Fallopian tube obstruction

The Fallopian tubes are organs specialized in the transport of gametes. They also transport and house the embryo in the first 4 days, providing it with nutrients, oxygen and other conditions needed to develop properly until it reaches the interior of the uterus (endometrium) where implantation and subsequent development will take place from day 5 until the end of the pregnancy.

They have a sticky end (the fimbria) that actively moves to look for the egg that each month must leave one of the two ovaries. When they find it, they affix it and take it to the interior of the tube where fertilization will take place in a region called the ampullary region. This is where the sperm must swim to meet the egg and the Fallopian tubes serve as a highway to guide them to this meeting.

The Fallopian tubes also have the capacity to move actively as does the intestine and have some cilia in their interior that are like small villi that cover it internally and have the capacity to move. By combining these two functions (peristalsis and cilia movements) we have an organ with the capacity to move and transport everything inside it. When fertilization occurs, the embryo is transported very effectively to the uterine cavity.

Any situation that alters the functions of fimbria, peristalsis and ciliary motility may represent a tubal disease. This can occur because of some inflammatory disease of the pelvis or secondary to the scarring that is generated when a woman is recovering or fighting this type of inflammation.

Endometriosis is a quite common example of pelvic inflammatory disease, as are uterine and tubal infections; and surgeries such as a complicated appendectomy or surgeries for the treatment of ovarian cysts.

A test for Fallopian tube patency can be performed to determine the actual condition of the Fallopian tubes. The most common is an imaging x-ray called hysterosalpingography, in which a catheter is passed through the cervix to administer a contrast medium that shows the uterine cavity and the path of the tubes perfectly. By taking the x-ray at different moments of the administration of the contrast medium, the doctor can evaluate the way the contrast medium is being transported and so can interpret how the Fallopian tubes and the fimbria are functioning.

A similar study can also be done not with radiography but with an ultrasound. An ultrasound can evaluate the liquid content of the structures very well. Stopping the flow of  liquid through the uterus and Fallopian tubes, allows the specialist to evaluate in real time the way in which liquid flows through the uterine cavity and tubes.

Another way to evaluate them is to visualize them directly by means of a surgery called diagnostic laparoscopy. In this procedure a contrast medium can also be administered through the cervix so that the surgeon can see exactly how the tubes behave and if they allow the passage of fluid without alterations.

When a woman has an obstruction in the Fallopian tubes, the problem is not necessarily accompanied by any symptoms or abnormalities that indicate that she may be having problems in this part of her body. However, the doctor may suspect it based on the patient’s medical history and background, and therefore request this type of study to better diagnose the problem and its most effective treatment.

When the tubal obstruction is in a single location (e.g., tubal ligation) or when there are external adhesions such as after appendicitis or peritonitis, it is possible to correct the problem with tubal surgery.

On the contrary, however, when the inflammation and damage has been to the interior of the tubes and the cilia-bearing cells have been damaged, the probability of obtaining a pregnancy is exceptionally low with corrective surgery and the best treatment option is in vitro fertilization.

In in vitro fertilization, eggs are removed and fertilized with sperm in the laboratory. The fertilized eggs are then introduced into the uterus through the vagina, bypassing the Fallopian tube.

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