After ovulation, if the route for the eggs to the uterus is blocked, a pregnancy cannot occur. Tubes that are twisted and thin normally have muscles in their walls that are too thin and cannot produce the pumping movement necessary to push the egg into the womb. Narrow and weak tubes are congenital. Agglutinations generate from inflammations on the ovaries and tubes - Chlamydia and Gonorrhoea being the main causes. An inflammation in the ovaries and fallopian tubes, the appendices of the uterus, is called adnexitis.
The impact of adnexitis on a woman is long term and can have an impact on both her private and professional life, including the risk of permanent infertility. Adnexitis predominantly results from a vaginal inflammation and, when other factors are involved, can allow organisms (mostly bacteria) to ascend to the uterus and fallopian tubes. The disease begins suddenly with strong abdominal pain,fever and other distinctive symptoms. Quick, timely, conservative treatment can avoid acute complications and a transition to the chronic stages of the disease.
Hysteroscopy and diagnostic Laparoscopy are the modern methods used to clarify organic causes in patients who cannot conceive naturally. The Laparoscopy offers the ability to examine the whole abdominal area, fallopian tubes, ovaries and outer uterus. It also allows a smear to be taken from the fallopian tubes in order to eliminate infections caused by bacteria or chlamydia and to thoroughly check if the tubes are open. Performing this under anaesthetic allows us to exclude and/or confirm a range of possible causes for infertility in one session, and very often treat them at the same time. This includes for example myomas, endometriosis, agglutinations of the fallopian tubes and pathological changes of the ovaries. In order to examine the uterus cavity, the diagnostic Laparoscopy is generally combined with a uterus Laparoscopy.
Here an ultrasound and a contrast liquid are used to examine the patency of the fallopian tubes. For the examination, the doctor inserts a thin catheter into the opening of the cervix, through which the contrast agent is applied. In the ultrasound, the doctor is able to see if and how the contrast agent flows through the fallopian tubes. The examination can be carried out as an outpatient procedure and does not require any anaesthetic. However, some women experience pain similar to period pains. This examination is applied often, as it does not entail radiation exposure or anaesthetic. Allergic reactions to the contrast agent or an infection of the womb (metritis) as a result of the procedure are very rare.
Open functional tubes are an essential precondition for the occurrence of natural pregnancy. If it can be proved that the tubes are closed or unusable in the long-term, then patients can profit from the IVF fund which will pay 70 % of the treatment and medication costs of an IVF or an ICSI treatment (provided a previous ligation of the tubes is NOT given!).
A corrective surgery of blocked tubes is not an established treatment and requires hours of microsurgery. Pregnancy rates after corrective surgery on both fallopian tubes and spermatic ducts are extremely low. On the other hand, "classic IVF treatment" is routine nowadays and has a pregnancy rate of approximately 50 % per attempt. The first therapy for cases of closed fallopian tubes is therefore IVF, and in the case of closed spermatic ducts the first treatment is TESE/ICSI.