Female and Unexplained Infertility
At one time, infertility due to female factors was thought to be the reason behind all fertility problems. Today, experts recognize that female infertility accounts for about 40% of all infertility cases, while male infertility accounts for 40% to 50% of cases, with the most common reasons being tubal blockages, ovulation problems and endometriosis. Unfortunately, around 15% to 20% of cases have no obvious cause associated with them, leading to a diagnosis of unexplained infertility.
Blockage of the fallopian tubes can be suggested on a hysterosalpingogram (HSG), but it is important to do a laparoscopy to confirm whether this is the case or not. Sometimes inadequate pressure when inserting the dye during a HSG can lead to a suggestion of blockage when one doesnï¿½t exist. Laparoscopy also gives the opportunity of taking a close look at the tubes to decide on the usefulness of tubal surgery to open them.
The most common cause of blocked tubes is infection, and the most common infection implicated is chlamydia. About 70% of women who have blocked tubes have had a chlamydia infection, though half the time it will have been silent and they will not have even been aware of it.
Where the tubes look otherwise quite normal and the block is close to the uterus, or where scar tissue adhesions are causing a distinct blockage, it is possible to do tubal surgery to open them up. Adhesions can sometimes be broken down through the laparoscope ï¿½ laparoscopic adhesiolysis. Other times or where a small segment of blocked tube needs to be removed, an open operation is needed. The tube may be swollen and full of fluid (hydrosalpinx) or the damage may be more severe and close to the finger-like fimbrial end of the tube where the egg first enters. In these situations tubal surgery is much more unlikely to be successful and in-vitro fertilisation (IVF) will often be suggested in the first instance. In any case, if pregnancy hasnï¿½t happened within 12 months following tubal surgery, IVF should be considered as the chance of success after this time is much lower.
Reversal of sterilisation is successful about 50-70% of the time, but is only rarely available on the NHS.