Tubal Blockage: Treatment Options and Success Rates

How to treat fallopian tube obstruction?

Dear Dr.
Jan,
I am 35 years old and have been married for five years without becoming pregnant.
Recently, I underwent a hysterosalpingography (HSG) at the hospital.
The doctor reviewed the report and informed me that there were no issues, but after the nurse retrieved the X-ray films, the doctor stated that there was a blockage in both fallopian tubes (which was quite shocking).
I was then given two options: 1.
surgery or 2.
in vitro fertilization (IVF).
I have some questions I would like to ask you.
1.
Is it common for a well-known teaching hospital in central Taiwan to make such an error? Should I trust the laboratory personnel or the doctor, or should I seek a second opinion at another facility?
2.
Is there a degree of severity regarding fallopian tube blockage, and what are the treatment options and success rates?
3.
If I choose not to undergo surgery, will there be any other complications aside from infertility?
Thank you.

candy, 30~39 year old female. Ask Date: 2000/09/18

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
It is inevitable that different specialties have variations in diagnosis and experience.
The question you asked may arise because the reports of general X-rays are issued by radiologists, who may have less experience in distinguishing issues related to obstetrics and gynecology infertility compared to obstetricians and gynecologists.

2.
Any medical condition can vary in severity; therefore, there is a distinction between complete and partial obstruction of the fallopian tubes.
If there is a complete obstruction, there are no treatment options other than surgery.
3.
Generally, there are no significant long-term sequelae.
However, if severe inflammation leads to obstruction along with pelvic or uterine adhesions, abdominal pain symptoms may occur.
It is advisable to consult an obstetrician and gynecologist with any questions to avoid delaying treatment.

Reply Date: 2000/09/18

More Info

Understanding tubal blockage is crucial for women facing infertility issues, especially when it comes to treatment options and their success rates. In your case, at 35 years old and having been married for five years without conceiving, the discovery of bilateral tubal blockage can indeed feel overwhelming. Let’s break down your questions for a clearer understanding.

1. Trusting the Diagnosis: It’s understandable to feel skeptical about the accuracy of the diagnosis, especially from a reputable teaching hospital. Medical imaging, such as Hysterosalpingography (HSG), is generally reliable, but errors can occur. If you have doubts, seeking a second opinion is a reasonable step. You might consider consulting another fertility specialist or undergoing a repeat HSG or a laparoscopy, which can provide a more definitive assessment of the condition of your fallopian tubes.

2. Severity of Tubal Blockage: Tubal blockage can vary in severity. It can be classified as complete blockage, partial blockage, or hydrosalpinx (fluid-filled fallopian tubes). The treatment options and success rates depend on the type and extent of the blockage. Surgical options, such as tubal cannulation or salpingostomy, can sometimes restore patency, especially if the blockage is not severe. However, the success rates for surgery can vary widely, often ranging from 30% to 70%, depending on factors like the patient's age, the cause of the blockage, and the surgical technique used.

On the other hand, in vitro fertilization (IVF) bypasses the fallopian tubes altogether, allowing for a higher success rate in cases of severe blockage. IVF success rates can vary based on age and other factors but generally range from 40% to 60% for women under 35. Given your age, IVF could be a highly effective option.

3. Potential Complications Beyond Infertility: If left untreated, tubal blockage can lead to other complications, such as ectopic pregnancy, where a fertilized egg implants outside the uterus, often in a fallopian tube. This condition can be life-threatening and requires immediate medical attention. Additionally, chronic pelvic pain can occur due to underlying conditions like endometriosis or pelvic inflammatory disease, which may also contribute to tubal blockage.

In summary, while the diagnosis of bilateral tubal blockage can be disheartening, it’s essential to explore all available options. Consulting with a fertility specialist can provide you with tailored advice based on your specific situation. Whether you choose to pursue surgery or IVF, understanding the implications and potential outcomes will empower you to make informed decisions about your reproductive health. Remember, many women with similar diagnoses have successfully conceived, so there is hope ahead.

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