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Problems With the Fallopian Tubes
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 of fallopian tube problems include the following:
Bacteria, such as those that can cause pelvic inflammatory disease or chlamydial infection (chlamydiae), 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. 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.
Other causes of fallopian tube problems include abnormalities in the pelvis that block the tubes, such as the following:
Procedures are done to determine whether the fallopian tubes are blocked. They include the following.
This procedure is most commonly used to check for problems with the fallopian tubes.
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.
Hysterosalpingography 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.
This procedure 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. 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 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 of fallopian tube problems 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.
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