To identify a fallopian tube or other pelvic abnormality, 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 a woman's age, but in vitro fertilization or surgery may be recommended.
(See also Overview of Infertility Overview of Infertility Infertility is a disease defined by the inability to achieve a pregnancy and/or the need for medical intervention to achieve a successful pregnancy. Infertility is defined as disease by the... read more .)
Locating the Female Reproductive Organs
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Ovulation and Implantation
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Causes
Fallopian tube problems result from conditions that block or damage the tube, including the following:
Surgery in the pelvis or lower abdomen
Inflammation that damages the uterus and fallopian tubes (such as that caused by tuberculosis Extrapulmonary tuberculosis or inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The 2 primary types of inflammatory bowel disease (IBD) are Crohn... read more )
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 infection (STI) refers to an infection that is passed through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with an infected partner... read more , 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 Chlamydia 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 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:
Fibroids Uterine Fibroids A fibroid is a noncancerous tumor of the uterus that is composed of muscle and fibrous tissue. Uterine fibroids are very common, occurring in approximately 70% of White women and 80% of Black... read more or polyps Cervical Polyps Cervical polyps are common fingerlike growths of tissue that protrude into the passageway through the cervix. Polyps are almost always benign (noncancerous). Cervical polyps may be caused by... read more in the uterus
Bands of scar tissue (adhesions) that form between normally unconnected structures in the uterus or pelvis (Asherman syndrome)
Birth defects of the uterus and fallopian tubes
Adhesions in the uterus are usually caused by infections or an injury during surgery, usually dilation and curettage Dilation and Curettage 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 (D and C). Scarring may also affect the cervix, especially after an infection of, injury to, or surgery on the cervix.
Diagnosis
Sometimes tests for pelvic infection
Sonohysterography (saline infusion sonography Saline Sonography 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 ) or hysterosalpingography, if sonohysterography is not available
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.
Sonohysterography (saline infusion sonography)
Sonohysterography Saline Sonography 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 is 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 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 Hysterosalpingography 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 because it does not require radiation or injection of a contrast agent.
After sonohysterography, for unknown reasons, fertility in young women appears to be slightly improved if the results are normal. Doctors may wait to see if young women become pregnant after this procedure before additional tests of fallopian tube function are done.
Sonohysterography, where available, has replaced hysterosalpingography. Sonohysterography has the advantages of being able to be performed in the clinician's office, does not require exposure to radiation, and is generally less costly than hysterosalpingography.
Hysterosalpingography
For hysterosalpingography Hysterosalpingography 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 , x-rays are taken as a radiopaque contrast agent Radiographic Contrast Agents Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... read more 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. Allergic reactions to the contrast agent (including iodine) are possible.
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.
As with sonohysterography, after hysterosalpingography, fertility in young women appears to be slightly improved if the results are normal.
Hysteroscopy
If an abnormality within the uterus is detected, doctors may examine the uterus with an instrument with a camera 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 , 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 a woman will become pregnant.
Laparoscopy
If evidence suggests that the fallopian tubes are blocked or that a woman may have endometriosis Endometriosis In endometriosis, patches of endometrial tissue—normally occurring only in the lining of the uterus (endometrium)—appear outside the uterus. Why endometrial tissue appears outside the uterus... read more , 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 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 to diagnose fallopian tube problems.
Instruments inserted through the laparoscope may also be used to dislodge or remove abnormal tissue in the pelvis.
Treatment
Antibiotics, if a pelvic infection is diagnosed
Laparoscopy and/or hysteroscopy to treat or remove 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 removed (such as uterine fibroids or polyps) if it is detected during a diagnostic surgery (for example, during hysteroscopy or laparoscopy).
Surgery can be done to repair a fallopian tube damaged by an ectopic pregnancy, an infection, or a prior tubal sterilization procedure, especially in younger women if the damage is not severe. However, after such surgery, the chances of a normal pregnancy are small. The chances of an ectopic pregnancy Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as a fallopian tube. In an ectopic pregnancy, the fetus cannot survive. Women with an ectopic... read more are higher than usual both before and after such surgery. Consequently, in vitro fertilization In vitro (test tube) fertilization (IVF) Assisted reproductive technologies (ARTs) involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. If infertility treatment with only... read more is often recommended instead.
Assisted reproductive technologies Assisted Reproductive Technologies (ARTs) Assisted reproductive technologies (ARTs) involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. If infertility treatment with only... read more are often a necessity or an alternative, particularly in women under age 30.