Female reproductive organs comprise of:
Uterus, Fallopian tubes and ovaries.
Altered function in any of these can land up into Assisted Reproduction with IVF as the last option with maximum success rates
Any discussion of the potential risks and benefits should also highlight the potential effect of delaying IVF treatment, especially in those above 35 years of age where other factors may play the determining role.
Whenever we as patients are told about the status of fallopian tubes which normally need to be functional and dynamic for natural pregnancy to happen but when affected then it can vary from:
- Complete blockage of both tubes
- Unilateral blockage
- Patent but non-functional
- Blockage can be due to spasm, debris or pathology
- Damage can be by Infection like Tuberculosis, scarring, post-surgical impact, adhesions
- Fluid accumulation in tubes- Hydrosalpinx
Depending on the status next step will be either
- As for whether its damage or dysfunction
- Try to open them by laparoscopy
- Or Directly go to IVF But the dilemma is as for whether to carry out IVF directly or undertake tubal surgery – an answer to this is based on –
- Clinical assessment of the severity of tubal damage
- Age of the patient
- Availability of specialized surgical services and IVF
Similarly, a second doubt which comes to mind is the impact of tubal dysfunction on IVF outcome.Although tubal disease, in general, is not associated with poor outcome from IVF, there is increasing evidence that distal tubal disease associated with hydrosalpinx may affect the chances of success from IVF treatment.
Many studies have shown that it can negatively influence the chance of success with IVF by decreasing implantation rates such that as per a combined study it was observed that there were differences in pregnancy rates after IVF in tubal infertility with and without hydrosalpinx, pregnancy rates of 31.2% were observed in the absence of hydrosalpinx and 19.7% in the presence of hydrosalpinx
- Each patient is different so cannot apply blanket treatment to all.
- Need a basic workup and scrutiny before planning treatment protocol.
- If the beginning is correct then we can have the best outcome at the end.
- Needs a systematic and Individualised approach