Tubal Factor Infertility
About a quarter of all cases of female infertility are due to tubal factor infertility. In this category are those women who have a blockage of the fallopian tube; those who may have only one blocked tube; those with no blockage, but with scarred tubes; and those with other types of tubal damage. This type of tubal infertility may be caused by an infection, such as pelvic inflammatory disease (PID), or because of endometriosis. In other cases, there may be residual scar tissue after pelvic surgery.
When damage to the tubes is minor, it may not be a simple matter to rule out other factors as the reason for apparent infertility. It may be that there are other reasons contributing to your difficulty in conceiving and some of these reasons may be quite significant. In general, where the standard tests for infertility show no other reason for the inability to conceive, and there is limited tubal damage, doctors will rule tubal factor as the reason for infertility. On the other hand, if only minimal scarring is present, your doctor may decide to rule the cause of your infertility as unexplained infertility.
IVF technology has been on a constant upward path of improvement over the past two decades. Because of this success, IVF is the most common treatment for tubal infertility.
PID is most often caused by an influx of gonorrhea or chlamydia to the uterus and tubes by way of the cervix. Infection, as it occurs in these tissues, tends to cause a severe inflammation. As the body tries to fight off the infection, bacteria, white blood cells, and fluid combine and fill the tubes with pus.
While the body will win the battle in time, killing bacteria and getting things under control, the inner lining of the tubes (tubal mucosa) is very delicate and will sustain permanent scarring. Sometimes this results in a partial or total blockage of the end of the tube leading to the ovaries. Scar tissue may even form on the outside of the tubes and on the ovaries.
While these factors can have a dire impact on reproductive function and conception, if PID is diagnosed early and the patient given aggressive IV antibiotic therapy, damage to the tubes is minimized and fertility may be maintained. A common occurrence after PID however, is tubal or ectopic pregnancy. Women who have suffered from PID have an increased risk for tubal pregnancy by 6-10 times that of women with no history for PID.
One study of 745 women who had PID at least once and then tried to conceive, found that 16% of these women were infertile as a result of tubal blockage. In those who did conceive, 6.4% had tubal pregnancies.