In order for the pregnancy to occur, firstly the woman’s fallopian tubes should be open and be able to catch the egg to have it meet with the sperm and be fertilized. If one of the woman’s tubes is clogged, it is difficult to obtain pregnancy in a natural way, but it is possible. In cases where both of the tubes are clogged, it is not possible to have a natural pregnancy without being treated via opening because the eggs and sperm cannot meet. In this context, the cause of infertility by about 30% is that the tubes are blocked.
In the seventies, the treatment of opening the blocked fallopian tubes was performed by micro-surgery in the form of open surgery. However, especially in the last 15 years, such operations can be performed as laparoscopic (closed surgery). Laparoscopic microsurgery (closed microsurgery) technique enables all the treatments used be conducted within open surgecy to be carried out as closed. Since the tubes are blocked, the tubes of the women who cannot get pregnant by natural way can also be opened with laparoscopic surgery. The chances of getting pregnant in a natural way within a year for the women who had laparoscopic surgery for their blocked fallopian tubes is about 60%.
How are the blocked tubes opened?
Surgical opening of closed tubes is performed by laparoscopy or laparotomy. In the laparoscopy technique, a small incision is made under the belly hole of the woman and a thin telescope is inserted into the abdomen. The camera is attached to the back of the telescope, which reflects the appearance of the tube’s abdomen on the screen
Within that, some small cuts are also made to the abdomen and mini instruments are placed for surgery. Here, the operation, opening the blocked tubes by laparoscopy, can be done with these small tools, with mini incisions, without damaging the aesthetic appearance of women. However, laparotomy is the procedure of opening a large incision into the abdomen of the woman and opening the blocked tubes with open surgery method, and it is not very preferred anymore.
Should the blocked tubes be opened or should IVF treatment be carried out?
For couples who cannot obtain pregnancy by natural way because of the blocked tubes, the treatment that should be considered first is the opening of the tubes with laparoscopic surgery. In our country, IVF treatment is directly recommended to women with clogged tubes, but in fact, the procedure applied in Europe is laparoscopic surgery. Because, after opening the tubes with laparoscopic surgery, the couple tries to get a natural pregnancy and usually succeed. Within the first year after the operation, a 60% chance of pregnancy is obtained.
However, in the treatment of IVF, the couple who cannot succeed within the first trial will go for the second and third trials, use medications and pay for each. If the pregnancy cannot be achieved by the natural way even after 1-2 years after the opening of the blocked tubes by laparoscopic surgery, the treatment of the IVF should be considered.
Should laparoscopy be performed in all cases where the tubes are obstructed?
No. Laparoscopic surgery is not performed for every patient whose tubes are problematic or clogged. If the woman’s tubes are severely damaged, swollen, or some of the tubes have been cut out, there is absolutely no need for laparoscopic surgery. Especially for women with severely damaged tubes, opening of the blocked tubes and opening the adhesion will certainly not be beneficial.
With damaged tubes, no pregnancy can be achieved or external pregnancy occurs one after the other. Therefore, in such cases, it will be more possible to achieve pregnancy through IVF treatment. However, for the women whose tubes are severely damaged, it is recommended to remove the tubes completely with laparoscopic surgery firstly.
What are the risks of the surgery for opening the tubes?
The surgery for opening blocked tubeshas certain risks as every surgical operation. For example, when the tubes are opened by laparoscopy, there is a risk of pregnancy (ectopic pregnancy) in the tubes. Especially if the woman’s tubes are damaged, the risk of ectopic pregnancy is higher. If the woman knows that her tubes are damaged, she should consult a doctor without delay in case of delayed menstruation or suspicion of pregnancy. In this way, whether there is an ectopic pregnancy or not can be found out and intervened quickly.
What are the reasons of the blocked tubes?
Reproductive tract infections, intraabdominal surgeries, endometriosis may cause the blockage of the tubes and partial or total occlusion of the tubes. Infections causing adhesions in the tubes can be also caused by sexually transmitted diseases or the tools used in the uterus in the earlier operations.
Addition to those above, the explosion of tuberculosis and appendicitis are the other causes of infection in the tubes. Adhesions inside the tubes may cause damage to the tubes and deterioration of their natural texture. For this reason, the woman’s egg can not meet the sperm, women can not get pregnant.