Fallopian tubes are a vital part of the female reproductive anatomy, since they allow that spermatozoa reach the egg and the displacement of the embryo up to the uterine cavity, where it will implant and result in pregnancy.
In order to achieve natural pregnancy, it’s necessary that the Fallopian tubes are permeable and functional. In some occasions there’s an obstructed Fallopian tube, whereas the other one is normal. As long as at least one of the Fallopian tubes is permeable and functional, pregnancy can be achieved naturally, if there’s no other infertility cause.
As we stated before, the Fallopian tubes must be functionally active and permeable, since a lesion on their wall or an adherence would limit their movement and reduce their efficiency when it comes to capturing the egg or displacing spermatozoa.
Many women that turn to assisted reproduction, because they couldn’t achieve pregnancy on their own, are diagnosed tubal alterations. Approximately 30%-40% of women with difficulties to achieve pregnancy present infertility problems caused by an alteration of the Fallopian tubes.
Causes of lesions in the Fallopian tubes
A pelvic infection is the most common cause of lesion, since it comprehends 80% of the cases. Chlamydia Trachomatis and Neisseria Gonorrhoeae are the most common microorganisms that cause the majority of these infections.
A pelvic surgery can cause scars that provoke adherences to the abdominal tissues and limit the activity of the Fallopian tubes. Some interventions can trigger a malfunction of the Fallopian tubes, such as appendicitis that gets complicated, extraction of cysts in the ovaries or fibroids.
Endometriosis, endometrial tissue outside the uterus, can get inside the ovaries and Fallopian tubes, making it difficult for the external part of the Fallopian tubes, the fimbriae, to receive the eggs.
There are other problems, such as congenital malformations of the Fallopian tubes, accessory tubes or pathology of immotile cilia, which provoke that the Fallopian tubes don’t receive the eggs properly, hence preventing spermatozoa from reaching it.
Hysterosalpingogram: the main test to check the permeability of the Fallopian tubes is a series of X-ray photos in which the displacement of a contrast agent from the cervix to the Fallopian tubes is analysed. If there’s no obstruction, the liquid exits through the part of the Fallopian tubes next to the ovaries; if there was any obstruction, it could be seen how the liquid remains trapped.
Laparoscopy: if there was any suspicion of endometriosis or any adherence, two small cuts are performed under the navel and a camera is introduced, allowing the observation of the Fallopian tubes from the abdominal cavity, as well as their relationship with the rest of the structures of the reproductive system. Action with microsurgery will be undertaken if needed.
Treatment of the obstruction
If the Fallopian tubes couldn’t carry out their functions properly, the most adequate assisted reproduction technique would be in vitro fertilisation. The fertilisation would take place in the laboratory, and after that, the embryo would be transferred to the uterus of the woman, hence avoiding the obstacle that the tubes represent.
If the woman is young and there are no other fertility problems related, be it endometriosis or any other alteration, there are experts that can eliminate the obstruction in some special cases. However, this doesn’t necessarily mean that the Fallopian tube will recover its functionality.
Analising the seminal quality is something crucial, before making any decision about any treatment, because if the quality was not enough to achieve pregnancy naturally, an in vitro fertilisation would immediately be applied, being the technique used in cases of obstruction of both Fallopian tubes.