Hydrosalpinx (Blocked Tube):
A hydrosalpinx carries risk of infection and very low pregnancy rates even after treatment. Hydrosalpinx can be treated laparoscopically, a procedure known as fimbrioplasty. In fimbrioplasty, an incision is made in the end of the tube and the edges of the incision are folded or flowered back, leaving an open tube. The best outcomes occur in young women with a small hydrosalpinx. Unfortunately, the tube often closes back up, and pregnancy rates are relatively low. Even when the fallopian tubes are bypassed, via techniques such as in vitro fertilization, a hydrosalpinx can have adverse effects on pregnancy rates. Basically a small hydrosalpinx in a young woman might be repaired with the understanding that further surgery might be necessary if the repair is unsuccessful; a larger hydrosalpinx should be removed, as these lower the chance of pregnancy with in-vitro fertilization.
Tubal Adhesions (Scar Tissue):
Some patients with an otherwise normal evaluation, including a normal Hysterosalpingogram, can have subtle adhesions over the fallopian tube and ovaries. These adhesions appear like cobwebs over the surface of these organs and can prevent eggs’ successful ovulation, prevent the tubes from picking up eggs, and limit the mobility of the tubes. Patients at special risk for these problems include those who have used IUDs, had abdominal problems like appendicitis, or an ovarian cyst removal. Limited adhesions benefit from laparoscopy. The adhesions can be removed with scissors, cautery, or a laser. Age is a significant factor that can affect who will respond to these procedures; younger women benefit more than older women.
Treating these problems is highly individualized and depends on the patient’s age, medical history, and the patient wishes. The available procedures we offer include:
- Laparoscopy is the standard procedure to evaluate and treat tubal disease. Under anesthesia, an incision is placed in the belly button, and a small camera is placed through the incision. The doctor can look at the pelvic organs, and introduce some treatment equipment through small ¼ inch incisions. Problems can be treated with scissors, cautery, or a laser.
- For the treatment of a tube blocked near the opening of the uterus, a tiny wire is placed through the cervix and uterus and into the tube. The wire gently opens the tube and may relieve an obstruction in this area. Tubal cannulation can be performed in the x-ray department under fluoroscopy or via a hysteroscope. A physician who is experienced in the techniques is essential.