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Problems With the Fallopian Tubes

by Robert W. Rebar, MD

The fallopian tube may be blocked or damaged, preventing the egg from moving from the ovary to the uterus to be implanted.

  • To identify the problem, doctors may use x-rays taken after a radiopaque dye is injected through the cervix or may 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.

Sometimes the fallopian tubes are blocked or damaged so that the egg cannot move from the ovary to the uterus.

Causes

Causes include previous conditions, such as the following:

  • Pelvic infections (such as pelvic inflammatory disease)

  • Use of an intrauterine device if it causes a pelvic infection (which is rare)

  • A ruptured appendix

  • Surgery in the pelvis or lower abdomen

  • A mislocated (ectopic) pregnancy in the fallopian tubes

Current conditions may also block the tubes:

  • Birth defects of the uterus and fallopian tubes

  • Endometriosis

  • Fibroids in the uterus

  • Bands of scar tissue between normally unconnected structures (adhesions) in the uterus or pelvis

Diagnosis

Procedures used to determine whether the fallopian tubes are blocked include the following:

  • Hysterosalpingography: X-rays are taken after a radiopaque dye is injected through the cervix. The dye outlines the interior of the uterus and fallopian tubes. This procedure is done a few days after a woman’s menstrual period ends. This procedure can detect 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 such women become pregnant after this procedure before additional tests of fallopian tube function are done.

  • Sonohysterography: 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. If the solution flows into the fallopian tubes, the tubes are not blocked. This procedure is quick and does not require an anesthetic. It is considered safer than hysterosalpingography because it does not require radiation or injection of a dye. However, it may not always be as accurate.

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.

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. This procedure 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.

Treatment

Treatment depends on the cause. Abnormal tissue is sometimes dislodged or removed during diagnosis (using hysteroscopy or laparoscopy).

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.