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Infertility Causes > Woman > Fallopian Tubes and Surrounding Structures Overview - Evaluation - Treatment Options - DiagnosisCauses of Tubal Problems This evaluation obviously begins with a history and physical exam. There are several historical factors that may suggest a problem. As part of the initial evaluation, a pelvic exam should also be performed. The physician is trying to feel anything that would suggest a problem. Finally, a pelvic ultrasound is worthwhile on the initial visit. It allows the physician to look at the ovaries and be sure there are no cysts or other visible problems that might make surgery or other evaluation necessary. The combination of a good pelvic exam and an ultrasound will assure the physician that there is not significant endometriosis, which would dictate that laparoscopy is indicated. Scar Tissue Any prior pelvic surgery may result in adhesions, or scar tissue. Any time surgery is done, there is a chance that adhesions will form as a result of that surgery. And adhesions form very quickly: Following a surgery, most (if not all) of the adhesions that will form have done so within the first couple of weeks. Adhesions can significantly distort the normal relationship of the tubes and ovaries and can make it physically impossible for the fimbria to pick up the egg. Therefore, any prior history of pelvic surgery must be considered a possible predisposing factor for pelvic adhesions. Infections Infection is the leading cause of pelvic adhesions and damage to the fallopian tubes. Gonorrhea and chlamydia are the sexually transmitted organisms responsible for the vast majority of cases of salpingitis (inflammation of the fallopian tubes, also known as pelvic inflammatory disease or PID). Infection with gonorrhea is a very serious disease leading to high fever, pain, and other symptoms that alert one to its presence. Chlamydia, on the other hand, can infect and damage the fallopian tubes without causing any symptoms. Chlamydia is the most common cause of tubal infection and damage, and a woman may never know she has had it. When a fallopian tube becomes infected, several things occur. One of the first changes to take place is damage to the cells that line the inside of the tube. Certain of these cells have what are known as microcilia on their surface. These microcilia are responsible for propelling the egg and embryo down the tube. When infection occurs, these microcilia are often damaged or destroyed, and they will not heal or reform. Secondly, it is a natural response of the body to try to contain an infection and prevent it from spreading. In attempting to do this, the fimbria of the tube close on each other. When scarring occurs, the fimbria may stay like this, thus closing off the tube and forming what is known as distal tubal disease. In severe cases, fluid may collect in the tube and form a hydrosalpinx, a dilated fallopian tube full of fluid. In other cases, there may be scarring and destruction of the part of the tube closest to the uterus, resulting in a change known as salpingitis isthmica nodosa (SIN). Other sources of inflammation may also lead to tubal damage. Appendicitis, particularly if the appendix ruptured, can cause significant adhesions and tubal damage. Endometriosis must also be considered as a potential cause of tubo-peritoneal problems, but endometriosis is addressed separately in Chapter 9. © 2005 Jarrett Fertility Group |
