2nd Infertility

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Answer

Damage to the Fallopian tubes as a result of prior pelvic inflammation is one of the most common female causes of infertility. Commonly (as was the case with RL), this results blockage of the tubes at their ends, while leaving them open and  connected to the uterine cavity. In such cases the Fallopian tubes often progressively fill with fluid (hydrosalpinx), distending that contains dead cells and other noxious products….potentially toxic to embryos. Leakage of such fluid back wards into the uterus can severely compromise implantation of transferred embryos. This is why women with hydrosalpinges are strongly advised to have such diseased tubes removed or ligated (at the point that they emerge from the uterine wall), prior to undergoing embryo transfer. Admittedly, it is often hard for patients to accept that their tubes will be gone, as it means that future conception will require IVF. This is where it is necessary to be explain that  such tubes are functionless and that even if they could be rendered patent (opened) through surgery, the likelihood of pregnancy occurring would be remote.

Women with tubal occlusion who want to have a baby, will  invariably require IVF. In many such cases one or both of their tubes will, over time, have progressively filled with toxic fluid that can drain back into the uterine cavity and thwart post-ET implantation. It follows that all cases of tubal blockage be careful evaluated for hydrosalpinges before ET and that when detected,  this first  be  surgically addressed through tubal ligation or removal (salpingectomy).

Geoff Sher