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Infertility Problems With the Fallopian Tubes and Abnormalities in the Pelvis

By

Robert W. Rebar

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

Medically Reviewed Oct 2022
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Topic Resources

If a fallopian tube is blocked or damaged, women may have fertility problems. A blocked or damaged fallopian tube can prevent the sperm from reaching the egg or prevent the egg or fertilized egg (zygote) from moving from the ovary to the uterus to be implanted. Abnormalities in the uterus or pelvis can prevent the egg from attaching to (implanting in) the lining of the uterus and can block the fallopian tubes.

  • To identify the problem, doctors may take x-rays as a radiopaque contrast agent is injected through the cervix (hysterosalpingography), do ultrasonography after a salt solution is injected inside the uterus (sonohysterography), or view the organs through a viewing tube (laparoscope) inserted through an incision just below the navel.

  • Treatment depends on the type and location of the abnormality (fallopian tubes or uterus) and the age of the woman, but in vitro fertilization or, in younger women, surgery may be recommended.

Locating the Female Reproductive Organs

Internal Female Genital Organs

Ovulation and Implantation

From Fertilization to Implantation

Causes

Fallopian tube problems result from conditions that block or damage the tube, including the following:

Bacteria, such as those that can cause pelvic inflammatory disease, can enter the vagina during sexual activity with a partner who has a sexually transmitted infection Overview of Sexually Transmitted Infections (STIs) Sexually transmitted (venereal) diseases are infections that are typically, but not exclusively, passed from person to person through sexual contact. Sexually transmitted infections may be caused... read more Overview of Sexually Transmitted Infections (STIs) , such as gonorrhea. The bacteria can spread from the vagina to infect the cervix. They may then spread upward, to the uterus and sometimes the fallopian tubes. Some bacteria such as chlamydiae Chlamydial and Other Nongonococcal Infections Chlamydial infections include sexually transmitted infections of the urethra, cervix, and rectum that are caused by the bacteria Chlamydia trachomatis. These bacteria can also infect... read more Chlamydial and Other Nongonococcal Infections can infect the fallopian tubes without causing any symptoms. These infections may permanently damage the fallopian tubes. Scar tissue may form and block the fallopian tubes.

Abnormalities in the pelvis can block the tubes or prevent the egg from implanting in the uterus. They include the following:

Diagnosis

  • Sometimes tests for pelvic infection

  • Hysterosalpingography or sonohysterography

  • Hysteroscopy to further evaluate abnormalities

  • Rarely, laparoscopy

If pelvic infection is suspected, tests to check for gonorrhea or chlamydial infection are done. Screening for sexually transmitted infections is a usual part of routine care when women are trying to become pregnant.

Procedures are done to determine whether the fallopian tubes are blocked. They include hysterosalpingography, sonohysterography, laparoscopy, and hysteroscopy. During laparoscopy and hysteroscopy, diagnosis and treatment are often done at the same time.

Hysterosalpingography

X-rays are taken as a radiopaque contrast agent is injected through the cervix. The contrast agent outlines the interior of the uterus and fallopian tubes. This procedure is done a few days after a woman’s menstrual period ends and before ovulation occurs. Hysterosalpingography does not require an anesthetic.

Hysterosalpingography can detect some 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 if the results are normal, possibly because the procedure temporarily widens (dilates) the tubes or clears the tubes of mucus and debris. Doctors may wait to see if young 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 more easily. 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 contrast agent. However, its accuracy depends on the skill of the practitioner doing the test.

Laparoscopy

If evidence suggests that the fallopian tubes are blocked or that a woman may have endometriosis, a small viewing tube called a laparoscope Laparoscopy Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more Laparoscopy is inserted in the pelvic cavity through a small incision just below the navel. Usually, a general anesthetic is used. Laparoscopy enables doctors to directly view the uterus, fallopian tubes, and ovaries. However, this procedure is rarely done.

Instruments inserted through the laparoscope may also be used to dislodge or remove abnormal tissue in the pelvis.

Hysteroscopy

If an abnormality within the uterus is detected, doctors examine the uterus with a viewing tube called a hysteroscope Hysteroscopy Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more Hysteroscopy , 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.

Treatment

  • Antibiotics, if a pelvic infection is diagnosed

  • Laparoscopy and/or hysteroscopy to dislodge or remove any abnormal tissue

  • In vitro fertilization or, in younger women, sometimes surgery

If pelvic infection is diagnosed, it is treated with antibiotics.

Treatment of fallopian tube or pelvic problems depends on the cause. Abnormal tissue is sometimes dislodged or removed during diagnosis (during hysteroscopy or laparoscopy). The pregnancy rate after one of these procedures is

  • After laparoscopy: Typically no more than 25%

  • After hysteroscopy: About 60 to 70%

Surgery can be done to repair a fallopian tube damaged by an ectopic pregnancy or an infection, especially in younger women if the problem was not severe. 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 In vitro (test tube) fertilization (IVF) Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more In vitro (test tube) fertilization (IVF) is often recommended instead.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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