What is Vaginal Obstruction and blocked fallopian tubes and Ectopic pregnancy?
Side Effects of Vaginal Obstruction blocked fallopian tubes?
The consequences of vaginal obstruction and blocked fallopian tubes depend on where the obstruction occurs and whether it is complete or partial. For instance, a woman with a partial obstruction may get her menstrual periods as normal but notice that her periods last longer than the typical four to seven days. However, a woman with complete vaginal obstruction, which means there is no hole in the transverse vaginal septum, may not get her period at all. Instead, the blood that should flow out will collect in the upper vagina, which causes abdominal pain and Tubal ligation reversal and Ectopic pregnancy.
Diagnosing Vaginal Obstruction
Typically, a doctor will diagnose vaginal obstruction at birth or when the baby is still a newborn. A doctor may notice the obstruction on an X-ray or via an ultrasound, images from which may reveal fluid in the vagina. Even without imaging tests, a trained doctor will notice an obstruction by abdominal or genital swelling.
If there are no obvious signs, a girl may not discover the obstruction until she hits puberty. At that time, she will not bleed even if she demonstrates other obvious signs of ovulation. She may also experience abdominal pain and swelling that comes and goes as blood builds up behind the obstruction.
Correcting a Vaginal Obstruction
Treatment for vaginal obstructions depends on where and how the blockage occurs. For instance, if a girl or woman has an imperforate hymen (the most common cause of vaginal obstruction), meaning the hymen tissue failed to split as normal, correcting the issue would require nothing more than a small incision. Once the fluid drains, the doctor will check for other issues. For this procedure, no anesthesia is necessary.
A high transverse septum, a cause of vaginal obstruction that occurs when the vagina does not fully develop, requires surgery to correct. Depending on the location and thickness of the blockage, the surgeon may have to remove the septum and then reconnect the upper and lower portions of the vagina. Some obstructions that occur higher up in the vaginal wall may require surgical removal. If removal is necessary, the surgeon may use part of the patient’s intestine or pieces of skin to join the upper and lower portions of the vagina.
Damaged or blocked fallopian tubes overview
- Damaged or blocked fallopian tubes is a common cause of female infertility, because inside the fallopian tube is the location where sperm fertilizes the woman’s egg.
- Tubal blockages or damage may be caused by pelvic inflammatory disease, endometriosis, previous surgeries, ectopic pregnancy or tubal ligation.
- Most women with damaged or blocked fallopian tubes do not experience any symptoms.
- If tubal damage or blockages cannot be corrected through surgery or tubal cannulation, which involves a doctor clearing the blockage with a medical instrument, a woman may still be able to get pregnant through in vitro fertilization (IVF).
How do damaged or blocked fallopian tubes cause infertility?
More than 30% of women who are given an infertile diagnosis have damaged or obstructed fallopian tubes. Tubal disease, tubal infertility, and tubal occlusion are further names for this disorder.
The reproductive organ in a woman’s body that connects the ovaries and the uterus is called the fallopian tube. The eggs leave the ovaries and go into the fallopian tubes when a woman ovulates. The fallopian tubes are where the sperm enters and perhaps fertilises the egg after travelling from the vagina through the uterus.
To become pregnant, the fertilised egg must travel from the fallopian tubes to the uterus with the resulting embryo. A woman may be unable to become pregnant if her fallopian tubes are damaged or clogged because they interfere with the sperm’s ability to reach the egg.
What causes damaged or blocked fallopian tubes?
Due to their small size, the fallopian tubes are easily damaged or blocked. The fallopian tubes are most commonly blocked or damaged because of scarring on the walls of the tubes caused by infection. Aside from infection, which can be due to various causes, tubes may be blocked by disease or damaged from surgery. The more frequent causes of tubal occlusion follow.
Pelvic inflammatory disease (PID)
PID is an infection that can develop when sexually transmitted diseases (STDs) or other infections go untreated. It is typically caused by gonorrhea or chlamydia. PID causes inflammation near the fallopian tubes, which can lead to the development of scar tissue and blockages.
Endometriosis
Endometriosis is a condition in which the uterus’ lining, the endometrium, starts to proliferate on various pelvic organs external to the uterus. Endometrium is normally expelled from a woman’s body as her menstrual flow during menstruation. However, unlike normal tissue, the endometrium that is developing outside of the uterus does not shed. Scar tissue may form as a result of the inflammation this produces.
Tubal infertility may result from endometriosis that grows on or close to the fallopian tubes because it may scar or obstruct the tubes.
Surgery
Damaged or obstructed fallopian tubes can also be brought on by prior procedures. Surgery for conditions such uterine fibroids or endometriosis, as well as various types of abdominal surgery, in particular, may result in
Ectopic pregnancy
An ectopic pregnancy is when a fertilized egg implants in the fallopian tubes, rather than in the uterus. Because fallopian tubes are small and narrow, the fertilized egg does not have the room it needs to grow. This can cause the fallopian tubes to rupture, which is life threatening and also renders the woman infertile.
If a doctor identifies an ectopic pregnancy before the fallopian tube ruptures, then surgery can be performed to remove the fertilized egg. Surgery can lead to fallopian tube scarring and sometimes removal.
Tubal ligation
Tubal ligation is an elective surgery in which a woman decides to have the ends of her fallopian tubes cut or blocked to prevent any future pregnancies. This procedure is sometimes referred to as “having your tubes tied.” Tubal ligation can be reversed in some cases, but it requires additional surgery.
Symptoms of damaged or blocked fallopian tubes
Unlike many other infertility conditions, blocked fallopian tubes do not typically have any associated symptoms. However, many of the conditions that lead to damaged or blocked fallopian tubes do cause symptoms. For example, endometriosis and PID may cause painful periods, pain during intercourse or heavy bleeding during and between periods.
Infertility or having trouble getting pregnant may be the first sign that a woman has blocked fallopian tubes. In the case of hydrosalpinx (when the fallopian tube has filled with fluid), a woman may also experience abdominal pain and unusual vaginal discharge.
- Pelvic inflammatory disease. This disease can cause scarring or hydrosalpinx.
- Endometriosis. Endometrial tissue can build up in the fallopian tubes and cause a blockage. Endometrial tissue on the outside of other organs can also cause adhesions that block the fallopian tubes.
- Certain sexually transmitted infections (STIs). Chlamydia and gonorrhea can cause scarring and lead to pelvic inflammatory disease.
- Past ectopic pregnancy. This can scar the fallopian tubes.
- Fibroids. These growths can block the fallopian tube, particularly where they attach to the uterus.
- Past abdominal surgery. Past surgery, especially on the fallopian tubes themselves, can lead to pelvic adhesions that block the tubes.
Diagnosing and treating damaged or blocked fallopian tubes
Doctors usually diagnose tubal blockage and damage using a hysterosalpingogram (HSG) test. During a HSG procedure, a doctor fills the uterus with a solution containing dye to provide visual contrast, then uses an X-ray to look at the uterus and fallopian tubes. If the doctor determines that a woman’s fallopian tubes are blocked, laparoscopy, a kind of minimally invasive surgery, may be performed to investigate the blockage.
The treatment for tubal disease will vary depending on the type of damage or blockage. In some cases, surgery may be recommended to remove the blockage. However, surgery is not always beneficial. If the damage or blockage cannot be treated, then a woman may still be able to get pregnant through IVF.
Types of treatment for damaged or blocked fallopian tubes
Hydrosalpinx treatment and surgery
In order to treat hydrosalpinx, which is when the fallopian tubes have a blockage causing fluid buildup, a doctor generally performs either a salpingectomy or a salpingostomy. In a salpingectomy, a doctor removes part of the blocked fallopian tube. This procedure improves the likelihood of conceiving through IVF more than other possible surgical treatments.
During a salpingostomy, a doctor creates a new opening in the fallopian tube near the ovary. Eggs from the ovaries can then travel through the new opening to the fallopian tubes. Over time, scar tissue can sometimes grow over this new opening, causing a new blockage. A variation of the salpingostomy is the fimbrioplasty, which involves creating a new opening and rebuilding the fimbriae (tissue near the ovaries). Doctors may recommend either procedure depending on the placement of the blockage.
Each of these surgeries typically requires a two- to three-day stay in the hospital and a four- to six-week recovery time. Risks of the surgeries include growth of new fallopian tube scar tissue, increased chance of ectopic pregnancy and such complications of surgery as blood loss, pain, and damage to organs or tissue.
Tubal cannulation
Tubal cannulation is a nonsurgical treatment for fallopian tube blockages, especially blockages closest to the uterus. During this procedure, a doctor guides a catheter through the vagina and uterus until it reaches the blockage. X-rays or ultrasound helps the doctor find the exact position of the blockage during the procedure. The doctor will then inflate a small balloon or use a thin wire to remove the blockage.
Tubal cannulation has minimal risks and downtime. Risks include infection and creating a tear in the fallopian tube wall.
Tubal ligation reversal
During tubal ligation reversal, a doctor surgically removes blockages from the fallopian tubes that were placed or added during a previous tubal ligation procedure. In many cases a doctor performs a tubal ligation reversal by removing the parts of the fallopian tubes with the blockages and reconnecting the two ends of each tube in a procedure called tubal reanastomosis.
Before scheduling the procedure, a doctor will evaluate if the woman is a good candidate for tubal ligation reversal. Women who had tubal ligation using tubal rings or clips have the best chance of achieving pregnancy naturally after tubal ligation reversal.
The procedure is considered an abdominal surgery and has a two-week recovery time. Risks of the tubal ligation reversal include infection, bleeding, scarring and increased chance of ectopic pregnancy.
Fertility after treatment for damaged or blocked fallopian tubes
Age, length of fallopian tubes, amount of tubal scarring and severity of associated fertility conditions all play a role in a woman’s ability to get pregnant after having fallopian tube blockage treatment. Between 10 and 80 percent of women whose treatments are successful are able to get pregnant in the future.
While there is no guarantee that a woman will be able to achieve pregnancy after tubal blockage treatment, certain factors do make pregnancy more likely. Women who had blockages near their uterus, rather than structural blockages or scarring, are more likely to be able to get pregnant after treatment. Additionally, women whose fallopian tubes are at least 7.5 cm in length after tubal surgery have a better chance of conceiving than women with shorter fallopian tubes.
Age can also factor into a woman’s fertility. Women who are over the age of 35 may have decreased fertility and need to consider undergoing intrauterine insemination (IUI) or IVF after fallopian tube blockage treatment.
IVF with damaged or blocked fallopian tubes
IVF is recommended for women who wish to get pregnant but have damaged or blocked fallopian tubes that cannot be treated. Even in instances where a woman no longer has fallopian tubes, she may be able to get pregnant through IVF. This is because during an IVF procedure, a fertilized egg at the embryo stage is placed directly into a woman’s uterus, bypassing the need for the sperm and egg to travel to the fallopian tubes or of a resulting embryo to travel to the uterus.
Risks of IVF include ovarian hyperstimulation syndrome caused by fertility medications, increased chance of multiple pregnancy (twins or more), and egg retrieval complications, such as infection, internal bleeding and damage of pelvic organs.
Treatment for Blocked Fallopian Tubes and Ectopic pregnancy
If you have one open tube and are otherwise healthy, you might be able to get pregnant without too much help. Your healthcare provider may give you fertility drugs to increase the chances of ovulating on the side with the open tube. This is not an option, however, if both tubes are blocked.
It is important to note that this medication is prescribed to help you conceive but it will not unblock a blocked fallopian tube. Likewise, exercise cannot unblock a blocked tube. The only thing that may help unblock a blocked tube is surgery, but it is not always successful. Here is what you need to know about surgery for blocked tubes as well as IVF and tubal ligation.
Laparoscopic Surgery
In some cases, laparoscopic surgery can open blocked tubes or remove scar tissue.9 Unfortunately, this treatment doesn’t always work. The chance of success depends on how old you are (the younger, the better), how bad and where the blockage is, and the cause of blockage. If just a few adhesions are between the tubes and ovaries, then the chances of getting pregnant after surgery are good.
If you have a blocked tube that is otherwise healthy, you have a 20% to 40% chance of getting pregnant after surgery.
Your risk of ectopic pregnancy is higher after surgery to treat tubal blockage.10 Your doctor should closely monitor you if you do get pregnant and be available to help you decide what’s best for you.
However, surgical repair isn’t always the best option. Situations that may be better for IVF include the presence of significant scaring, moderate to severe endometriosis, or moderate to severe male factor infertility.10 Your doctor can help you review whether surgical repair or going straight to IVF treatment would be best for your situation.
In Vitro Fertilization and Ectopic pregnancy
Before the invention of in vitro fertilization (IVF), if repair surgery didn’t work or wasn’t an option, women with blocked tubes had no options to get pregnant. The use of IVF makes conception possible.
IVF treatment involves taking fertility drugs to stimulate the ovaries. Then, using an ultrasound-guided needle through the vaginal wall, your doctor retrieves the eggs directly from the ovaries. In the lab, the eggs are put together with sperm from the male partner or a sperm donor. Hopefully, some of the eggs fertilize and some healthy embryos result. One or two healthy embryos are chosen and transferred to the uterus.
IVF completely avoids the fallopian tubes, so blockages don’t matter. That said, research has found that an inflamed tube can significantly decrease the odds of IVF success. If you have a hydrosalpinx (fluid-filled tube), your doctor may recommend surgery to remove the tube.11 Then, after recovering from surgery, IVF can be tried.
Tubal Ligation Reversal
Tubal ligation surgery is a permanent form of birth control, commonly known as “getting your tubes tied.” There are different kinds of tubal ligation. Possibilities include a surgeon cutting the tubes, banding them, clamping them, or placing specialized coils inside them. The idea is to intentionally block the fallopian tubes so the sperm can’t reach the egg.
A significant number of women later regret having a tubal ligation—anywhere from 20% to 30%.12
The good news is that even though this kind of birth control is considered permanent, it can be reversed for many women. Surgical repair of a tubal ligation is more likely to be successful than women having tubal surgery to repair disease-based blockages. Micro-surgical repair is often less expensive than IVF, costing as much as half per delivery.