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Fallopian Tube Damage
Fallopian Tube Damage
The fallopian tubes are delicate structures of
only about the same thickness as the lead of a pencil. Because of
this, they can easily become blocked. Blockage may arise as a
result of scarring due to infection or previous abdominal surgery,
or because of fibrous adhesions, which may distort the tubes or
reduce their mobility by attaching them to other adjacent
tissues.
Pelvic inflammatory disease (PID) due to sexually transmitted
micro-organisms such as gonococci, chlamydia or other pathogens, is
the main cause of tubal infertility. In addition, PID is associated
with a 2- to 8-fold risk of subsequent ectopic pregnancy. Follow-up
studies on the fertility of women with laparoscopically documented
PID (where the physician directly views the uterus, fallopian tubes
and the pelvic cavity) have shown that for each episode of
infection, there is at least a 10% risk of subsequent tubal
infertility, irrespective of the type of micro-organism causing the
infection. The effect seems to be additive, with the risk of tubal
infertility doubling after a second episode of PID.
Comparison of a normal and inflamed fallopian
tube
Whilst gonorrhoea remains the most common cause
of PID, chlamydia infections are becoming increasingly frequent and
are now the second most common cause of tubal infertility. Three
out of four women with tubal infertility are seropositive for
chlamydia compared with 1 out of 4 fertile women. Repeated exposure
to the micro-organism causes alterations in the tubal mucosa,
intratubular adhesions and distal obstruction. It is possible that
Chlamydia infections are becoming more common because the organisms
are resistant to many of the drugs used to treat gonorrhoea and are
thus being ‘selected’ by use of inappropriate antibiotics before
proper bacterial diagnosis.
A history of salpingitis (inflammation of the fallopian tubes) is
associated with the highest relative risk of infertility.
Approximately one-third of women presenting for infertility
evaluation will exhibit signs and symptoms indicative of problems
due to uterine or fallopian tube abnormalities. Blocked or damaged
fallopian tubes may reduce fertility by preventing sperm from
reaching the ovum or by preventing the egg from reaching the
uterus.
Tubal infertility may also arise after septic abortion, infection
following childbirth (puerperal sepsis), peritonitis or following
abdominal surgery. Infertility caused by some of these factors is
partly preventable; an uncomplicated appendectomy does not increase
the risk of a subsequent tubal blockage, whereas a ruptured
appendix causes a 5-fold increase in such risk.
Tubal infertility can sometimes be treated by surgery, but if this
is not possible, or if surgery is unsuccessful, IVF may be the
solution. Tubal surgery is a major procedure involving a general
anaesthetic and often lasts for several hours. The operation is
usually carried out with the aid of an operating microscope.
Surgery is successful in about 45% of patients when the obstruction
is at the uterine end of the tubes, but only in 20-25% when
obstruction is at the fimbrial ends of the tubes, closest to the
ovaries. After most types of tubal surgery, there is an increased
risk of subsequent ectopic pregnancy.
In a small group of patients, a uterine factor will be shown to be
the cause of infertility. Such factors can include congenital
malformation, adhesions or the presence of benign tumours called
leiomyomas. A small percentage of these patients can be treated
with surgery.
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