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Tubal Dysfunction and Pelvic Lesions

By Robert W. Rebar, MD, Professor and Chair, Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. School of Medicine

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Tubal dysfunction is fallopian tube obstruction or epithelial dysfunction that impairs oocyte, zygote, and/or sperm motility; pelvic lesions are structural abnormalities that can impede fertilization or implantation.

Etiology

Tubal dysfunction can result from

Pelvic lesions that can impede fertility include

  • Intrauterine adhesions (Asherman syndrome)

  • Fibroids obstructing the fallopian tubes or distorting the uterine cavity

  • Certain malformations

  • Pelvic adhesions

Endometriosis can cause tubal, uterine, or other lesions that impair fertility.

Diagnosis

  • Hysterosalpingography

  • Sometimes sonohysterography or laparoscopy

All infertility evaluations include assessment of the fallopian tubes.

Most often, hysterosalpingography (fluoroscopic imaging of the uterus and fallopian tubes after injection of a radiopaque agent into the uterus) is done 2 to 5 days after cessation of menstrual flow. Hysterosalpingography rarely indicates tubal patency falsely but indicates tubal obstruction falsely in about 15% of cases. This test can also detect some pelvic and intrauterine lesions. For unexplained reasons, fertility in women appears to be enhanced after hysterosalpingography if the test result is normal. Thus, if hysterosalpingography results are normal, additional diagnostic tests of tubal function can be delayed for several cycles in young women.

Intrauterine and tubal lesions can be detected or further evaluated by sonohysterography (injection of isotonic fluid through the cervix into the uterus during ultrasonography). Tubal lesions can be further evaluated with laparoscopy, and intrauterine lesions with hysteroscopy. Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy.

Treatment

  • Laparoscopy and/or hysteroscopy

  • Assisted reproductive techniques

During laparoscopy, pelvic adhesions can be lysed, or pelvic endometriosis can be fulgurated or ablated by laser. During hysteroscopy, adhesions can be lysed, and submucous fibroids and intrauterine polyps can be removed. Pregnancy rates after laparoscopic treatment of pelvic abnormalities are low (typically no more than 25%), but hysteroscopic treatment of intrauterine abnormalities is often successful, with a pregnancy rate of about 60 to 70%. Assisted reproductive techniques are often necessary for women with pelvic abnormalities and are generally preferable.

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* This is the Professional Version. *