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Nita was just recovering from surgery for an ectopic pregnancy. Her left fallopian tube had to be removed laparoscopically as it had ruptured and she was bleeding internally. She was 30 and was trying to conceive from five long years. With just one fallopian tube left, she wondered and worried whether it was possible to get pregnant. She was also unsure and pondered how long she should try naturally before seeking help from a fertility specialist. This issue with fallopian tubes can be a true story for many women grappling with fertility issues.
Every woman has a pair of fallopian tubes on either side of the uterus. This slender tube helps to connect the ovary to the uterus. It plays a vital role in capturing the ovulated egg, allowing its fertilisation with the sperm and then transporting the growing embryo into the uterus.
Having a single fallopian tube is not uncommon and couples are often apprehensive about their chances of conception. There are various reasons for having a single fallopian tube:
* Blockage of one fallopian tube because of pelvic infection
* Surgical removal of one tube usually because of ectopic pregnancy or damage (hydrosalpinx)
* Pelvic adhesions due to pelvic infection or endometriosis
* Some women are born with a single fallopian tube. Tubal blocks are usually asymptomatic and diagnosis requires a specific test to be performed.
Tubal block can be diagnosed by various tests such as hystersalpingography (HSG), laparoscopy, HyCoSy or Sonosalpingography (SSG).
In an HSG, a radio-opaque liquid is instilled into the uterus through a narrow tube and X-ray images are taken as the dye courses through the uterus and passes through the tubes into the pelvis. In SSG and HyCoSy, the uterus and tubes are filled with saline or a contrast medium respectively, and ultrasound is done to assess the inside of the uterus and whether the tubes are open.
Of these options, laparoscopy is most accurate and is the gold standard. This minimally invasive key hole surgery gives an opportunity not only to diagnose the block but also allows a chance to surgically open the tubal block. However being a surgery, most patients are generally offered the other simpler alternatives as a first line.
A woman can definitely conceive with one fallopian tube. Nonetheless, certain facts must be borne in mind.
Chances of conceiving naturally are entirely dependent upon the condition of the existing tube. If undamaged, possibility of natural conception is highest. But then underlying conditions such as pelvic infection or endometriosis often affect both tubes equally or to a varying degree.
Chances of getting pregnant in one month is usually 25-30 percent in women less than 30 years. Hence, it often takes a few months for any couple to conceive naturally. Since all women have two ovaries, and a single egg ovulates every month, the side on which ovulation occurs is random.
Women with a single open fallopian tube have a chance to conceive only in the month when ovulation occurs on the same side as the open tube. Consequently, such couples take longer to get pregnant as they lose the months when ovulation occurs on the side of the blocked tube.
Ability to conceive is dependent on many other factors – age of the woman, ovarian reserve, semen parameters and a normal uterus. Ovarian reserve assessment is extremely important to take the right reproductive decision for any couple. Younger age than 30 years, good ovarian reserve, normal semen parameters and a normal uterus increase the probability of success.
Prior to attempting natural conception, couples will benefit from an assessment with a fertility specialist to understand their odds of getting pregnant and guidance regarding when to seek help if unsuccessful.
Women who fit the criteria to try naturally should try for a period of one year (if less than 35 years) or six months (if over 35 years).
If unsuccessful, the couple will benefit from consulting a fertility specialist for further evaluation and possible treatment. Treatment options include surgery to open the tubal block, intra-uterine insemination (IUI) when ovulation occurs on the side of the open tube or in-vitro fertilisation (IVF).
If surgery is an option, it must be performed by a laparoscopic surgeon who has good experience in fertility surgery. If surgery is unsuccessful, or if you have multiple factors such as low ovarian reserve or poor sperm quality, In-Vitro Fertilisation is recommended.
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