Merck Manual

Please confirm that you are a health care professional

honeypot link

Tubal Dysfunction and Pelvic Abnormalities

By

Robert W. Rebar

, MD, Western Michigan University Homer Stryker M.D. School of Medicine

Medically Reviewed Sep 2022
View Patient Education
Topic Resources

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

Etiology of Tubal Dysfunction and Pelvic Abnormalities

Tubal dysfunction can result from

Pelvic structural abnormalities that can impede fertility include

Also, cervical factors, including cervicitis or injury (eg, conization procedures for cervical intraepithelial neoplasia, obstetric cervical laceration), may contribute to infertility by impairing the production of cervical mucus Abnormal Cervical Mucus Rarely, abnormal cervical mucus impairs fertility by inhibiting penetration or increasing destruction of sperm. (See also Overview of Infertility.) Normally, cervical mucus is stimulated to... read more .

Diagnosis of Tubal Dysfunction and Pelvic Abnormalities

  • Tests for cervical gonorrhea or chlamydia, if cervicitis or PID are suspected

  • Hysterosalpingography or sonohysterography

  • Hysteroscopy to further evaluate abnormalities

  • Rarely laparoscopy

If pelvic infection is suspected, tests should be done for gonorrhea or chlamydia. Also, screening for sexually transmitted infections is typically done as part of routine preconception care.

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 abnormalities. 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 abnormalities; it has replaced hysterosalpingography in many specialized infertility centers.

Hysteroscopy may be done to further evaluate intrauterine lesions.

Rarely, laparoscopy is done to further evaluate tubal lesions.

Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy.

Treatment of Tubal Dysfunction and Pelvic Abnormalities

  • Antibiotics if cervicitis or PID is present

  • Laparoscopy and/or hysteroscopy

  • Assisted reproductive techniques

Cervicitis or PID, if present, is treated with antibiotics. Treatment of existing infection is important in general and may improve cervical mucus. Antimicrobial therapy does not treat pelvic adhesions caused by current or past pelvic infection.

During laparoscopy, pelvic adhesions can be lysed, or pelvic endometriosis can be fulgurated or ablated by laser. During hysteroscopy, intrauterine 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%.

View Patient Education
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP