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Tubal
dysfunction is fallopian tube obstruction or epithelial
dysfunction that impairs zygote motility; pelvic
lesions are structural abnormalities that can impede fertilization
or implantation.
Tubal dysfunction can result from pelvic inflammatory disease, use of an intrauterine device, ruptured appendix, lower abdominal surgery leading to pelvic adhesions, inflammatory disorders (eg, TB), or ectopic pregnancy. Pelvic lesions such as intrauterine adhesions (Asherman's syndrome), fibroids obstructing the fallopian tubes or distorting the uterine cavity, and certain malformations can impede fertility, as can pelvic adhesions. Endometriosis can cause tubal, uterine, or other lesions that impair fertility.
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 often indicates tubal obstruction falsely. This test can also detect some pelvic and intrauterine lesions. For unexplained reasons, fertility appears to be enhanced after hysterosalpingography if the test result is normal. Thus, in these cases, additional diagnostic tests of tubal function can be delayed for several cycles. Tubal lesions can be further evaluated with laparoscopy. Intrauterine and tubal lesions can be detected or further evaluated by sonohysterography (injection of isotonic fluid through the cervix into the uterus during ultrasonography) or hysteroscopy.
Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy. During laparoscopy, pelvic adhesions can be lysed, or pelvic endometriosis can be fulgurated or ablated by laser. Similarly, during hysteroscopy, adhesions can be lysed, and submucous fibroids and intrauterine polyps can be removed.
Last full review/revision November 2005
Content last modified November 2005
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