Infertility: tubal abnormalities

Fallopian tubes under a magnifying glass

Damaged or blocked tubes can cause infertility. These abnormalities are frequent and represent 50% of the indications for in vitro fertilization. 

Fertilization: the key role of the fallopian tubes

Small reminder: the tubes have a key role in fertilization. Once released by the ovary (at the time of ovulation), the egg will nest in the pinna of the tube. It is joined by the sperm. If one of them succeeds in penetrating it, then there is fertilization. But for this mechanism to work, there must be at least one “operational” ovary and proboscis. When these two organs are blocked, natural fertilization – and therefore pregnancy – is impossible.Also, if one of the tubes is not completely blocked, there is a risk of ectopic pregnancy because the egg may have difficulty moving from the tube to the uterine cavity.

Tubal abnormalities: causes of obstruction of the fallopian tubes

The tubes are sometimes disturbed by adhesion phenomena that prevent the passage of the egg, sperm and embryo. These abnormalities, which can cause infertility, can have three origins:

  • Infectious

    We then speak of salpingitis or inflammation of the tubes. It is often linked to a sexually transmitted infection, particularly transmitted by the microbe chlamydiae. This infection can cause either the creation of tissues around the tubes which then mechanically obstruct the freedom of passage between the ovary and the tube, or an obstruction of the tube at the level of its end. Improperly evacuated uterine curettage (following miscarriage) or improper IUD insertion can also cause infection.

  •  Postoperative

    In this case, it is tubal problems due to post-operative complications. Many interventions, however trivial, can damage the tubes : an appendectomy, gynecological surgery on the ovaries or the operation of a uterine fibroid.

  •  endometriosis

    This frequent gynecological disease, which manifests itself by the presence of small fragments of endometrium (pieces of the uterine lining) on ​​the tubes and in the ovaries, or even on other organs, can damage the quality of the tubes, or even block them.

How do you know if the tubes are blocked?

In any infertility assessment, we check the condition of the tubes. Once the basic examinations have been carried out (temperature curve, hormonal measurements, Hünher test), the doctor will prescribe a hysterosalpingography ou hysteroscopy. This examination, known to be painful, makes it possible to check the patency of the tubes.

  • Hysterosalpingography: how is it going?

The gynecologist introduces a small cannula into the cervix through which he injects a liquid opaque to X-rays. Five or six images are taken in order to visualize the uterine cavity, the tubes and the passage of the product through them.

If, following the hysterosalpingography, there is doubt about the condition of the tubes or if the doctors suspect you have endometriosis, they may suggest that you have an laparoscopy. This examination requires general anesthesia. The surgeon makes a small incision at the navel and inserts a laparoscope. This “tube”, equipped with an optical system, allowsassess tubal patency, but also to check the condition of the ovaries and uterus. During this operation, the surgeon may attempt to unblock the tubes

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