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Tubal Dysfunction and Pelvic Abnormalities

By

Robert W. Rebar

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

Reviewed/Revised Feb 2024
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Topic Resources

Tubal dysfunction is fallopian tube obstruction or epithelial dysfunction that impairs oocyte, zygote, and/or sperm motility; pelvic structural abnormalities can impede fertilization or implantation.

Etiology of Tubal Dysfunction and Pelvic Abnormalities

Tubal dysfunction can result from

Pelvic structural abnormalities that can impede fertility include

Also, cervical factors, including cervicitis or injury (eg, conization procedures for cervical intraepithelial neoplasia, obstetric cervical laceration), may contribute to infertility by impairing the production of cervical mucus Abnormal Cervical Mucus Rarely, abnormal cervical mucus impairs fertility by inhibiting penetration or increasing destruction of sperm. (See also Overview of Infertility.) Normally, cervical mucus is stimulated to... read more .

Diagnosis of Tubal Dysfunction and Pelvic Abnormalities

All infertility evaluations include assessment of the fallopian tubes.

For initial evaluation of tubal dysfunction and assessment of the uterine cavity, SIS (injection of isotonic fluid through the cervix into the uterus during ultrasonography), where available, has now replaced HSG (fluoroscopic imaging of the uterus and fallopian tubes after injection of a radiopaque agent into the uterus). Advantages of SIS compared with HSG include: can be performed in the clinician's office; does not involve exposure to radiation; and is less costly. The false-positive rate with SIS may be slightly lower than the 15% observed with HSG, and both rarely indicate tubal patency falsely. Both tests can also detect some pelvic and intrauterine abnormalities (magnetic resonance imaging may be required or a definitive diagnosis).

Both SIS and HSG are done 2 to 5 days after cessation of menstrual flow. For unexplained reasons, fertility in women appears to be enhanced after HSG or SIS, if the test result is normal. Thus, if results are normal, additional diagnostic tests of tubal function can be delayed for several cycles in young women.

Hysteroscopy may be done to further evaluate intrauterine lesions.

Rarely, laparoscopy is done to further evaluate tubal lesions.

Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy.

Treatment of Tubal Dysfunction and Pelvic Abnormalities

  • Antibiotics if cervicitis or pelvic inflammatory disease (PID) is present

  • Laparoscopy and/or hysteroscopy

  • Assisted reproductive technologies

  • Sometimes tubal surgery, in younger women

During laparoscopy, pelvic adhesions can be lysed, and pelvic endometriosis can be fulgurated or ablated by laser. During hysteroscopy, intrauterine adhesions can be lysed, and submucous fibroids and intrauterine polyps can be removed. Pregnancy rates after laparoscopic treatment of pelvic abnormalities are low (typically no more than 25%), but hysteroscopic treatment of intrauterine abnormalities is often successful, with a pregnancy rate of approximately 60 to 70%.

Surgery can be done to repair a fallopian tube with distal tubal damage (eg, due to ectopic pregnancy or infection) or to reverse a prior tubal sterilization procedure (tubal reanastomosis surgery), especially in younger women and if the damage is not severe. However, these surgeries have low success rates. The chances of an ectopic pregnancy are higher than usual both before and after such surgery. Consequently, in vitro fertilization In vitro fertilization (IVF) Assisted reproductive technologies (ARTs) involve manipulation of sperm and ova or embryos in vitro with the goal of producing a pregnancy. For assisted reproductive technologies, oocytes and... read more In vitro fertilization (IVF) is often recommended instead.

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