Problems With the Fallopian Tubes
The fallopian tubes may be abnormal in structure or function. If they are blocked, the egg cannot move from the ovary to the uterus. Causes of fallopian tube problems include previous infections (such as pelvic inflammatory disease), endometriosis, a ruptured appendix, and surgery in the pelvis. A mislocated (ectopic) pregnancy in the fallopian tubes can also cause damage. Structural disorders can block the fallopian tubes. These disorders include birth defects of the uterus and fallopian tubes, fibroids in the uterus, and bands of scar tissue between normally unconnected structures (adhesions) in the uterus or pelvis.
Diagnosis and Treatment
To determine whether the fallopian tubes are blocked, doctors can use hysterosalpingography. In this procedure, x-rays are taken after a radiopaque dye is injected through the cervix. The dye outlines the interior of the uterus and fallopian tubes. This procedure is performed shortly after a woman's menstrual period ends. This procedure can detect 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 with normal results, fertility appears to be slightly improved, possibly because the procedure temporarily widens (dilates) the tubes or clears the tubes of mucus. Therefore, doctors may wait to see if a woman becomes pregnant after this procedure before additional tests of fallopian tube function are performed.
Another procedure (called sonohysterography) is sometimes used to determine whether the fallopian tubes are blocked. 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. If the solution flows into the fallopian tubes, the tubes are not blocked. This procedure is quick and does not require an anesthetic. It is considered safer than hysterosalpingography because it does not require radiation or injection of a dye. However, it is not as accurate.
If an abnormality within the uterus is detected, doctors examine the uterus with a viewing tube called a hysteroscope, which is inserted through the cervix into the uterus. If adhesions, a polyp, or a small fibroid is detected, the hysteroscope may be used to dislodge or remove the abnormal tissue, increasing the chances that the woman will become pregnant.
If evidence suggests that the fallopian tubes are blocked or that a woman may have endometriosis, a small viewing tube called a laparoscope is inserted in the pelvic cavity through a small incision just below the navel. Usually, a general anesthetic is used. This procedure enables doctors to directly view the uterus, fallopian tubes, and ovaries. The laparoscope may also be used to dislodge or remove abnormal tissue in the pelvis.
Treatment depends on the cause. Surgery can be performed to repair a damaged fallopian tube caused by an ectopic pregnancy or an infection. However, after such surgery, the chances of a normal pregnancy are small, and those of an ectopic pregnancy are great. Consequently, surgery is not often recommended. In vitro fertilization is recommended for most couples.
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