English

Josiah Musewu Cosmas

doi:10.5897/mcs2019.0126

Abstract

Women can still conceive naturally or through in vitro fertilization (IVF) with the one oviduct that is properly functioning if only one oviduct is blocked, however, the chances are decreased particularly if the blockage is close to the ovary (hydrosalpinx) because of wash out phenomena and toxic fluid produced by the fallopian tube that is blocked. In situations where only a single tube has hydrosalpinx specialists should advise patients appropriately and must be given options, to choose between undergoing salpingostomy, a surgical process that involves tubal reconstruction to expand their odds of getting pregnant naturally by removing the blockage or IVF treatment. For women with one working oviduct specialists must be on the lookout for ectopic pregnancy. This will enable early diagnosis of ectopic pregnancy and a treatment technique that spares the tube can be utilized. The patient is a woman of African origin with blood group O staying at Manyame Park Harare. She has never married before and has been trying to get pregnant from 2005. She eventually got a successful pregnancy in 2014 and delivered first child in 2015 after several interventions. Her infertility was initially due to the presence of hydrosalpinx on the left fallopian tube, scarring in the fimbriae of left tube, high prolactin level and was subsequently due to loss of the only working tube after ectopic pregnancy. The patient got pregnant whilst she was on bromocriptine, unfortunately the pregnancy did not last to full term. Chlomiphene was later added to her drug regiment and after six cycles she had an ectopic pregnancy which destroyed her only working tube. The patient then tried IVF treatments to achieve pregnancy. She underwent two IVF treatment cycles which failed to achieve pregnancy. The patient finally underwent tubal reconstruction microsurgery which enabled her to have two successful natural pregnancies. Gynaecologists must be vigilant in diagnosis of infertility factors and should give enough appropriate information to female patients when making decisions concerning fertility interventions. Key words: Fertility, in vitro fertilization (IVF), salpingostomy, hydrosalpinx, prolactin, fimbriae. &nbsp

Highlights

Tubal blockage is a usual cause for inability to conceive among women (Banu et al, 2009)
The birth rates of IVF treatment are higher than those achieved by microsurgery, most specialists are generally biased towards in vitro fertilization leading to a decline in tubal surgery
The main guilty party for the couple's infertility was the patient’s high prolactin level, despite the fact that one tube was blocked it was still possible for the patient to become pregnant since one of the tubes was not blocked and X-ray methods are associated with false positives

Summary

Introduction

Tubal blockage is a usual cause for inability to conceive among women (Banu et al, 2009). Transmitted diseases are associated with high incidences of tubal blockage especially sexually transmitted infections (STIs) caused by Chlamydia trachomatis and Neisseria gonorrhoea (Hoof, 2007; Akande et al, 2010). Immunoallergic reactions may take place in the tube, leading to permanent tubal alterations and possibly infertility (Judlin, 2009). In patients with tubal blockage, conception can only be achieved through costly and complex treatments, for example, in vitro treatment or surgery. The live birth rates achieved through (IVF) has increased from 24 to 39.3% in some centres due to improved current clinical practice (Heitmann et al, 2015). The birth rates of IVF treatment are higher than those achieved by microsurgery, most specialists are generally biased towards in vitro fertilization leading to a decline in tubal surgery. There is no straightforward prognostic grouping of tubal blockages, the health of the tubal mucosa and the extent to which the tube is damaged is the key which determines the outcome

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