Blockage of the Fallopian Tubes

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Blockage of the Fallopian Tubes

Can Chinese Medicine Treat Fallopian Tube Blockage?

Once a disease has changed or damaged the tissue of the fallopian tube, then acupuncture and herbal medicine can offer limited therapeutic benefit. Western medicine, similarly, offers little to reverse such damage but often has ways of removing or side-stepping the problem. From the point of view of the TCM doctor, blockage of the fallopian tubes is a much more difficult cause of infertility to cure than functional causes. However, from the Western specialist’s point of view, this sort of infertility, in the absence of any other complicating factors, is one of the easiest and most satisfying to treat, whether by microsurgery, which removes the damaged portion of the tube, or more commonly by in vitro fertilization (IVF) techniques which circumnavigate the tubes altogether.

Where the structure of the tube is not damaged but its function is impaired, then treatment with Chinese medicine can expect a good outcome.

In determining just how much help a TCM doctor can offer to a woman suffering from infertility due to tubal blockage, we need to know just how much damage has been done and what it is that is causing the obstruction.

Diagnosis of Tubal Blockage

There is no way to test the patency of the tubes other than with rather invasive procedures. A tubal blockage is itself asymptomatic, although a history of pelvic infection will raise suspicion of tubal disease.

A hysterosalpingo-contrast-sonography (HyCoSy) is the preferred technique for investigation of Fallopian tube patency. It is a dynamic ultrasound of the uterus and tubes taken while a solution of galactose and 1% palmitic acid (Levovist) – or a mixture of air and saline – is infused into the uterine cavity and observed as it moves through the Fallopian tubes. The bright echoes generated by the solution and the use of color Doppler imaging allow clear visualization of the tubes and their function. The procedure is performed in the first 10 days of the menstrual cycle and after the period has finished. The HyCoSy also allows examination of the other pelvic organs including the ovaries.

A hysterosalpingogram (HSG) is an X-ray of the inside of the uterus and tubes, which is achieved by injection of an X-ray opaque medium through the cervix. This dye is forced into the uterus and tubes under pressure until it spills into the pelvic cavity if the tubes are patent.

A degree of discomfort is often experienced by the woman having either the HyCoSy or the HSG. Period pain medication taken before the procedure can lessen the cramps.

The pressure of the fluid passing through the tubes may have the therapeutic function of clearing some tubal obstructions (such as those caused by muscle spasm or mucus secretions).

A laparoscopy is a surgical procedure by which a surgeon can see directly into the pelvic cavity by means of a small fiberoptic tube passed down a catheter. The health of the fallopian tubes from the outside can be seen and their patency tested by passing a colored dye up through the cervix and watching for its appearance at the far end of the tube. The patient does not experience the immediate discomfort of the HSG but there will be postoperative discomfort and the after-effects of general anesthesia.

The Structure of the Fallopian Tubes

Each fallopian tube is a thin, fragile tube about 10 cm long (Fig. 6.1). At the end near the ovaries, it fans out like a hand with fingers (the fimbriae) to catch the egg as it is released from the ovary. The section of tube attached to the fimbria is called the ‘ampulla’ and is wide and thin-walled. The section of the tube attached to the uterus is called the ‘isthmus’ and is much narrower and has thicker, more muscular walls. Inside the tube are secretory cells, which produce substances essential for the survival of the egg and the embryo. Also lining the inside of the tube are ciliated cells, so-called for their hair-like projections which push the egg down the tube toward the isthmus with waving motions.

The point where the ampulla meets the narrow isthmus is where the egg waits to meet its sperm, and then where the pre-embryo, if fertilization has occurred, waits to go through its first few cell divisions. The rising levels of progesterone produced by the corpus luteum clear the secretions and relax the muscles in the isthmus to allow the pre-embryo through to the uterus. Although we do not yet know all the secrets of the tube and its relationship with the new embryo, presumably there are special conditions and nutrients provided by the cells lining the tube that are important for the fertilized egg as it completes its first few cell divisions. Two or three days later it will be launched into the uterine cavity to find its nesting spot.

Damage to the Structure of the Tube

Fallopian tubes sustain damage most frequently through infection and inflammation. Chlamydia is one of the most common causes of tubal infection. About 40% of untreated chlamydia infections cause pelvic inflammatory disease (PID), and about 20% of such infected women become infertile. Gonorrhea is the second most common sexually transmitted disease after chlamydia in developed nations, and it also causes PID and consequent infertility. Tuberculosis and yeast infections can also damage the tubes. Intrauterine devices or IUDs have a now infamous history of causing infection, although the subsequent damage is usually isolated to one tube.

If antibiotic therapy is instituted quickly, some of these infections can be controlled in time to prevent damage to the tubes. However, if the infection produces few clinical symptoms and therefore escapes treatment, it often becomes chronic. This leads to chronic salpingitis (chronic inflammation of the tube). In this case, scarring occurs along the inner walls, disrupting the natural function of the cells lining the tube and most often blocking its passage too.

If the blockage occurs near the fimbrial end, the tube can become distended with fluid secretions which cannot escape either from the blocked end or from the isthmus end near the uterus. This creates a hydrosalpinx. In the luteal phase, increasing levels of progesterone relax and clear the isthmus and the fluid is released. The fluid that is released from the hydrosalpinx will flood the uterus and pass out through the vagina, experienced as a watery discharge by the patient. If there has been a conception and an embryo has arrived in the uterus via the other tube (if it is not blocked) or via an IVF transfer procedure, then it is in critical danger of being washed out by this fluid. Therefore, tubes that form hydrosalpinges are usually removed or clipped before IVF procedures.

Microsurgery offers a good treatment option if the tubes are not damaged along too much of their length. If the blockage is in the isthmus near the uterus, then microsurgery is more effective and post-surgery pregnancy rates up to 70% have been reported.1 If there is extensive damage to the tubes, however, IVF becomes the only option. IVF was developed for exactly these conditions and still obtains its best results in young women who are infertile due to blocked tubes.

Treatment with Chinese Medicine for Early-Stage Structural Blockages

TCM works best if the structure of tissues and organs has not been too damaged by a disease process. In the case of pelvic infections, this means acting as soon as infection is suspected, i.e., giving herbs and antibiotics. In a developing country such as China, where advanced microsurgery techniques or IVF procedures may not be so readily available or affordable for many women, some attempt has been made to develop ways of breaking down blockages in the tubes. The best results are obtained when herbs are administered per rectum in addition to oral administration, and, although clinical research in China is not as scientifically rigorous as in the West, there are a number of reports in their medical literature which indicate encouraging possibilities. Six clinical trials examining fallopian tube blockage are described, which include not only herbs to be swallowed but also herbs used as retention enemas and herbs applied to the abdomen. One paper claims a 72% conception rate in 50 women after 3–6 months treatment; another paper reports a 70% conception rate in 150 women after a year of treatment and a third paper reports a 55% conception rate after 6 months.2 Until the research is carried out in a regulatory monitored environment, the results should not be accepted uncritically.

Diagnosis

Diagnosis of fallopian tube blockage is based on an understanding of the origins of the disease and the presenting signs and symptoms. Using modern technology is a helpful first step – first, to confirm the blockage itself; then, to determine its extent and site. Prognosis can be helped with this information, e.g.: whether the blockage is an absolute one or one which can be forced open with pressure; whether the tube is extensively damaged and stiff and sclerosed along its length or just in one site; and whether the site of obstruction is near the ovary or the uterus. TCM specialists claim better success with treatment of blockages near the fimbrial end, whereas microsurgeons can treat blockages at the uterus end more effectively.

TCM describes tubal blockage – as it does for any physical tissue damage or obstruction – as Blood stagnation, but in varying degrees and with various complications.

The Blood stagnation in this case can arise from:

and is classified as mild (the Blood is retarded) through severe (there is complete Blood stasis).

Blood Stagnation Due to Invasion by Cold

Invasion by Cold of the uterus occurs at times when the uterus is open or vulnerable, i.e. during the period, just after delivery of a baby or after a miscarriage or abortion. Cold is said to congeal the Blood such that its movement is inhibited and local circulation quickly becomes inefficient. Thus, Cold reaching the tubes affects their function and contributes to infertility. There may be a feeling of cold in the abdomen and any period pain or ovulation pain will respond well to warmth. The pulse will be retarded and tight if there is pain, otherwise thready. The tongue may be unaffected if the Cold invasion is recent, or it may be purplish if stagnation has become entrenched.

Herbal formula: If the obstruction of the tube is partial or caused by spasms or contractions, then use of the well-known formula Shao Fu Zhu Yu Tang to warm the lower abdomen and resolve Blood stagnation will be effective.

The addition of warming medicinals (Xiao Hui Xiang, Rou Gui, and Gan Jiang) to a collection of Blood-regulating herbs (Dang Gui, Chuan Xiong, Chi Shao, Yan Hu Suo and Mo Yao) encourages movement of Blood which has been retarded by Cold. Wu Ling Zhi and Pu Huang in combination dissolve any Blood which has congealed and clotted due to the Cold.

If the blockage is complete, add to the decoction 1.5 g of a powder made from grinding:

Wu Gong 1 or 2 pieces Scolopendra Subspinipes
Quan Xie 6 g Buthus Martensi

Acupuncture points: Points (Table 6.1) used in the treatment are:

Table 6.1

Acupuncture pointsa used in the treatment of tubal blockage from Blood stagnation and Cold

Treatment goal Acupuncture points
To regulate and move Qi and Cold and/or masses in the abdomen Choose from KI-14, Ren-4, ST-29, ST-28, SP-13
To regulate Qi and Blood in the lateral abdomen SP-6 and LIV-5

aUse even or reducing method and use moxa on the abdomen points.

KI-14 Siman
Ren-4 Guanyuan
ST-29 Guilai
ST-28 Shuidao
SP-13 Fushe
LIV-5 Ligou
SP-6 Sanyinjiao

Blood Stagnation Due to Invasion by Heat

Invasion by Heat to the Uterus causes inflammation and bleeding and eventually Blood stagnation. Endometritis and some forms of acute infection fall into this category. There may be burning pain in the abdomen, thirst and irritability and frequent heavy periods or functional uterine bleeding.

Herbal formula: Combining some herbs from a Blood stagnation formula (Ge Xia Zhu Yu Tang) with one to clear Heat (Dan Zhi Xiao Yao San), addresses the inflammation and the tube obstruction. Antibiotics may also be required in this case.

This formula combines herbs to dispel Blood stasis (Dang Gui, Chuan Xiong, Tao Ren, Hong Hua, Wu Ling Zhi, Yan Hu Suo) with herbs to clear Heat (Chi Shao, Mu Dan Pi, Zhi Zi, Bo He) and regulate the Qi (Xiang Fu, Zhi Ke, Wu Yao). Fu Ling helps clear any Damp that might become associated with the Heat and create chronic pelvic disease. Chai Hu is removed from Dan Zhi Xiao Yao San in this combination because of its lifting effect on the herbs; this formula needs to be active in the lower Jiao.

Acupuncture points: Points (Table 6.2) used in the treatment are:

Table 6.2

Acupuncture pointsa used in the treatment of tubal blockage from Blood stagnation and Heat

Treatment goal Acupuncture points
To clear Heat in the Blood and regulate Qi LIV-2
To clear Heat in the Blood to stop bleeding and regulate Qi in the lower Jiao LIV-1
To cool and regulate Blood and dispel stagnation SP-10
To regulate Blood in the Chong and Ren vessels, clear Heat from the Blood and stop bleeding KI-8 and KI-13

aAll points (except LIV-1) are reduced.

LIV-2 Xingjian
LIV-1 Dadun
SP-10 Xuehai
KI-8 Jiaoxin
KI-13 Qixue

Blood Stagnation Due to Accumulation of Damp-Heat

This type of tubal obstruction is associated with pelvic infection which will usually require antibiotic treatment. If any infection or inflammation persists after antibiotic treatment (i.e., chronic PID develops), then further effort is required to clear Heat and Damp and resolve Blood stasis.

Herbal formula: Use the following formula:

Related posts:

  1. A tale of two clinics — the treatment of infertility with Chinese medicine or Western medicine
  2. Assisted reproduction technology and in vitro fertilization
  3. Gynecologic disorders which can cause infertility
  4. Traditional Chinese medicine treatment of the IVF patient

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Jul 11, 2016 | Posted by in PEDIATRICS | Comments Off on Blockage of the Fallopian Tubes

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