What are blocked fallopian tubes and structural issues?

The Fallopian tubes are two very small muscular tubes that run along either side of your uterus to your ovaries and are responsible for transporting your egg from your ovary to your uterus. During ovulation, your egg will travel from your ovary to your Fallopian tube where the sperm will meet the egg and attempt at fertilization. If successful, the fertilized egg is pushed through your Fallopian tube and into the uterus where it will find its implantation site and progresses with the pregnancy!

Any blockage along this route is considered a blockage of your Fallopian Tube and can prevent a pregnancy from occurring. These types of blockages are the cause of one third of all female infertility.

What does blocked fallopian tubes mean?

There are different types of Fallopian tube blockages. Medically, they are distinguished by where along the Fallopian tube the blockage occurs.

There are 3 main areas where blockages occur:

1. Proximal tube blockages: This area is around the isthmus of the fallopian tube, which is the part that is connected to the uterus. Issues in this area often occur because of infection due to pelvic inflammatory disease (PID) or complications from surgeries, abortions or missed miscarriages.
2. Midsegment tubal blockages: This area of the tube is called the ampullary, the central section of the tube moving towards the uterus. This is the main part of your fallopian tube. Issues here often result from tubal ligation damage. Tubal ligation is a surgical procedure to permanently prevent pregnancy (often called “getting the tubes tied”). If a woman decides she wants to get pregnant after this surgery is performed, it can be surgically reversed with a 75% success rate, however the more surgery that is performed, the more scar tissue is created which can cause a blockage within the tubes.
3. Distal tubal blockage: This type of blockage affects the fallopian tube end near the ovary. This blockage is often associated with hydrosalpinx, or fluid filled obstruction of the tube. This is often caused by sexually transmitted infections, which can cause infection and adhesion of the tube. Chlamydia is one of the most common causes of tubal infection.

Whenever any part of the fallopian tube is compromised, it can affect fertility. Women who suffer from other pelvic complications such as endometriosis, uterine fibroids, PID or have a past history of abdominal surgery or ectopic pregnancy are also at an increased risk for compromised fallopian tubes due to scar tissue formation or structures within the uterine cavity that block affective fertilization, implantation or push up against structures that cause compression and blockage of the tubes.

What causes blocked fallopian tubes?

Fallopian blockage may result from several possible causes:

• Hydrosalpinx, which is when a fallopian tube fills with fluid (most often from infection)
• Tubal scarring or adhesions from salpingitis, or inflammation of the fallopian tubes. This is usually from a previously undetected or untreated infection of the tubes, most often from a sexually transmitted infection
• Lesions within the uterine lining due to endometriosis or fibroids
• Scar tissue adhesion formation from previous abdominal or pelvic surgeries
• Tubal ligation surgeries

What other structural issues can affect fertility?

Other structural issues can affect fertility depending on their location and relationship on how it may interrupt the natural route of egg release, fertilization and implantation.

Structural issues can stem from:

• Uterine fibroids and/or polyps
• Ovarian cysts
• Abnormal uterine shape
• Severe intrauterine scarring
• Inflammatory bowel disorders
• Hydrosalpinx

How does it impact fertility?

 If there is an interruption of the pathway between the ovary and the uterus, fertility can be impeded, prevented or compromised. We also require optimal environment and function of each structure involved in fertility for pregnancy to occur. Generally medical practitioners will be looking for the following:

• A blocked fallopian tube that prevents the fertilized egg from reaching the uterus
• A blocked fallopian tube that can lead to an ectopic pregnancy, which is when the embryo implants in the tube and can be very dangerous
• Issues within the uterine lining that prevent a pregnancy from properly implanting and progressing. This can include fibroids, polyps, endometrial lesions, adenomyosis or scar tissue from past surgeries.

Signs that you may have a structural issue affecting fertility:

 Often there are no obvious symptomatic signs of a blocked fallopian tube until issues with fertility present. Women can have regular periods and cervical mucus with a blocked fallopian tube. The only way to confirm a blocked fallopian tube is through medical testing.

Signs of other structural issues such as endometriosis, uterine fibroids or ovarian cysts will present with abnormalities within your menstrual cycle that can include abnormal bleeding between cycles, long and heavy periods, severe cramping and pain during your period and sometimes mid-cycle. It is important to pay attention to your cycle symptoms and seek advice on how to correct any menstrual abnormalities to increase your fertility potential.

How to test for structural issues:

Pelvic ultrasound: This examines the female pelvic organs including the uterus, endometrium (lining of the uterus), cervix and ovaries. Most pelvic ultrasounds are performed using both trans-abdominal (on your abdomen) and transvaginal (probe inserted into your vagina) approaches.

Trans-abdominal will provide an overview of the pelvis, and helpful to assess possible large pelvic masses that may extend into the abdomen.

Transvaginal is an internal examination that produces images that are more specific and clear of the pelvic organs due to closer proximity.
These are used to investigate a number of issues including menstrual abnormalities, infertility and pelvic pain. Often the ultrasound may not provide all the answers, and further diagnostic tests more specific for the concern will be performed.

Sonohystogram: This is also an ultrasound procedure that allows the doctor to look at the endometrial cavity, or the inside of your uterus and the endometrium. A thin catheter is inserted through the opening of your cervix and a small amount of sterile saline is introduced into your uterus through the catheter. The transvaginal ultrasound is then used to image the uterus.
This will be used to asses for any lesions within the endometrium, the health of the endometrium and to assess the shape of the endometrial cavity. The saline can evaluate the shape of the uterus and detect conditions that may cause problems like recurrent miscarriages or infertility.

Testing for tubal patency: There are two ways in which to test for tubal patency meaning if your fallopian tubes are open and unobstructed.

1. Hysterosalpingogram (HSG): this is an Xray test of the inside of the uterus and tubes using a contrast dye to view any obstructions. The dye is injected into the uterus and tubes, which then spills into the fallopian tubes if the tubes are patent. Xrays are taken to determine if there is injury or abnormal shape/structure to the uterus and fallopian tubes.
2. Laparoscopy Chromotubation: This is a more invasive procedure requiring surgery and general anaesthesia. It is similar to an HSG because if also uses a dye that is passed into the uterus and fallopian tubes however the surgeon can see directly into the pelvic cavity. This allows them to see the dye spilling into the tube and assess the health of the tubes from the outside. This test can also be used to assess if there are any adhesions or endometrial growths in the pelvic cavity.

How to Treat Structural Issues:

A blocked fallopian tube is not a dead-end diagnosis. There are techniques available that can help to open them again. Structural issues that may be impeding fertility can also be treated and fertility improved. It is important to note that depending on the severity of the damage to a fallopian tube, it may be difficult to reverse the damage. In this case, IVF treatments may be the best option for a successful pregnancy.

Conventional Treatments:

Surgery: There are different surgical procedure options depending on the cause and location of the structural damage. A salpingectomy is when a part of your fallopian tube is removed and is often used to treat hydrosalpinx; often before IVF treatments are performed. A salpingostomy is when the surgeon creates a new opening in the fallopian tube closest to the ovary. A tubal cannulation is performed for a proximal tubal blockage (closest to the uterus).

Many of these surgical procedures can be very successful but do not come without risks. Any surgery can create scar tissue and adhesions in the future and could cause future issues in terms of conception. Any abdominal surgery puts you at greater risk of infection and can be an uncomfortable healing process.

Alternative Treatments:

Most of the alternative treatments work to reduce inflammation and improve circulation while also ensuring a healthy hormonal balance.

Arvigo massage: Arvigo Massage is an ancient Mayan technique of abdominal massage. These techniques are used to address positions and the health of the pelvic and abdominal organs. When reproductive organs shift, they can constrict normal flow of blood and lymph, and disrupt nerve connections. It is believed that by shifting the uterus back into place balance is restored in the pelvic area and the surrounding organs, toxins are more effectively released and there is greater blood flow overall. In terms of structural issues, the techniques can help to loosen adhesions from past surgeries or pelvic conditions such as endometriosis that may be causing your organs to stick together.

Topical Castor Oil: Castor oil packs have traditionally been used for healing tissues and reducing inflammation in the body. A castor oil pack is ideally a piece of flannel cloth soaked in castor oil and placed upon the skin. These can help reduce inflammation, increase circulation and promote tissue healing to the structures underneath your skin. Applying heat over top of the castor oil pack helps to increase the absorbability of the castor oil.

Traditional Chinese Medicine: According to Jane Lyttleton, TCM works best if the structural damage has not progressed too severely. TCM specialists claim better success with distal tube blockages. Blocked tubes are diagnosed as Blood Stagnation in TCM terms but in varying degrees.
Both acupuncture and herbs would be used to address the cause of the blood stagnation and to help invigorate and move the blood in the uterus (Uterus in TCM includes all the main reproductive organs).

Treat Underlying Disease:

If testing revealed an underlying disease process such as endometriosis, uterine fibroids or ovarian cysts, then treatment would need to be directed at correcting these processes and regaining the health of your reproductive organs. Diet, lifestyle, hormonal balancing through herbs and nutrient supplementation, acupuncture and physical medicine are all options that can be used.

Decrease Inflammation:

Many of the causes of blocked fallopian tubes have an inflammatory picture at the root. Adopting lifestyle and diet practices that help to decrease inflammation are critical for both treatment and prevention of progression of the condition. Identifying aggravating foods and removing them from the diet is a great first step (either through an elimination diet or food sensitivity testing). An anti-inflammatory diet rich in vegetables, fruits, good fats and optimal protein can help the body find a greater state of balance. Physical activity 3-5 times a week has countless benefits for your health, including regulating the inflammation in the body.

On top of this, there are many herbs and supplements that are anti-inflammatory:

Turmeric: Also known as Curcumin, has natural anti-inflammatory and anti-tumour actions for the body. The easiest way to take in absorbable Curcumin is through capsule form.

Ginger: Ginger also has natural anti-inflammatory effects as well as increasing circulation. Ginger can also come in capsule form, and a good starting dose is 250 mg per day. You can also easily add ginger into your diet but adding it to smoothies, stir-fries, teas, baking and soups.

Supplements to consider:

Proteolytic enzymes:

Proteolytic enzymes are naturally found in our bodies and they help to break down the proteins in our food. These enzymes are also important to break down protein accumulation in other parts of our body, such as fibrosis and scar tissue and they decrease inflammation.

As we age, we begin to produce less of our proteolytic enzymes, which may be why we tend to have more concerns and greater inflammation as we age. Fibrosis (scar tissue formation) occurs in our organs as we age, and can show up in different ways such as fibroids, cysts, scar tissue from surgeries, in our arteries and so on.

There is the hypothesis that providing the body with proteolytic enzymes helps to break down existing scar tissue and decrease inflammation. The research is inconclusive at this point, however there have been many clinical reports of success.

There are many different formulations of proteolytic enzymes on the market so dosage suggestion can vary.

Chinese herbs for Blood Stagnation / Stasis:

Common herbs that are considered to regulate blood in traditional Chinese medicine include Dang Gui (Angelica sinensis root), Chuan Xiong (Ligusticum root), Chi Shao (Red Peony Root), Yuan Hu Suo (Corydalis yanhusuo) and Mo Yao (Myrrh).

Please consult with a Naturopathic doctor, or Chinese medical doctor for advice on Chinese herbal supplements.

Homeopathy:

Homeopathy is an energetic health modality that looks at the entire symptom picture of the person. Finding the right homeopathic remedy for you is best done in conjugtion with a liscened and knowledgeable practitioner.

One remedy, Thiosinaminum, is a rememdy made from mustard seed and known for treating scar tissues and fibroid growth and may be a great place to start if you are experiencing structural issues impeding fertility.

Botanical Medicine:

There are other herbs that can be considered, depending on the cause of the structural blockages. There are herbs known for their anti-microbial effect in situations of infection, herbs that increase circulation and herbs that help to balance the hormonal picture of the body. Understanding the root cause of your condition will inform what the best botanical choices are for you.
Certain herbs of note are:

Goldenseal (Hydrastic Canadensis): Anti-microbial and anti-inflammatory. It is also known as “King of the Mucous Membranes”, supporting their health and integrity.

Dong Quai (Angelica sinensis): Great herb for promoting circulation to the reproductive organs and helps to decrease tissue congestion.

References

• Advanced Women’s Imaging http://www.advancedwomensimaging.com.au/saline-sono-hysterogram
• Arvigo Institute LLC. The Arvigo Techniques of Mayan Abdominal Massage https://arvigotherapy.com/
• Hershlag, A MD; Diamond M MD; DeCherney A MD Adhesiolysis. Clinical Obstetrics & Gynecology:June 1991 – Volume 34 – Issue 2 – ppg 395-402
• Hoffman, D Medical Herbalism Healing Arts Press 2003
• Lyttleton, J. Treatment of Infertility with Chinese medicine. Churchill Livingston, 2013.
  

Disclaimer

Please note that the content on www.unexplainedinfertilityinfo.com is for educational and informational purposes only, and is not intended as medical advice. The information contained here is not intended to provide medical advice, diagnosis or treatment. The purpose of this website is to inspire readers to make informed decisions about their health and fertility, in collaboration with a qualified health professional. Readers should always consult with a qualified health professional prior to making any health changes, especially when related to any specific diagnosis or condition.