Fallopian Tubes

The fallopian tube may be blocked or damaged, preventing the sperm from reaching the egg or preventing the egg or fertilized egg (zygote) from moving from the ovary to the uterus to be implanted. Abnormalities in the pelvis can prevent the egg from attaching to (implanting in) the lining of the uterus and can block the fallopian tubes.

• To identify the problem, doctors may use x-rays taken after a radiopaque contrast agent is injected through the cervix (hysterosalpingography), do ultrasonography after a salt solution is injected inside the uterus (sonohysterography), or view the organs through a viewing tube (laparoscope) inserted through an incision just below the navel.

• The fallopian tubes can sometimes be repaired, but in vitro fertilization is usually recommended.

Fallopian tube problems result from conditions that block or damage the tube, including the following:

• Pelvic infections (such as pelvic inflammatory disease)

• Use of an intrauterine device if it causes a pelvic infection (which is rare)

• A ruptured appendix

• Surgery in the pelvis or lower abdomen

• Inflammation that damages the uterus and fallopian tubes (such as that caused by tuberculosis)

• A mislocated (ectopic) pregnancy in the fallopian tubes

• Endometriosis

Bacteria, such as those that can cause pelvic inflammatory disease, can enter the vagina during sexual intercourse with a partner who has a sexually transmitted infection. The bacteria can spread from the vagina to infect the cervix. They may then spread upward, to the uterus and sometimes the fallopian tubes. Some bacteria such as chlamydiae can infect the fallopian tubes without causing any symptoms. These infections may permanently damage the fallopian tubes, uterus, and surrounding tissue. Scar tissue may form and block the fallopian tubes.

Abnormalities in the pelvis can block the tubes or prevent the egg from implanting in the uterus. They include the following:

• Birth defects of the uterus and fallopian tubes

• Endometriosis

• Fibroids or polyps in the uterus

• Bands of scar tissue (adhesions) that form between normally unconnected structures in the uterus or pelvis

Adhesions in the uterus are usually caused by infections or an injury during surgery, usually dilation and curettage (D and C). This disorder is called Asherman syndrome.