(See also Overview of Infertility.)
Tubal dysfunction can result from
Use of an intrauterine device (a rare cause of pelvic infection)
Lower abdominal surgery leading to pelvic adhesions
Inflammatory disorders (eg, inflammatory bowel disease, tuberculosis)
Pelvic lesions that can impede fertility include
Intrauterine adhesions (Asherman syndrome)
Fibroids obstructing the fallopian tubes or distorting the uterine cavity
Endometriosis can cause tubal, uterine, or other lesions that impair fertility.
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.
Sonohysterography (injection of isotonic fluid through the cervix into the uterus during ultrasonography) is done to detect or further evaluate intrauterine and tubal lesions.
Rarely, laparoscopy is done to further evaluate tubal lesions.
Hysteroscopy may be done to further evaluate intrauterine lesions
Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy.
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.