Solving Tubal Problems
"I've had abnormal and painful periods ever since I went through puberty, "Carrie Y. told the support group. "To stop bleeding all of the time, I had to go on the Pill when I was fifteen. The doctor told my mother that I wasn't ovulating and might never conceive.
"I lost my virginity on the operating table. I can't even remember how many D&Cs I had before I was twenty-five."
"Did you cramp a lot?" one member asked.
"Yes, but I thought everyone cramped and that having pain with your periods was normal. The pain eventually got so bad that when I was in my early twenties, I had to stay home during the first two days of my period. I learned later that discomfort from normal periods shouldn't interfere with your daily routines. But since I never knew any differently, all of those years I didn't question it." She paused. "Not until that awful day. My husband and I had decided to try to have a baby. I'd been taking clomiphene for several months, to get me to ovulate, and my period was a week late. That wasn't anything unusual, since my periods were frequently forty to fifty days apart. But I'd been regular since I'd been on clomiphene. When my basal body temperature stayed up that week, we both became pretty excited. After two years of trying, I was sure I was pregnant.
"But that morning at work I had terrible cramps, like I needed to have a bowel movement. The pain in my side was so bad that I had to go home. Later that afternoon I did go to the bathroom and the pain stopped. But not for long. It became so severe that I thought I was going to pass out. I called the doctor. I cried all the way to the hospital.
"After running some tests, he told me that I had either appendicitis or a tubal pregnancy. I'd begun to spot, so I was afraid I was losing a baby. He had me stay at the hospital overnight.
"The next morning I was weak but I felt better. Since they'd found some blood in my urine, the doctor thought I was passing a kidney stone. And he sent me home.
"The pain continued and the bleeding got worse, so I went back to the hospital and had a D&C. The doctor didn't think I was pregnant because he couldn't find any tissue in the material he removed.
"When I returned home, the pain in my right side was gone, but I was bleeding like a leaky faucet. I knew it wasn't right. I was a D&C expert by then. Another thing that puzzled me was that my breasts were still swollen and tender. But when I called the doctor, he didn't seem very concerned. He just said, 'You can expect some bleeding after a D&C.'
"Even though the bleeding continued, I returned to work. In the middle of the morning, searing pain doubled me over. My secretary rushed me to the hospital. I had an ectopic pregnancy and had lost a quart of blood. That wasn't all I could have lost. I nearly lost my right tube and ovary."
The group was quiet.
"What caused it?" a voice asked from the back row.
"When they did my laparoscopy, they found out that I have endometriosis. That's probably why my periods were screwed up. The doctor said that my adhesions were so thick he could hardly find my tubes."
"What did you do?" a woman asked.
"First of all, I changed doctors. After all I'd been through, I'd lost faith in him. My new doctor is performing a laparoscopy next week. He believes he can clean out the adhesions and endometriosis and possibly restore my tubes to normal. We'll know more after the surgery."
Tubal problems are the leading cause of female fertility problems. With the tremendous increase in PID and sexually transmitted infections, and with the increased incidence of endometriosis, tubal problems account for half of female infertility.
What Causes Tubal Problems?
A number of different problems can impair fallopian tube function:
Abdominal adhesions and scar tissue that immobilize fallopian tubes
Adhesions and scar tissue that prevent the egg from entering the tube and traveling toward the uterus
Damage from an ectopic pregnancy or sterilization surgery
These problems can be caused by a variety of events:
Pelvic inflammatory disease (PID)
In utero DES exposure
Salpingitis isthmica nodosa
When infection and disease attack delicate tubal structures, the tubes may become deformed and cease to function. Trapped in adhesions and scar tissue, they can no longer retrieve the egg and coax it toward the uterus. Infection and damage from ectopic pregnancy may strip the vital ciliated lining from the inner walls. When this happens, sperm cannot meet egg, and fertilization cannot occur. If the tubes are obstructed only partially, sperm may be able to meet egg, but the developing embryo can become trapped inside the tube and cause a painful and even life-threatening ectopic pregnancy.
The PID epidemic alone is claiming the fertility of hundreds of thousands of women each year. Up to 60% of women who have antibodies to chlamydia are unaware that they ever had an infection will this stealthy invader that can destroy your fallopian tubes and rob your fertility without the slightest hint. Fortunately microsurgery, laser surgery, and in vitro fertilization techniques can restore fertility to many of those victims.
Diagnosing and Evaluating Tubal Problems
Normal Tubal Function
The fallopian tube is an active, muscular organ that retrieves the egg from the ovary and coaxes it toward the oncoming sperm. If adhesions restrict the tube's mobility or if infection has stripped the tiny cilia from the tubal lining the tube cannot perform its vital job. The various tests I use will help me determine if:
The tubes are open (patent)
The fimbria are open and free to grasp the ovary
The tubes are free from adhesions so they can move
The inner lining of tiny hairs (cilia) is intact
I can evaluate tubal performance by tubal X ray (hysterosalpingogram), sonohysterosgraphy (an ultrasound test), laparoscopy (telescopic look into the abdomen), and tuboscopy (telescopic look inside the tubes).