The mechanical ability of the sperm to be conducted to the site of the oocyte and the fertilized oocyte to be propelled into the uterus demand patent fallopian tubes. Clearly, the tube must be open to allow fertility. Also important is the ability of the tube to freely move across the surface of the ovary in order to sweep the oocyte into the tube. If the tube is not able to pick up the oocyte from the surface of the ovary, no pregnancy will result.
Patients with "tubal factor" infertility often have a history of a pelvic infection, endometriosis, or previous abdominal or pelvic surgery. Frequently, however, patients are unable to clearly identify a source for their tubal adhesions. For example, a patient who experienced a chlamydial infection, may have attributed the lower abdominal pain, fever and cramping to a gastrointestinal viral infection and often cannot recollect the time of infection.
Adhesions may be asymptomatic or may result in pelvic pain. Normal movement of the bowel and ovaries across the visceral surfaces of the abdomen may be impeded by pelvic adhesions and results in these organs pulling on the abdominal wall. This may result in both pelvic and abdominal pain.
Tubal disease significant enough to result in hydrosalpinges may result in adnexal masses. Similarly adhesions, which adhere the ovaries to uterus, may often be interpreted as a uterus with posterior fibroids on physical examination.
Tubal adhesions or hydrosalpinges (i.e., obstructed, fluid-filled fallopian tubes) are suggested when contrast pools are seen on a hysterosalpingogram (Figure 10), but definitive diagnosis requires visualization at laparoscopy. Tubal occlusion may be diagnosed by hysterosalpingography or by laparoscopy. Most recently, fluid extravasation into the pelvis after flushing of an intrauterine cannula may be seen by an experienced ultrasonographer (26). However, this test is less reliable than the former and is dependent on the skill of the sonographer, patient factors such as weight and air in the bowel and resolution capabilities of the ultrasound machine.
In vitro fertilization results in the greatest chances of pregnancy for the couple whose infertility is the result of pelvic adhesions or blocked Fallopian tubes. Surgical correction increases the chances of fertility; however, unless the adhesions are filmy and their extent is limited, surgical lysis incurs a high likelihood recurrence of adhesion.