The fallopian tubes serve the important role of allowing the sperm and egg to interact with each other directly.
Fertilization takes place within the tubes and the embryo is then guided back to the uterus for implantation. The inside of the tubes is delicate and can be damaged easily. Sexually transmitted infections such as chlamydia and gonorrhea can both damage the tubes. Pelvic inflammatory disease, also typically caused by Chlamydia or gonorrhea, is a more severe and symptomatic infection that is damaging.
Even if the tube is not completely blocked by these infections, there can be tubal scarring which will increase the risk of a tubal (ectopic) pregnancy. Any abdominal or pelvic surgery carries the risk of scar tissue within the pelvis and tubal dysfunction. Notable examples are removal of the appendix (especially if it had ruptured) and C-section. Endometriosis is a disease which can lead to pelvic scarring and tubal damage.
Evaluation of Tubal Dysfunction
There are two main ways to test the function of the tubes, one in a radiology suite and one in the operating room.
A hysterosalpingogram (HSG) is a radiological test in which a catheter is placed beyond the cervix and dye (which can be seen by X-ray) is injected into the uterus and tubes. This test allows evaluation of the shape of the uterus and, if the dye is able to pass through the tubes into the pelvis, confirms tubal patency. It also demonstrates the diameter or caliber of the tube. A severely damaged tube is more likely to look “sausage” shaped and not to pass dye (a.k.a. hydrosalpinx).
Laparoscopy is an outpatient surgery in which the physician places a camera into the pelvis to get a direct look at the pelvis. The ends of the fallopian tubes have finger-like projections that are important for egg pick-up. These ends can be evaluated at the time of laparoscopy. Surgical treatment may involve removal of pelvic scar tissue to normalize anatomy as much as possible. For severe tubal damage or severe adhesions in the pelvis, in vitro fertilization (IVF) is the best treatment. The tubes are bypassed in both egg pick-up and embryo transfer.