Causes of infertility

Causes of infertility

One of the causes of infertility is blocked Fallopian tubes

What you need to know

Humans' ultimate urge is to reproduce or to have their kids. Infertility is a social and mental health issue that impacts individuals and their families' overall well-being. The inability of a couple to conceive after 12 months of average frequency unprotected coitus is known as infertility. The inability to conceive following a year of unprotected sexual activity is known as infertility (regardless of aetiology). About 10% to 15% of fertile couples are affected. Treatment for tubal blockage is challenging and accounts for 25–35 per cent of female infertility cases, making it the second most frequent cause of infertility (Axita et al., 2021). Tubal problems are a common cause of infertility in women, while numerous other factors may play a role. In at least thirty per cent of female cases, fallopian tube occlusion is the cause of infertility. Therefore, figuring out tubal patency is essential to diagnosing this condition. Therefore, figuring out tubal patency is critical in diagnosing this condition. Hydrotubation, X-ray hysterosalpingography (HSG), laparoscopy, and the dye test were employed to assess tubal patency. These methods do, however, come with several drawbacks. Because hydrotubation is done blindly and with poor precision, it is no longer often used (Axita et al., 2021).

In contrast, HSG has an excellent accuracy rate of 83% for tubal patency detection. HSG, on the other hand, has been connected to potentially allergenic compounds and radiation exposure. Laparoscopy and the dye test are widely regarded as the current gold standard due to their simple methodology and high accuracy (Axita et al., 2021). However, this operation is expensive, invasive, and associated with hazards related to anaesthesia and surgery. Women who are infertile for primary or secondary causes might have their fallopian tube patency assessed with an imaging modality called a hysterosalpingogram (HSG). Tubal disorders may be the cause of both primary and secondary infertility. Several studies have shown that women with fallopian tube blockage on HSG were more likely to suffer secondary infertility than initial infertility. One typical reason why women are infertile is tubal blockage (Axita et al., 2021).

The evaluation of infertility must include an examination of the fallopian tubes and the endometrial cavity. Currently, chromopertubation during hysteroscopy and laparoscopy (HLC) or hysterosalpingography (HSG) is used to accomplish this. When assessing the integrity of the uterine cavity and identifying tubal status, HLC is the gold standard. HLC helps the physician to identify and address the problem. Compared to HLC, HSG has been demonstrated to have a 72-85% sensitivity and a 68-89 per cent specificity in determining tubal patency (Axita et al., 2021).

The World Health Organisation (WHO) declared TB a worldwide emergency in 1994, claiming an annual effect of 8 million people and 2 million deaths, primarily among women in underdeveloped countries. Female genital tuberculosis is commonly diagnosed in poor nations by symptoms such as infertility, menstrual dysfunction, persistent pelvic discomfort, stomach pain, anorexia, weight loss, and fever. Genital tuberculosis is often caused by pulmonary or abdominal TB. The fallopian tubes, endometrium, and ovary are the most often afflicted genital organs, whereas the cervix, vagina, and vulva are less prevalent (Axita et al., 2021). According to a recent study, the most pervasive cause of tubal factor infertility is fallopian tube blockage caused by sexually transmitted infections with Chlamydia trachomatis or Neisseria gonorrhoeae, resulting in salpingitis. Pelvic infections from tuberculosis, injury from previous surgeries or sterilisation, ischemic nodules, endometriosis, polyps or mucus, tubal spasms, and congenitally abnormal tubes can all impact tubal patency. Peritoneal variables such as peritubular adhesions, endometriosis, altered tubal motility, and fimbrial end obstruction can impact tubal patency.

Tubal injury leads to blockages in 12% of instances. Following a pelvic inflammatory disease, the incidence increases to 23%. The fallopian tube is a muscle tube that links the ovary to the uterus. It is separated into four sections: interstitial, isthmus, ampulla, and fimbrial. The fallopian tube plays a crucial role in sperm attachment and fertilisation, and its proper function is required for natural conception. Blockage of the fallopian tubes is a common and primary cause of infertility. Fallopian tubes are two thin tubes that connect the ovaries to the uterus. They are about 4 inches long and about as wide as a pencil. After being released from the ovaries, eggs travel through the fallopian tubes, and sperm swims up to fertilise the egg. The fallopian tube is a 7-9 cm long trumpet-shaped device that connects the uterine cavity's cornu to the ovary. The fimbriated end sweeps across the ovary and transports the ovulated egg to the fallopian tube for fertilisation (Ambildhuke et al., 2022).

Hysterosalpingography (HSG):

Because it is inexpensive and non-invasive, it is the most often utilised technique. After injecting radiopaque dye into the uterus to examine the fallopian tubes, the X-ray room should be equipped with an image intensifier. The uterine cavity and tubes should be visualised using a Foley catheter and a ruby cannula. The test should be administered during a late menstrual period between days seven and ten. It is inappropriate to do this test if there is a pelvic infection (Ambildhuke et al., 2022). During hysterosalpingography, a radiopaque contrast agent is injected to enable fluoroscopic visualisation of the fallopian tubes and uterus. There is an 84% sensitivity and a 75% specificity. Tubal spasms are blamed for the poor imaging accuracy of this technique; however, they have been mitigated by intravenous scopolamine administration and patient swapping. It has been shown that by removing particles from the fallopian tubes, HSG and greasy contrast agents provide particular therapeutic effects. The radiation from X-rays is the sole drawback. Concept: The peritoneal cavity and cervical canal are joined via a tube. As a result, the radiopaque dye that enters the peritoneal cavity after being forced via the cervix shows that the fallopian tube is clear (Ambildhuke et al., 2022). Observation: The bilateral dye spilling from both ossia confirms patency. When hydrosalpinx occurs, a noticeable amount of dye is present, but there is no peritoneal leak (Ambildhuke et al., 2022).

Laproscopic Chromopertubation:

The disadvantages of this procedure are its high cost, invasive nature, and the need for anaesthesia. Laparoscopy can assess the fallopian tube's structure and relationship with other tissues and organs, separate fallopian tube and pelvic adhesions, restore fallopian tube shape and movement, and diagnose pelvic endometriosis. It can also be used simultaneously. It raises the likelihood of secondary infertility in pregnant women. Hydrosalpinx during hysteroscopy shows tubal blockage. The guide wire can be recanalised and monitored laparoscopically, effectively treating proximal fallopian tube lesions (Ambildhuke et al., 2022).

Most women with blocked fallopian tubes do not have any symptoms. However, some women may experience:

• Irregular periods

• Painful periods

• Pelvic pain

• Pain during sex

• Difficulty getting pregnant
  

Medical treatment of tubal obstruction

Interventional tubal recanalisation, also known as fallopian tube recanalisation (FTR), is a highly successful technique for resolving proximal tubal blockage, with up to 90% technical success rates. However, over 20% of patients had unsatisfactory results after interventional recanalisation. The conception rate following this treatment varies, averaging 33%. While a recent study found that pregnancy rates following FTR varied greatly, the probable factors influencing the success rate of FTR are unknown. As a result, there needs to be more consistent evidence about the technical success rate after FTR and a lack of data on the elements that influence it (Ambildhuke et al., 2022). For women without endometriosis or pelvic inflammatory disease who are suspected of having fallopian tube infertility, hysterosalpingography (HSG) can be used as a preliminary screening test. Alternatively, if one is available, a hysterosalpingo-contrast-ultrasonography (HyCoSy) should be used. If the patient has any associated comorbidities, laparoscopic chromopertubation should be performed. Tuboplasty (microsurgery) is advised for young women with tubal obstruction and previous tubal sterilisation. Depending on the location of the block, many tuboplasty techniques have been conducted, with successful pregnancy rates ranging from 27% for fimbrial surgery to 50%-60% for isthmic blockage. In the case of significant hydrosalpinx resulting in distal tubal disease, a salpingectomy and IVF are recommended (Ambildhuke et al., 2022).

Blocked fallopian tubes could be improved naturally by:

Preparing the combo: What is the combo?

The combo is the preparation of the following items.

*Ginger

*Garlic

*Cloves

*Tumeric

Preparation: Soak the four items together( in all small quantities) for three days and drink a tot(small glass cup) or half a regular cup, both morning and evening. After three days, make tea from them and add it to your daily meal.

If blocked fallopian tubes occur, several things can be done to improve the chances of getting pregnant:

• Talk to your doctor about the best treatment options for you.

• Consider IVF if other treatments are not successful.

• Stay healthy by eating a balanced diet, exercising regularly, and getting enough sleep.

• Reduce stress levels.

• Manage any underlying medical conditions, such as STIs or endometriosis.

• Quit smoking

Conclusion

Blocked fallopian tubes are a common cause of infertility, but there are several treatments available. If you have blocked fallopian tubes, talk to your doctor about the best treatment options.

To your health

Nwabekee