Tubal infertility

Kirsty Brookes, Ying Cheong
In: Management of Infertility for the MRCOG and Beyond · 2014 · pp. 45–56 · doi:10.1017/cbo9781107445178.006 · W4232089634
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This review outlines the classification of tubal disease into three grades and discusses management options for tubal factor infertility, noting that endometriosis is a primary cause alongside infection and surgery.

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This chapter outlines the epidemiology, anatomy, and clinical management of tubal infertility, which accounts for 25–35% of female infertility cases. It identifies sexually transmitted infections as the primary cause of tubal damage, alongside pelvic surgery, leading to pathologies such as adhesions, blockages, or hydrosalpinx that impair conception. The text reviews the essential role of fallopian tube structure in ovum pickup and transport, noting that severe damage typically requires in vitro fertilisation, while surgery may be beneficial in selected cases. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

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. The main causes of tubal factor infertility include previous tubal infection, previous surgery, endometriosis and congenital abnormalities. Infection, endometriosis and surgery affect tubal function via different mechanisms but all lead to inflammation. Classification of tubal disease is essential for use in clinical trials but also as a potential prognostic indicator to assist patients and clinicians in decisions regarding further management. The tubal disease is classified into grade I - minor, grade II - intermediate or moderate and grade III - severe. Once tubal disease has been identified, management options include expectant management, tubal cannulation, surgery and IVF. Several prognostic factors need to be considered when counselling women regarding their individual further management options.
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- Frontmatter - Contents - About the authors - Preface - Acknowledgements - Abbreviations - 1 Epidemiology and initial assessment - 2 Male factor infertility - 3 Ovulatory disorders - 4 Tubal infertility - 5 Endometriosis-related infertility - 6 Uterine factors in infertility - 7 Unexplained infertility - 8 Assisted reproduction – preparation and work-up of couples - 9 Assisted reproduction – clinical and laboratory procedures - Index Published online by Cambridge University Press: 05 June 2014 Book contents - Frontmatter - Contents - About the authors - Preface - Acknowledgements - Abbreviations - 1 Epidemiology and initial assessment - 2 Male factor infertility - 3 Ovulatory disorders - 4 Tubal infertility - 5 Endometriosis-related infertility - 6 Uterine factors in infertility - 7 Unexplained infertility - 8 Assisted reproduction – preparation and work-up of couples - 9 Assisted reproduction – clinical and laboratory procedures - Index 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. - Type - Chapter - Information - Management of Infertility for the MRCOG and Beyond , pp. 45 - 56Publisher: Cambridge University PressPrint publication year: 2014 Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Tubal infertility - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Tubal infertility - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Tubal infertility - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014

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