If one tube is patent in a patient with proven fertility then there is quite a change she will get pregnant (including ectopics) if she is not older than say forty at the moment. If she has been treated with proper antibiotics I assume so is/are her partner(s), and perhaps the existing other partners of her partner and the partners of those.

I disagree that infertility a has major health impact on the communities. It is a problem at the individual/family level. In some communities the birth rate is so high that the country/community is threatened because food, education, health services, infrastructure and cannot keep up with the population increase. So infertility is in such countries good for the country. For example, the population in Niger, much malnutrition, increases with 3.8%/year (therefore doubles at that rate every 18 years). There is no rich country that kan keep up with such a fast increase and Niger is one of the poorest countries in the world, but I read and hear that infertility is one of the most frequent complaints seen in health institutions. Providing the means for voluntary contraception is much more a priority on the national level than (at its extreme, IVF services)

In Europe, in the past 5-10% became religious (nuns) or (monks, priests) in the past, still with this voluntary infertility, the populations increased so seriously, before modern agricultural technologies existed, that many felt forced to move to the "new" world that is the America's, Australia, South Africa, New Zealand. With a travel-related mortality at least comparable to the death rates of refugees direction North America and Europe presently.

Ask the Irish.

A hydrosalpinx is a condition that occurs when the fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.

A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx.

Using ICSI is part of the treatment method

Dear dr. Douwe Verkuyl,

Thank you for your valuable answer, I totally agree with you that increase fertility impose a great impact to increase suffering in certain countries especially those who have no legislation for number of children allowed per families, on the other hand, this infertility issue impose a huge impact on individual or families who are part of the communities and they spend a lot of time, effort, money, stress and even travelling seeking for babies and hope, and this will go back to the communities after all. These suffering matter draw back individual from moving foreword in other important subject like creativity, science,etc and also those go in negative point against development of communities.

I think, (this is my opinion only) we should try to change culture and beliefs in communities so suffering will be low in all aspect among those of high fertility and those seeking fertility, and I think is an Imaginary mission to be accomplished.

Best regards

"have no legislation for number of children allowed per families" I certainly do not propagate that, it is contra-productive and - my personal opinion - it is globally perhaps just as important, and less contra-productive, that the amount of fossil fuel for personal/family use (coal, gas, petrol, diesel, plastic) consumed has an upper limit per person, until a complete new energy technology is available to all. Plus of course, there are more than 200 million couples in the world that have an unmet need for contraception [1]. Let us start by giving these people, maximum, pro active services long before - if at all - we initiate above legislation. No fertile person should leave a health worker before she/he explores whether he/she/they might require assistance with contraception: methods or counselling/information. This, even when she is pregnant in order to be prepared for after the pregnancy or, if because a cesarean section is needed later, there suddenly is an opportunity to tie the tubes in case the family is (over) complete [2]. By the way, could somebody perhaps repeat this study [2] elsewhere under your own circumstances, questionnaires are provided and need little adaption.

And if a client/patient would like for example an IUD or vasectomy or tubal ligation try to provide it on the spot if there are no contraindications. Postponing, appointments to next week/month or to far away places results in unintended pregnancies (and sometimes unsafe backstreets). And of course the price of contraception should not be a factor, "penny wise pound foolish" for governments/health services. Moreover, in Niger the maternal mortality is 0.5%, what will happen to the children if mother dies during the 5th pregnancy?

PS. One reason infertility gives so much sadness is that the value of women in many cultures is mainly dependent on the production of children. It is not only men who rub that in, competition among women especially in polygyny situations seems to be rife, but is exploited by men?

Having a profession, e.g, teacher, manager, politician, nurse, midwife, doctor, farmer, social worker, civil servant, scientist, engineer can be just as satisfying as having (many) children. Many children was in the past beneficial: many would die anyway, the land needed labour, and/or the cows/goats herding, money for schools was often not needed, schools not seldom lead to unemployment these days, and having many unemployed young men with frustrated ambitions leads to civil unrest/war dangerous, demeaning migrations.

[1] Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

Vladimíra Kantorová, Mark C. Wheldon, Philipp Ueffing, Aisha N. Z. Dasgupta

In a Bayesian hierarchical modelling study, Vladimira Kantorova and colleagues estimate progress towards meeting women's contraceptive needs in 185 countries.

Author Summary

http://click.e.plos.org/?qs=130cec4770cb067e5bc282901dfc6a12d6f4d0141d9675f7e4e5c044139264108854741bae6a97bc6f5eb34c1980608d

open access, easy to find on line

[2] The Right to Informed Choice. A Study and ... - PLOS ONE

It seems that you are upset dr. Douwe Verkuyl , its a scientific discussion with different point of view, its ok, you see something that I cannot see and vice versa.

may be you didn't meet infertile couple and felt their suffering and how you can convince them that this is the God willing after they suffered years of waiting and driving money which that could be avoided from beginning of most cases by proper health education.

every should go in equilibrium way.

Indeed, I totally agree with SDG for 2030 [2] but were is the application on the ground (talking about Middle east, North and south Africa) keep it to minimum, we are talking here about changing concept of culture of communities over years which is a hard Job. Even in China as there was legislation for delivery of one baby only and enforcing taxes to delivery of other one, infertile people also suffering a lot seeking for this only one child, we are talking about mother instinct of motherhood, majority of woman want to become pregnant and get a baby and this is the natur of life and may be a brother or sister for her child but again donot go foreword with that and here is the role for family planing with Active community participation and lIntra and Inter-sectoral linkages under guidance of PHC and governments.

" No fertile person should leave a health worker before she/he explores whether he/she/they might require assistance with contraception: methods or counselling/information." xcellent and I hope so " No fertile person should leave a health worker before she/he explores whether he/she/they might require assistance with contraception: methods or counselling/information."

" satisfying as having (many) children " may be as you said in wars but now a days is a bad idea.

" the value of women in many cultures is mainly dependent on the production of children. It is not only men who rub that in, competition among women especially in polygyny situations seems to be rife, but is exploited by men? " this is the sad reality of course an I opposite it ,on the other hand, the over freedom in the west also contribute to this massive unmet need in the family planning as " UWRA account for an increasing share of users of modern contraceptive methods globally (15.7% in 2019 up from 12.1% in 2000), driven in part by an increase in contraceptive use among UWRA and an increase in the proportion of women who are unmarried. " [2]

every culture has its drawn Defects.

" could somebody perhaps repeat this study " yes of course, as soon as the situation met regarding time free and resources, I will try to repeat this study in our community but with better methodology and less limitation as it seems there were a lot of limitation in this study [2] .

my best wishes.

it is not just me: https://doi.org/10.1016/j.contraception.2019.12.010

Article One Key Question® and the Desire to Avoid Pregnancy Scale: A...

The population under the study is not representative even if the sample is large as its taken from places were not always infertile women went. go to the infertility clinic and repeat the study.

Here is what happens when a person or couple learn that she/they are not able to conceive:

Thanks dear Béatrice Marianne Ewalds-Kvist for this nice paper, its really give insight view of suffering among people with infertility.

"A woman who is not able to give her husband

a child faces the danger of being divorced.

This fear is real while she is subjected to

psychological abuse; her husband threatens and

blames her." Nice such a loving till-death-us-parts-partner. What about:

"A man who is not able to give his wife

a child faces the danger of being divorced.

This fear is real while he is subjected to

psychological abuse; his wife threatens to poison him and

blames him." Could you write this in Iran? (with 1/3 of the subfertile couples there is something wrong with the men, moreover infertility of women is in mijn experience not seldom related to blocked tubes, related to an infection she got via her partner)

Is it possible to liberate yourself somewhat? It seems that the problem is not so much infertility, there are in many cultures women who elect not to have children and get satisfaction from a career for example, but the attitude from the husband, no loving support and understanding.

Be on more equal terms with men.

And if infertility is such a serious problem "major health impact" nationally that perhaps all the effort and money invested in nuclear weapons could be better employed in the apparently very serious problem of infertility. All that money for development of arms, security, boycotts would be enough to have 5 IVF teams in every hospital in Iran.

Thanks Dear Douwe Verkuyl for arise this important issue which is fundamental in our locality. We are facing each day the bad culture in our locality which have been dominant by those old families may be who transmit bad habit on no scientific base, and this is also applied to a woman with many females in her spring, her husband and all the community blaming her for inability to bring the boy neglecting the major male effect in the area and focusing on minor female effect.

Realy, Its quite rare to find a couple that when they faced infertility and the husband is the cause, rarely find that man asks his wife's choice to stay with him or leave him.

When I face such situation, I didn't let the wife her self to inform the husband, I insist to transfer the information directly to him, to decrease the misunderstanding and the belief of her husband that maybe his wife is lying to him, besides the mass refusal of male community to take the medicine as a part of women treatment of infection, saying "I Have No Problem, I will take no medicine, it's only your situation"

We, really need to change the culture and increase health awareness in the community, and remove the bad habit that the community raise on them, and creating new moral belief and respect, by this and only this you can achieve that all the money spend on the nuclear bomb, could be transferred to help the humanity not destroyed it.

If you can change people believe, be sure this can be achieved.

Sincerely.