from removal or delinking of the tubes prior to IVF. 

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