Tubal factor can be acquired through pelvic inflammatory disease as a result of gonorrhea/Chlamydia infection or septic abortion, abdominal diseases like appendicitis, prior tubal or ovarian surgery, severe endometriosis. Furhermore some women may have history of surgical sterilization procedure through bilateral tubal interruption.
Tubal factor evaluation may need transvaginal ultrasound, which may show distended tubal segments due to their obstruction at their distal ends (Hydrosalpinx), hysterosalpingography (HSG) an X-ray method involving radi-opaque contrast injection of uterus, and tubes may show tubal occlusion at any segment of the tubes. If one or all of these tests were positive the patients may need evaluation by an outpatient surgical techniques called as laparoscopy. Laparoscopy may be combined with hysteroscopy especially if proximal tubal cannulation for proximal tubal occlusion is indicated. Through laparoscopy micro-surgical techniques can be applied to restore the tubal patency and function if feasible. If tubal factor cannot be treated surgically than IVF wil be the only option to conceive. In the presence of hydrosalpinx your doctor may inform you about removing the distended tube(s) through laparoscopy before your IVF procedure to enhance pregnancy rates. Presence of hydrosalpinx has been shown to decrease IVF pregnancy rate by up to 50%.
Some women who underwent surgical sterilization may desire their tubes to be reconstructed. This procedure is called tubal reversal. In select individuals cumulative pregnancy rate in the year following tubal reversal procedure are in the range of 50-80%. Several clinical characteristics are associated with these high success rates for tubal reversal: Patient under 40 years of age, tubal length after tubal reversal greater than 4 cm, previous sterilization by Falope ring, clip or Pomeroy (most postpartum tubal sterilizations) type tubal sterilization and absence of associated pelvic pathology such as endometriosis, severe pelvic scarring.