What is a tubal infection and how can it cause infertility?
One of the main causes of infertility in women is tubal disease which can be tubal obstruction, infection, or inflammation of the fallopian tubes. Salpingitis or tubal infection is an infection that causes inflammation of the fallopian tubes and reproductive organs.
The fallopian tubes play an important role in conception because they are a conduit between the uterus and the ovaries. The egg from the ovary after ovulation should reach the fallopian tube and sperm after sexual activity, swimming the full distance of the vagina, cervix and uterus. The process of fertilization, that is, when the sperm meets the egg, takes place in the fallopian tubes. After fertilization, the embryo develops for another five to six days in the fallopian tube to become a blastocyst, then reaches the uterus to implant. Therefore, the tubes should be open on both sides and they should be free of adhesions, healthy enough to nourish an embryo and propel it to the uterus. In short, it is not just a line pipe, but it has several important roles.
Tubal infections are one of the pelvic inflammatory diseases (PIDs) that can cause infertility in women in severe cases. There are two types of salpingitis:
Acute salpingitis: Acute salpingitis causes swelling of the fallopian tubes, which may start to emit fluid. This can lead to the development of pus in the fallopian tubes.
Chronic salpingitis: Chronic salpingitis lasts longer but with mild symptoms. In many cases, women cannot notice the symptoms of the infection.
Symptoms of a tubal infection
* Painful sex
* Pain in the lower abdomen
*Lower back pain
* Pain during urination
* Foul odor from vaginal discharge
* Spotting during the menstrual cycle
Causes of tubal infections
* Tubal infections are mainly caused by the presence of dangerous bacteria like Chlamydia trachomatis (responsible for STD chlamydia) and Neisseria gonorrhoeae (which causes gonorrhea). Other bacteria that can cause salpingitis include mycoplasmas, staphylococci, and streptococci.
* Unprotected sex is the primary means by which these bacteria enter a woman’s reproductive system. Other causes are poor hygiene, procedures like abortion, childbirth, etc.
* In India, tuberculosis is also a very common cause of infection and damage to the tubes.
Effect of tubal infections on fertility
An infection of the tubes causes scarring or blockage of the fallopian tubes, which could lead to permanent damage. Sometimes they swell to form hydrosalpinx (a condition where the fallopian tube is blocked by a watery fluid). The transport of sperm to the egg will be hampered, which will lead to infertility. Previous surgeries and endometriosis can cause tubal adhesions and infertility.
An ectopic pregnancy is a situation where the egg is fertilized but will not be able to enter the uterus due to damaged fallopian tubes. There is a good chance that the embryo will start to develop in the tube. The embryo that attaches itself anywhere outside the uterus is extremely risky. If left untreated, it will continue to grow and will rupture the tube. Cases of ectopic pregnancy can be life threatening and should receive immediate medical attention.
Diagnosis of tubal infections
If you see any of the signs and symptoms mentioned above, you need to see a doctor to reduce the risk of complications in the future. Your doctor may perform the following tests for diagnosis:
* Vaginal or cervical swab
* Blood and urine tests
* Pelvic examination
* Abdominal or transvaginal ultrasound
* Hysterosalpingography or HSG test
Treatment of tubal infections
Early diagnosis is important for salpingitis because treatment will depend on the severity of the infection. Prompt treatment will prevent blockage or scarring of the fallopian tubes.
Your doctor will prescribe oral antibiotics to treat a minor infection. If the infection has become severe, causing a blockage or scarring, the doctor will perform surgery to remove the damaged areas. Laparoscopic surgery may also be done if there is an abscess in the fallopian tubes or ovaries to drain fluid. The fluid-filled area can also be removed during surgery.
How IVF Can Help With Serious Infections
If the infection goes undiagnosed early and damages the tubes that cannot be corrected surgically, women may opt for in vitro fertilization (IVF) for conception. Whatever happens normally in the fallopian tube, during an IVF process performed in an IVF lab. With IVF, your egg will not have to reach your uterus through the fallopian tubes because the embryo is prepared in a Petri dish and inserted into the cervix. However, the success rates of IVF depend on several factors such as the age and the quality of the eggs and sperm.
As soon as you see signs and symptoms of tubal infections, you need to see a doctor for an early diagnosis. In infertility, IVF or other assisted reproductive technologies (ART) could help women conceive.
(The author is a fertility consultant, Nova IVF Fertility, Bangalore.)
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