Infertility treatment for fallopian tube problems close to the ovary

On average, about 20% to 30% of women who have fallopian tube surgery near the ovary end of the tube (distal occlusion) go on to have a baby.¹ Generally, the younger you are, the less severe your tubal disease or damage, therefore less tube needs to be removed and your chance of conceiving and carrying a pregnancy is better. But tubal surgery (no matter where the blockage occurs) increases your risk for having an ectopic pregnancy. Your doctor will recommend the most promising treatment option(s) for your condition.

The most common treatments include:

• Hydrosalpinx treatment, recommended for all affected women who plan to conceive naturally or with in vitro fertilization (IVF).² When tubal disease generates fluid, a blockage forms (hydrosalpinx), usually near the end of the tube. The toxic fluid can also drain down the fallopian tube and into the uterus, reducing your chances of pregnancy. A hydrosalpinx makes it half as likely that an IVF procedure will succeed.³ Hydrosalpinx treatments include:
  • Surgically removing the diseased portion of the tube (salpingectomy). This is usually laparoscopic surgery. Salpingectomy is the recommended treatment for hydrosalpinx.
  • Drawing fluid from the tube (needle aspiration), though fluid can quickly regenerate after this procedure.
  • Creating a drainage hole in the tube (laparoscopic salpingostomy).
  • Laparoscopically blocking the fallopian tube where it joins with the uterus. This keeps the fluid from affecting an IVF embryo in the uterus. In small studies, this procedure has produced results similar to salpingectomy.⁴
• In vitro fertilization (IVF). If you decide against tubal treatment because of other fertility concerns (such as your age or your partner's fertility) or if you haven't become pregnant for 12 to 18 months since having a tubal procedure, you can consider in vitro fertilization (IVF). Chances of IVF success are closely tied to egg quality, which also is affected by your age. If you are over age 40 and trying IVF, using donor eggs can significantly improve your chances of having a baby.

Treatment of a hydrosalpinx improves your chances of successful IVF.³

Citations

1. Al-Inany H (2005). Female infertility, search date April 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. Levens ED (2006). Infertility. In DC Dale, DD Federman, eds., ACP Medicine, section 16, chap. 7. New York: WebMD.

3. American Society for Reproductive Medicine Practice Committee (2006). Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertility and Sterility, 86(Suppl 4): S200-S201.

4. Surrey ES, Schoolcraft WB (2001). Laparoscopic management of hydrosalpinges before in vitro fertilization-embryo transfer: Salpingectomy versus proximal tubal occlusion. Fertility and Sterility, 75(3): 612-617.