Problems With the Fallopian Tubes and Abnormalities in the Pelvis
(See also Overview of Infertility.)
The fallopian tube may be blocked or damaged, preventing the sperm from reaching the egg or preventing the egg, or fertilized egg (zygote) from moving from the ovary to the uterus to be implanted. Abnormalities in the pelvis can prevent the egg from attaching to (implanting in) the lining of the uterus and can block the fallopian tubes.
To identify the problem, doctors may use x-rays taken after a radiopaque contrast agent is injected through the cervix, do ultrasonography after a salt solution is injected inside the uterus (sonohysterography), or view the organs through a viewing tube (laparoscope) inserted through an incision just below the navel.
The fallopian tubes can sometimes be repaired, but in vitro fertilization is usually recommended.
Fallopian tube problems result from conditions that block or damage the tube, including the following:
Pelvic infections (such as pelvic inflammatory disease)
Use of an intrauterine device if it causes a pelvic infection (which is rare)
Surgery in the pelvis or lower abdomen
Inflammation that damages the uterus and fallopian tubes (such as tuberculosis)
A mislocated (ectopic) pregnancy in the fallopian tubes
Bacteria, such as those that can cause pelvic inflammatory disease, can enter the vagina during sexual intercourse with a partner who has a sexually transmitted disease. The bacteria can spread from the vagina to infect the cervix. They may then spread upward, to the uterus and sometimes the fallopian tubes. Some bacteria such as chlamydiae can infect the fallopian tubes without causing any symptoms. These infections may permanently damage the fallopian tubes, uterus, and surrounding tissue. Scar tissue may form and block the fallopian tubes.
Abnormalities in the pelvis can block the tubes or prevent the egg from implanting in the uterus. They include the following:
Birth defects of the uterus and fallopian tubes
Fibroids in the uterus
Bands of scar tissue (adhesions) that form between normally unconnected structures in the uterus or pelvis
Adhesions in the uterus are usually caused by infections or an injury during surgery, usually dilation and curettage (D and C). This disorder is called Asherman syndrome.
Procedures are done to determine whether the fallopian tubes are blocked. They include hysterosalpingography, sonohysterography, laparoscopy, and hysteroscopy. During laparoscopy and hysteroscopy, diagnosis and treatment are often done at the same time.
Hysterosalpingography is most commonly used to check for problems with the fallopian tubes.
X-rays are taken after a radiopaque contrast agent is injected through the cervix. The contrast agent outlines the interior of the uterus and fallopian tubes. This procedure is done a few days after a woman’s menstrual period ends.
Hysterosalpingography can detect some structural disorders that can block the fallopian tubes. However, in about 15% of cases, hysterosalpingography indicates that the fallopian tubes are blocked when they are not—called a false-positive result.
After hysterosalpingography, fertility in young women appears to be slightly improved even if the results are normal, possibly because the procedure temporarily widens (dilates) the tubes or clears the tubes of mucus. Doctors may wait to see if young women become pregnant after this procedure before additional tests of fallopian tube function are done.
Sonohysterography is sometimes used to detect and/or to further evaluate problems with the fallopian tubes and other abnormalities in the pelvis.
A salt (saline) solution is injected into the interior of the uterus through the cervix during ultrasonography so that the interior is distended and abnormalities can be seen more easily. If the solution flows into the fallopian tubes, the tubes are not blocked.
Sonohysterography is quick and does not require an anesthetic. It is considered safer than hysterosalpingography because it does not require radiation or injection of a contrast agent. However, it may not always be as accurate.
If evidence suggests that the fallopian tubes are blocked or that a woman may have endometriosis, a small viewing tube called a laparoscope is inserted in the pelvic cavity through a small incision just below the navel. Usually, a general anesthetic is used. Laparoscopy enables doctors to directly view the uterus, fallopian tubes, and ovaries.
Instruments inserted through the laparoscope may also be used to dislodge or remove abnormal tissue in the pelvis.
If an abnormality within the uterus is detected, doctors examine the uterus with a viewing tube called a hysteroscope, which is inserted through the vagina and cervix into the uterus. If adhesions, a polyp, or a small fibroid is detected, instruments inserted through the hysteroscope may be used to dislodge or remove the abnormal tissue, increasing the chances that the woman will become pregnant.
Treatment of fallopian tube or pelvic problems depends on the cause. Abnormal tissue is sometimes dislodged or removed during diagnosis (during hysteroscopy or laparoscopy). If abnormalities in the uterus are corrected during hysteroscopy, the pregnancy rate afterward is about 60 to 70%.
Surgery can be done to repair a fallopian tube damaged by an ectopic pregnancy or an infection. However, after such surgery, the chances of a normal pregnancy are small. The chances of an ectopic pregnancy are higher than usual both before and after such surgery. Consequently, in vitro fertilization is often recommended instead.