Pelvic adhesive disease (scar tissue in the pelvis) and problems with the fallopian tubes are a cause of infertility in about 25% of patients seeking care at fertility clinics. These conditions contribute to / cause infertility because they prevent normal transport of the egg, sperm, and embryo through the fallopian tubes.

There are many causes of pelvic adhesive and fallopian tube disease but pelvic infections, endometriosis, and scar tissue / damage from prior surgery explain most causes. Pelvic infections arise from a number of causes including sexually transmitted disease, appendicitis, and inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. It is important to note that about 1 in 3 women who have had a sexually transmitted infection were not aware of the infection and therefore, may not be aware they at risk for fallopian tube problems. Endometriosis, discussed in a separate post, causes inflammation in the pelvis and disrupts normal tubal anatomy.

Assessment of the fallopian tubes can be accomplished via three methods:
1) hysterosalpingogram (HSG) 2) hysterosalpingo-contrast sonography (ultrasound) and 3) laparoscopic surgery. The most common method to assess tubal patency is the HSG which uses contrast dye and an X-ray to evaluate the fallopian tubes. In a similar manner, using air bubbles, ultrasound can evaluate the fallopian tubes. Lastly, surgery along with the instillation of colored dye (chromopertubation) through the fallopian tubes can assess not only the fallopian tubes but also evaluate the pelvis for endometriosis and the presence of scar tissue. HSG is rarely useful for the detection of scar tissue and / or endometriosis. If a tubal obstruction is noted, it is important to identify the size and location as obstructions close to the uterus (proximal) are often due to tubal spasm or mucus and are not “true” tubal blockages. Obstruction farther away (more lateral, distal) from the uterus tends to represent concerning tubal problems.

Treatment for tubal disease depends on a number of factors including severity and location of disease. IVF is by far the most effective therapy for tubal disease as it eliminates the need for fallopian tubes. In fact, the first attempted IVF cycle in the United States was a patient with bilateral tubal disease. Surgery and ovulation enhancement (assuming at least one fallopian tube is open) are less effective but also reasonable treatments that may be considered under some circumstances. Lastly, patients with tubal disease are at increased risk for an ectopic pregnancy within the fallopian tubes. Patients with tubal problems who become pregnant must be followed closely early in pregnancy until the location of the pregnancy can be confirmed.

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