3. Diagnosis and Management of Tubal Factor Infertility

  1. Emre Seli MD1,2,3
  1. Amanda N. Kallen and
  2. Pinar H. Kodaman MD, PhD

Published Online: 8 MAR 2011

DOI: 10.1002/9781444393958.ch3

Infertility

Infertility

How to Cite

Kallen, A. N. and Kodaman, P. H. (2011) Diagnosis and Management of Tubal Factor Infertility, in Infertility (ed E. Seli), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444393958.ch3

Editor Information

  1. 1

    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA

  2. 2

    Division of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, Connecticut, USA

  3. 3

    Oocyte Donation and Gestational Surrogacy Program, Yale University School of Medicine, New Haven, Connecticut, USA

Author Information

  1. Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA

Publication History

  1. Published Online: 8 MAR 2011
  2. Published Print: 23 MAR 2011

Book Series:

  1. Gynecology in Practice

Book Series Editors:

  1. Aydin Arici

ISBN Information

Print ISBN: 9781444333534

Online ISBN: 9781444393958

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Keywords:

  • diagnosis and management - of tubal factor infertility;
  • tubal disease - proximal or distal, and unilateral or bilateral;
  • history of PID, strong risk factors for tubal disease - pelvic pathology, as endometriosis, ectopic pregnancy and complicated appendicitis;
  • distal tubal obstruction - more common than proximal obstruction;
  • proximal tubal disease;
  • hysterosalpingography (HSG), injection - of a radio-opaque contrast material into uterine cavity;
  • Sonohysterography (SHG), or saline infusion sonography (SIS) - alternative method to HSG;
  • Salpingoscopy, also known as falloposcopy - endoscopic evaluation of tubal mucosa;
  • tubal infertility management - proximal tubal disease;
  • tubal surgery versus in-vitro fertilization and embryo transfer

Summary

As a tubal factor is a common cause of infertility, evaluation of the infertile couple should include assessment of the fallopian tubes for patency. Hysterosalpingography, sonohysterography, and chlamydia serology can be used for diagnosing tubal disease, though laparoscopy with chromopertubation remains the “gold standard”. Tubal disease can be unilateral or bilateral, and proximal or distal in nature. Surgical repair is an option for some patients, while in-vitro fertilization, which completely bypasses the tubes, is the best option for others, particularly those with diminishing ovarian reserve. Although the approach to the diagnosis of tubal factor is fairly standard, management decisions need to be individualized to the patient based on age, ovarian reserve, the presence or absence of other infertility factors, and insurance coverage for assisted reproductive technologies.