Tubal microsurgery

learn more about sterility and infertility

Around 15% of the population suffer from sterility and/or infertility, which is considered to be a high proportion.

A couple is considered to be sterile when after a year of regular unprotected sexual activity; the woman has never been pregnant.

Sterility is often confused with infertility, but they are not the same. Infertility occurs when a couple has had multiple miscarriages. The woman's age has important repercussions in this situation.

Between the age of 20 and 35 there is a slight drop in fertility, which falls further between 35 and 40 years old and a big decline occurs between 40 and 45 years old. Between 45 and 50, fertility rates are very much reduced. 

Tubal reversal ligation. [Infography only available in Spanish]
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Sterility (in both women and men) is firstly defined by a woman who has never been pregnant, and secondly, when a woman has never fallen pregnant again 1-2 years after her first pregnancy despite having tried to do so.

The causes of sterility are varied and must be studied both physically and functionally. In general, the causes can be organic, functional, immune or even psychological.

Overall, 25-35% of women suffer from sterility due to physical problems in the Fallopian tubes. The Fallopian tubes are two structures connecting the uterus with the two ovaries and this is where fertilisation occurs. Fertilisation cannot occur if there is an obstruction or if the Fallopian tubes do not work properly.

There are many causes for blocked Fallopian tubes. For example, infections caused by microorganisms like Chlamydia and Gonococcus (generally sexually transmitted) can cause an inflammation which is capable of obstructing the Fallopian tubes. The same occurs as a result of an abdominal infection such as appendicitis, diverticulitis or previous surgery on the ovaries and fibroids, for example.

'Hydrosalpinx' can be another cause and obstructs the distal third of the tube, filling it with inflammatory liquid. The liquid can then pass through the uterine cavity and cause a chronic inflammation, which would affect the endometrium's ability to host an embryo.

A further source of sterility due to tubal blockage is Endometriosis  which occurs when the endometrial tissue 'leaves' the uterus and 'invades' the peritoneum or ovaries causing a chronic inflammation in the pelvis and tubal obstruction.

And, finally, tubal blockages can be caused by sterilisation operations in women, also known as a tubal ligation. In total, it's estimated that 25% of women who have undergone a tubal ligation procedure as a contraceptive method decide afterwards that they want to have children again.

This is a very significant percentage and at the Clínica, we have a wide experience in the microsurgical treatment for this problem using microsurgical techniques with success rates over 45%, and even higher rates in women under 35.

When faced with a case of sterility, it's essential to determine if it is caused by tubal obstruction and the main identifying technique used for this is ultrasound.

With this technique one can detect the presence of certain lesions in the tubes that are suspected of being blocked and the specialist can identify whether it is caused by 'Hydrosalpinx' or 'Pyosalpinx' (tubal inflamations).

To precisely determine the permeability of the tubes, the Clínica has developed a methodwhich involves introducing saline solution into the uterus. Then, using a Doppler ultrasound, the specialist can see if the solution travels through the tubes or not.

This is a very well tolerated procedure for the patients when compared with the conventional technique, a Hysterosalpingogram. This treatment involves introducing contrasting liquid into the uterus and using radiography to observe what happens. The Clínica ́s technique has many benefits: there is no need for previous preparation, it is less invasive for the cervix and therefore there is less post procedure discomfort, as well as no need for exposing the patient to ionizing radiation.

If the permeability of the tubes has been confirmed, no additional diagnostic tests are required.

All couples who want children and have been unsuccessfully trying for a baby for over a year whilst maintaining normal sexual relations, without the use of contraception, should undergo a series of tests".

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