Fallopian tube obstruction
Encyclopedia
Fallopian tube obstruction is a major cause of female infertility
. Blocked fallopian tube
s are unable to let the ovum
and the sperm
converge, thus making fertilization impossible. Fallopian Tubes are also known as oviducts, uterine tubes, and salpinges (singular salpinx).
) is typically associated with hydrosalpinx
formation and often caused by Chlamydia trachomatis
. Pelvic adhesions may be associated with such an infection. In less severe forms, the fimbriae may be aggluntinated and damaged, but some patency may still be preserved. Midsegment tubal obstruction can be due to tubal ligation procedures as that part of the tube is a common target of sterilization interventions. Proximal tubal occlusion can occur after infection such as a septic abortion
. Also, some tubal sterilization procedures such as the Essure
procedure target the part of the tube that is close to the uterus..
(PID). The rate of tubal infertility has been reported to be 12% after one, 23% after two, and 53% after three episodes of PID. The Fallopian tubes may also be occluded or disabled by endometritis
, infections after childbirth
and intraabdominal infections including appendicitis
and peritonitis
. The formation of adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. It has been reported that women with distal tubal occlusion have a higher rate of HIV infection.
Fallopian tubes may be blocked as a method of contraception. In these situations tubes tend to be healthy and typically patients requesting the procedure had children. While tubal ligation
is considered a permanent procedure, some patients later regret their decision and want the procedure "undone".
is not possible, testing of tubal patency is feasible. A hysterosalpingogram will demonstrate that tubes are open when the radioopaque dye spills into the abdominal cavity. Sonography
can demonstrate tubal abnormalities such as a hydrosalpinx
indicative of tubal occlusion. During surgery, typically laparoscopy
, the status of the tubes can be inspected and a dye such as methylene blue
can be injected in a process termed chromotubation into the uterus and shown to pass through the tubes when the cervix is occluded. Laparoscopic chromotubation has ben described as the gold standard of tubal evaluation. As tubal disease is often related to Chlamydia infection, testing for Chlamydia antibodies
has become a cost-effective screening device for tubal pathology.
Tubal insufflation is only of historical interest as an older office method to indicate patency; it was used prior to laparoscopic evaluation of pelvic organs.
) was used to restore patency to the tubes and thus possibly normal function. However, in most situations today, in vitro fertilization is used to overcome tubal infertility as it is more cost-effective, less invasive, and results are immediate. With IVF, after stimulation of ovarian follicles, egg cells are removed via a sonographic directed vaginal puncture into the ovary, these eggs are fertiized outside the body, and the resultant embryo placed transcervically into the uterus; - the tubes are bypassed in this process.
Different types of tuboplasty have been developed and can be applied by laparoscopy
or laparotomy
. They include lysis of adhesions, fimbrioplasty (repairing the fimbriated end of the tubes), salpinostomy (creating an opening for the tube), resection and reananstomosis (removing a piece of blocked tube and reuniting the remaining patent parts of the tube), and tubal reimplantation (reconnecting the tube to the uterus). Further, using fluoroscopy
or hysteroscopy
proximal tubal occlusion can be overcome by transcervical catheter recanalization or falloposcopy.
Results of tubal surgery are inversely related to damage that exists prior to surgery. Development of adhesions remains a problem. Patients with operated tubes are at increased risk for ectopic pregnancy
.
Surgical repair of fallopian tubes that have been occluded by a sterilization procedure generally have good success rates provided enough healthy tubal tissue is present for the surgeon to perform a tubal reversal
.
While IVF therapy has largely replaced tubal surgery in the treatment of infertility, the presence of hydrosalpinx
is an detriment to IVF success. It has been recommended that prior to IVF, laparoscopic surgery should be done to either block or remove hydrosalpinges.
Female infertility
-Causes and factors:Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, or strictly by location.-Acquired versus genetic:...
. Blocked fallopian tube
Fallopian tube
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s are unable to let the ovum
Ovum
An ovum is a haploid female reproductive cell or gamete. Both animals and embryophytes have ova. The term ovule is used for the young ovum of an animal, as well as the plant structure that carries the female gametophyte and egg cell and develops into a seed after fertilization...
and the sperm
Sperm
The term sperm is derived from the Greek word sperma and refers to the male reproductive cells. In the types of sexual reproduction known as anisogamy and oogamy, there is a marked difference in the size of the gametes with the smaller one being termed the "male" or sperm cell...
converge, thus making fertilization impossible. Fallopian Tubes are also known as oviducts, uterine tubes, and salpinges (singular salpinx).
Types
About 20% of female infertility can be attributed to tubal causes. Distal tubal occlusion (affecting the end towards the ovaryOvary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
) is typically associated with hydrosalpinx
Hydrosalpinx
A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in...
formation and often caused by Chlamydia trachomatis
Chlamydia trachomatis
Chlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies...
. Pelvic adhesions may be associated with such an infection. In less severe forms, the fimbriae may be aggluntinated and damaged, but some patency may still be preserved. Midsegment tubal obstruction can be due to tubal ligation procedures as that part of the tube is a common target of sterilization interventions. Proximal tubal occlusion can occur after infection such as a septic abortion
Septic abortion
A septic abortion or septic miscarriage is a form of miscarriage that is associated with a serious uterine infection. The infection carries risk of spreading infection to other parts of the body and cause septicaemia, a grave risk to the life of the woman.-Causes:A septic abortion can occur when...
. Also, some tubal sterilization procedures such as the Essure
Essure
Essure is a permanent transcervical sterilization procedure for women developed by Conceptus Inc. It was approved for use in the United States on November 4, 2002....
procedure target the part of the tube that is close to the uterus..
Causes
Most commonly a tube may be obstructed due to infection such as pelvic inflammatory diseasePelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
(PID). The rate of tubal infertility has been reported to be 12% after one, 23% after two, and 53% after three episodes of PID. The Fallopian tubes may also be occluded or disabled by endometritis
Endometritis
Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. Pathologists have traditionally classified endometritis as either acute or chronic: acute endometritis is characterized by the presence of microabscesses or neutrophils within the endometrial glands, while...
, infections after childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
and intraabdominal infections including appendicitis
Appendicitis
Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
and peritonitis
Peritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
. The formation of adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. It has been reported that women with distal tubal occlusion have a higher rate of HIV infection.
Fallopian tubes may be blocked as a method of contraception. In these situations tubes tend to be healthy and typically patients requesting the procedure had children. While tubal ligation
Tubal ligation
Tubal ligation or tubectomy is a surgical procedure for sterilization in which a woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization...
is considered a permanent procedure, some patients later regret their decision and want the procedure "undone".
Evaluation
While a full testing of tubal functions in patients with infertilityInfertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
is not possible, testing of tubal patency is feasible. A hysterosalpingogram will demonstrate that tubes are open when the radioopaque dye spills into the abdominal cavity. Sonography
Gynecologic ultrasonography
Gynecologic ultrasonography or Gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs, specifically the uterus, the ovaries, the Fallopian tubes, as well as the bladder, the adnexa, the Pouch of Douglas, and any findings in the pelvis of relevance...
can demonstrate tubal abnormalities such as a hydrosalpinx
Hydrosalpinx
A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in...
indicative of tubal occlusion. During surgery, typically laparoscopy
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
, the status of the tubes can be inspected and a dye such as methylene blue
Methylene blue
Methylene blue is a heterocyclic aromatic chemical compound with the molecular formula C16H18N3SCl. It has many uses in a range of different fields, such as biology and chemistry. At room temperature it appears as a solid, odorless, dark green powder, that yields a blue solution when dissolved in...
can be injected in a process termed chromotubation into the uterus and shown to pass through the tubes when the cervix is occluded. Laparoscopic chromotubation has ben described as the gold standard of tubal evaluation. As tubal disease is often related to Chlamydia infection, testing for Chlamydia antibodies
Chlamydia antibodies
Chlamydia antibodies are antibodies targeting bacteria of the Chlamydia genus, but it generally refers specifically to antibodies targeting Chlamydia trachomatis, which is the cause of Chlamydia infection in humans.-Usage:...
has become a cost-effective screening device for tubal pathology.
Tubal insufflation is only of historical interest as an older office method to indicate patency; it was used prior to laparoscopic evaluation of pelvic organs.
Treatment
Traditionally Fallopian tubal surgery (tuboplastyTuboplasty
A tuboplasty is a surgical operation to correct a fallopian tube obstruction or adhesion, to achieve a pregnancy in women with tubal infertility. Thus, it is a form of assisted reproductive technology.-Techniques:...
) was used to restore patency to the tubes and thus possibly normal function. However, in most situations today, in vitro fertilization is used to overcome tubal infertility as it is more cost-effective, less invasive, and results are immediate. With IVF, after stimulation of ovarian follicles, egg cells are removed via a sonographic directed vaginal puncture into the ovary, these eggs are fertiized outside the body, and the resultant embryo placed transcervically into the uterus; - the tubes are bypassed in this process.
Different types of tuboplasty have been developed and can be applied by laparoscopy
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
or laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
. They include lysis of adhesions, fimbrioplasty (repairing the fimbriated end of the tubes), salpinostomy (creating an opening for the tube), resection and reananstomosis (removing a piece of blocked tube and reuniting the remaining patent parts of the tube), and tubal reimplantation (reconnecting the tube to the uterus). Further, using fluoroscopy
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
or hysteroscopy
Hysteroscopy
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
proximal tubal occlusion can be overcome by transcervical catheter recanalization or falloposcopy.
Results of tubal surgery are inversely related to damage that exists prior to surgery. Development of adhesions remains a problem. Patients with operated tubes are at increased risk for ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
.
Surgical repair of fallopian tubes that have been occluded by a sterilization procedure generally have good success rates provided enough healthy tubal tissue is present for the surgeon to perform a tubal reversal
Tubal reversal
Tubal reversal, also called tubal sterilization reversal or tubal ligation reversal, is a surgical procedure that attempts to restore fertility to women after a tubal ligation...
.
While IVF therapy has largely replaced tubal surgery in the treatment of infertility, the presence of hydrosalpinx
Hydrosalpinx
A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in...
is an detriment to IVF success. It has been recommended that prior to IVF, laparoscopic surgery should be done to either block or remove hydrosalpinges.