Implantation process and bleeding

Why are fallopian tubes so important?

The sperm and the egg both have to travel through the fallopian tubes attached to the uterus if fertilization and implantation can be successful. The sperm moves up and the egg moves down the fallopian tube.

After ovulation, the egg is picked up by the fallopian tube and moves towards the uterus. Fertilization takes place inside the fallopian tube, in the distal part of it closer to the ovary. 

Any damage to these tubes increases complications such as ectopic pregnancy, and it makes getting pregnant harder to the point that affected tubes make it harder to get pregnant. Damage to the fallopian tubes, after ovarian dysfunction, is a major cause of infertility in about 25% of infertility cases.

The role of the fallopian tubes in infertility

In about 30% of couples, the man has an infertility issue, in about 30 % of couples, the woman has an issue, and in about 30% they both have a fertility problem. In the remaining 10-15%, no specific problems can be found through traditional tests (unexplained infertility).

After an ovulation problem, tubal damage is one of the most common causes of infertility in women, accounting for fifteen to twenty-five percent of all infertility cases. The damage to the fallopian tubes can be the result of a variety of causes. Most of the time the damage to the fallopian tubes is completely unknown to the woman as there are rarely symptoms other than infertility. Some women, however, have severe pain around the time of their period and may also have irregular or heavy periods. However, this is often attributed by the woman to her period as it is what she considers normal.

What is tubal damage?

The term tubal damage is used to describe a number of problems found within the fallopian tubes. Adhesions along the tube can make it more difficult for the tube to pick up an egg. Damage to the lining of the tube can keep the sperm from reaching an egg. A blockage inside the tube can prevent the sperm to move up the tube and join the egg, and a fertilized egg can be prevented from reaching the uterus and increases the chances of an ectopic pregnancy.

What are the causes of tubal damage?

There are several causes of tubal damage.

There are several tests that can be utilized to diagnose tubal problems. An ultrasound is often the starting point for these tests. A healthy fallopian tube is usually invisible to this test, if it shows up in ultrasound it is a good indication that there has been some damage. 

Are there symptoms of fallopian tube problems?

Just because there is no pelvic pain does not mean the fallopian tubes are open. Fallopian tube diseases and blockage are among the top three reasons for infertility and there are rarely any symptoms.

Sometimes a tubal problem may be caused by endometriosis, a condition where the inside lining of the uterus is on the outside of the uterus and affects the fallopian tubes. Some women do have symptoms of endometriosis, such as pelvic pain during the menstrual period.

But in general, a blockage of the fallopian tubes does not produce any symptoms. You need to have the patency (openness) of the tubes tested with a hysterosalpingogram or laparoscopy if you want to know whether they are open or not.

Can endometriosis cause tubal factor infertility?

One main cause of tubal damage is endometriosis. Endometriosis is a common disease in which the cells that are typically found inside the womb begin to grow outside of the womb. While these cells can grow in the ovaries, bowels, bladder, they create tubal damage when they grow inside the fallopian tubes. Every month when the woman menstruates these cells, regardless of where they are in the body, act as though they were inside the womb. They attempt to shed and leave the body. When they cannot vacate the body they form cysts and can cause chronic inflammation and adhesions which damage the tubes. While endometriosis can occur in women under thirty it usually affects women in their thirties and forties. Most women with endometriosis are fertile, however, they have trouble conceiving because of the damage to their fallopian tubes. 

A pelvic exam can indicate endometriosis if the doctor observes tenderness and is able to feel ovarian cysts. Additional tests such as ultrasounds, MRI, and CAT scans can also be useful in locating and identifying cysts on the ovaries. However, neither these tests nor a physical exam is enough to diagnose endometriosis. The only way to make a diagnosis is by laparoscopy. With the use of laparoscopy, a doctor can determine if the patient has endometriosis the extent of damage caused by it. There are four stages of endometriosis that are widely recognized in the medical field. The stages are minimal, mild, moderate, and severe.

What are some other issues causing tubal factor infertility?

Besides endometriosis, there are many other causes of tubal factor infertility. These include past or present infections of the pelvic area (often chlamydia or gonorrhea), appendicitis, myomas, salpingitis isthmica nodosa (SIN), or dried mucus. 

How is tubal factor infertility diagnosed?

Because there are often no specific symptoms other than infertility, certain tests must be done to diagnose tubal patency and tubal factor infertility:

  • Hysterosalpingogram (HSG): This is a test done by injecting a dye (X-ray) or water (sonohysterosalpingogram) through the cervix and through the vagina. The fallopian tubes are visualized on X-ray or on sonogram (ultrasound). Because the tube can close during a hysterosalpingogram in response to the dye injection, tubal factor infertility can be diagnosed incorrectly. More from ACOG.
  • Laparoscopy: A laparoscopy is done under general anesthesia and an instrument is inserted into the abdomen to visualize the pelvic organs.

Treatment of fallopian tube damage

Reasons for treating fallopian tube damage include a desire to get pregnant and if you have symptoms like pain.  If your fallopian tubes are blocked, treatment depends on how severely they are blocked or damaged. If there is a really small amount of scar tissue or adhesions, your doctor can use laparoscopic surgery to remove the blockage and open the tubes. However, in many cases even when there is a small blockage, surgery cannot always open the blockage. In addition, even after a small blockage has been opened, there is an increased risk of having an ectopic pregnancy. With larger amounts of blockage, surgery to open the tubes may not be possible. In cases of severe blockage, getting pregnant with in-vitro fertilization(IVF) may be the best option.

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