Pocket ObGyn – Tubal Factor Infertility
See Abbreviations
Definition & Epidemiology (Curr Opin Infect Dis. 2004;17(1):49;2005)
- Infertility caused by obliteration of the fallopian tube, usually by prior pelvic 20–30% of infertility may be tubal factor. Very common.
Etiology
- Obliteration of the fallopian tube or damage to fimbriae by infectious or inflamm Most cases caused by prev Hx of PID.
- Less common causes are inflammation related to endometriosis, inflamm bowel dz, & surgical adhesions
Clinical Manifestations
- Usually asymptomatic but may have dysmenorrhea & dyspareunia if endometriosis
- Hx of PID, ectopic Preg, or prior pelvic Surg
Diagnostic Workup/Studies
- HSG – diagnostic, but also may fertility
- Consider laparoscopy w/ chromopertubation if endometriosis suspected
- Chlamydia Ab testing may be helpful to screen pts at high risk for tubal factor infertility, but role of testing has not been clearly defined yet (Fertil Steril 1994;62:305)
Treatment and Medications (Fertil Steril 2012;97:539)
- Prox tubal obst ® tubal cannulation
- Mild hydrosalpinges ® laparoscopic fimbrioplasty or neosalpingostomy
- Irreparable hydrosalpinges ® Salpingectomy or prox tubal occlusion improves IVF Preg rates.
- Decision to pursue Surg IVF based on age of woman, number of children desired, extent of tubal dz