4 - Tubal infertility

Summary

Introduction

Fallopian tube damage accounts for 25–35% of infertility in women. In approximately three-quarters of cases the damage results from sexually transmitted infection (STIs) but tubal damage can also be as a result of pelvic surgery. The fallopian tubes play an essential role in conception, and tubal pathologies such as peritubal adhesions, proximal and/or distal tubal blockage, hydrosalpinx formation or endosalpingeal damage all have an adverse impact on fertility. The management of tubal disease depends on the initial pathological process and the severity of damage. In vitro fertilisation (IVF) remains the main treatment strategy for women with severely damaged fallopian tubes. Surgery can be useful in selected cases of tubal infertility and may have a complementary role for some women undergoing IVF. This chapter discusses these processes further but initially the basic anatomy of these remarkable but vulnerable structures is reviewed.

Anatomy

The fallopian tubes are derived from the müllerian ducts and are formed at the 6th week of embryological development. They comprise the isthmus, ampulla and infundibulum, with the latter's fimbrial end essential for picking up an ovum from the rupturing ovarian follicle. Each tube is about 10 cm long (range 7–14 cm). The lumen varies in diameter from 0.1 mm at the isthmus to 1 cm at the distal end of the ampulla. The columnar epithelium lining the tubes includes two different cell types: ciliated cells concentrated at the distal end of the tube and secretory cells at the ampullary region.