Fix The Tubes or Lose The Tubes

The American Society of Reproductive Medicine has just issued it's new Committee on the role of tubal surgery now that we also have in vitro fertilization (IVF). Women who have had prior PID, prior endometriosis, prior pelvic surgery, previous tubal ligation, or other chronic vaginal  infections may have blocked fallopian tubes as the reason for their infertility. For many years we only had the ability to perform open surgeries to correct these problems and help women with tubal blockage have a child. Then for many years physicians were erring on the side of IVF because the pregnancy rate per cycle is slightly better than say putting cut tubes back together. But tubal surgeries can be very cost effective and fixing the tubes, if it works, will allow women to be fertile for the years going forward, not just that one cycle of IVf. So the committee has weighed in on a number of issues, first they have said that a firm diagnosis of the problem should be achieved. And if there is blockage on the x-ray or ultrasound, consider repeating the test, sometimes they will show openings in a second round. Also the committee has indicated that a tube damaged beyond repair should be removed. Tubes that only have a bit of scaring at their end should be opened surgically to try to correct fertility issues. Some women with prior tubal ligations should try to have their tubes reconnected not just have IVF. Some women with blockage at the point where the tube implants could have a type of drilling procedure that is done under ultrasound, x-ray or with the hysteroscope (operating within the uterus) that just reopens the blocked portion. So the committee reminded women that some tubes can be fixed, others you may need to lose by surgical removal to improve your chance at fertility.


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