What is a fallopian tube ?

The fallopian tubes emerge from each side of the uterus and extend to the surface of the ovary. The ovarian end of each of the tubes is funnel-like which surrounds the ovary. The funnel-like end comprises many fine, delicate finger-like projections called “fimbriae”. These fimbriae “capture” the egg as soon as it is released from the ovary. If this egg meets the sperms, it gets fertilized in the tube and the early stages of embryo development takes place in the Fallopian tube. The cells of the Falopian tube provide all the nutrition needed by the egg, the sperms and the embryos.

What can go wrong with a woman’s fallopian tube ?

Damage to the fimbriae can result in them not being able to “capture” the egg and direct it into the tube. Damage to the inner linings of the cells of the tube can prevent fertilization; development of the embryo and in some instances the movement of the embryo towards the uterus resulting in an “ectopic pregnancy”. The tubes may be blocked because of a pelvic infection and this will prevent the sperm from fertilizing an egg. Endometriosis may also result in tubal blockage. The fallopian tubes are surgically severed and the ends sewn up to prevent pregnancy.

What tests can be done to determine whether a woman’s fallopian tubes are normal ?

Three types of tests are now available for evaluating the status of the fallopian tubes. These are :

Hysterosalpingography: A radio-opaque dye is injected into the uterus through the vagina and then X-rays are taken. If the tube is not blocked then the dye can be seen emerging /spilling out of the fallopian tube. If no dye emerges out of the tube then one can conclude that it is blocked.

Hysterosonosalpingography: Where large amounts of fluid is injected into the uterus through the vagina. If the tubes are not blocked then this fluid emerges out of the fimbrial end of the fallopian tubes. The entire procedure is performed under ultrasound guidance and the fluid that comes out can be seen ultra-sonographically.

Diagnostic Laparoscopy: In this procedure, a fibre-optic telescope, a laparoscope, is inserted into the abdomen through the navel. With the laparoscope, the surgeon can directly visualise the status of the fallopian tube. One can see the position of the fimbriae and also whether the tubes are open or blocked. Then a coloured dye such as methylene blue is injected through the vagina. If the tubes are open (patent) then the dye spills out of the fimbrial end of fallopian tube immediately. No dye will spill out of the fallopian tube if it is blocked. And if there is some damage to tube then the dye will spill out slowly.

Can abnormalities of the fallopian tube be corrected ?

If the fallopian tube is blocked because of tubal ligation as in cases of tubal sterilisation then it can be surgically reversed. However, whenever the blockage of the tube is a result of pelvic infection then surgical correction may not be possible. No medical therapy is known as yet to correct damaged fallopian tubes.

What are the options available for women with damaged fallopian tubes to bear a child ?

In women where there is a pathological damage to the fallopian tube then surgical correction of the tube is not possible. In such women the best option for bearing a child is in vitro fertilization and embryo transfer.