Damaged or blocked tubes can cause infertility. We take stock of these anomalies.
Table of contents
- Fallopian tubes under the microscope
- Fertilization: the key role of the fallopian tubes
- Tubal abnormalities: causes of fallopian tube blockage
- How do I know if the tubes are blocked?
Damaged or blocked fallopian tubes can cause infertility. These abnormalities are common and represent 50% of the indications for in vitro fertilization.
Fallopian tubes under the microscope
Damaged or blocked fallopian tubes can cause infertility. These anomalies are common and account for 50% of the indications for in vitro fertilization.
Fertilization: the key role of the fallopian tubes
A quick reminder: the fallopian tubes play a key role in fertilization. Once released by the ovary (at the time of ovulation), the egg will nestle in the tube. The spermatozoa join it. If one of them succeeds in penetrating it, fertilization occurs. But for this mechanism to work, there must be at least one ovary and one “operational” tube. When these two organs are blocked, natural fertilization – and therefore pregnancy – is impossible. If one of the tubes is not entirely blocked, ectopic pregnancy risks because the egg may have difficulty moving from the tube to the uterine cavity.
Each horn is composed of 4 parts:
- A uterine part that passes through the thickness of the uterine muscle
- The tubal isthmus
- The tubal ampulla, the place of fertilization
- The infundibulum which ends in 10 to 15 fringes, one of which, the ovarian fringe, is connected to the ovary. This fringe has a small opening to allow the eggs produced by the ovary to begin their descent from the fallopian tubes.
Tubal abnormalities: causes of fallopian tube blockage
The fallopian tubes are sometimes disrupted by adhesions that prevent the passage of the egg, sperm, and embryo. These abnormalities, which can cause infertility, can have three origins:
This is called PID or inflammation of the fallopian tubes. It is often linked to a sexually transmitted infection, in particular transmitted by the microbe chlamydia. This infection can lead either to the creation of tissue around the tubes, which then mechanically hinders the free passage between the ovary and the tube, or to an obstruction of the tube at its end. An improperly evacuated uterine curettage (following a miscarriage) or the inappropriate insertion of an IUD can also cause an infection.
In this case, it is a question of tubal problems due to post-operative complications. Many operations, however commonplace, can damage the fallopian tubes: an appendectomy, gynecological surgery on the ovaries, or surgery for a uterine fibroid.
This common gynecological disease, which manifests itself by the presence of small fragments of the endometrium (pieces of the uterine mucous membrane) on the fallopian tubes and in the ovaries, or even on other organs, can damage the quality of the fallopian tubes or even block them.
How do I know if the tubes are blocked?
In any infertility assessment, the state of the fallopian tubes is checked. Once the basic tests have been carried out (temperature curve, hormone hysteroscopy. The doctor will prescribe hysterosalpingography or hysteroscopy. This examination, which is known to be painful, allows the permeability of the tubes to be checked.
Hysterosalpingography: how does it work?
The gynecologist introduces a small cannula into the cervix through which he injects a liquid that is opaque to X-rays. Five or six images are taken to visualize the uterine cavity, the tubes, and the product’s passage through them. If, following the hysterosalpingography, there is any doubt about the state of the tubes or if the doctors suspect endometriosis, they may suggest that you have a laparoscopy. This examination requires a general anesthetic. The surgeon makes a small incision in the navel and inserts a laparoscope. This “tube,” equipped with an optical system, makes it possible to evaluate the tubes’ permeability and check the state of the ovaries and the uterus. During this procedure, the surgeon may attempt to unblock the tubes.
Damaged or blocked fallopian tubes are a significant cause of infertility. Either by preventing the sperm from reaching the egg, the ovary has ovulated into the fallopian tube, or by preventing a fertilized egg (an embryo) from traveling to the uterus to the implant for pregnancy.