Tubal factor infertility

The fallopian tubes are the site of tubal factor infertility
Specialty| Obstetrics, gynecology

Tubal factor infertility (TFI) is female infertility caused by diseases, obstructions, damage, scarring, congenital malformations or other factors which impede the descent of a fertilized or unfertilized ovum into the uterus through the fallopian tubes and prevents a normal pregnancy and full term birth. Tubal factors cause 25-30% of infertility cases.[1] Tubal factor is one complication of chlamydia trachomatis infection in women.[2]

Sexually transmitted chlamydia and genital mycoplasma infections are preventable causes of infertility and negative pregnancy outcomes. When the infections progress and ascend, they can result in TFI. Infertility can have multiple possible causes and may not be recognized for years after a gonorrhea, chlamydia or Mycoplasma infection has caused tubal damage, as the affected woman may not have attempted to become pregnant until years later.[2]

## Contents

* 1 Signs and symptoms
* 2 Cause
* 3 Diagnosis
* 4 Treatment
* 5 See also
* 6 References
* 7 External links

## Signs and symptoms

Infertility is the major symptom of TFI and is generally defined as a woman under 35 who has not become pregnant after 12 months without the use of contraception. Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization.[3] When the inability to conceive is accompanied by signs and symptoms of pelvic inflammatory disease such as lower abdominal pain, TFI may be present. A history of pelvic inflammatory disease, the laproscopic evidence of scarring and a diagnosis of salpingitis supports the diagnosis.

## Cause

Tubal factor infertility can be due to chlamydia infection and testing for chlamydia antibodies is one diagnostic tool.[4] A Mycoplasma genitalium infection has also been linked to TFI.[5] Women have difficulty getting pregnant or carrying a baby to term due to the buildup of scar tissue in the fallopian tubes causing damage to the cilia on the epithelial cells.[6][7] TFI can also be due to endometriosis.[8]

## Diagnosis

The physician will obtain a medical history and evaluate for tubal obstructions and infections. Obstruction can occur anywhere along the length of the tube. It can be partially or completely blocked. The extent of obstruction is typically assessed using hysterosalpingogram (HSG). Some use laparoscopy to establish the extent of the disease. Pelvic adhesions can be visualized, if present.[4]

Distal tubal obstruction is more often observed (70%) than proximal obstruction. It can be caused by hydrosalpinges, pelvic adhesions, or fusion of the fimbriae. Tubal obstruction is caused by infection, endometriosis, myomas, salpingitis isthmica nodosa (SIN), or dried mucus. Because the tube can spasm during the injection of the dye during a hysterosalpingogram, it can be misdiagnosed.[4]

## Treatment

If tubal factor infertility is suspected to be the cause of the infertility treatment begins with or without confirmation of infection because of complications that may result from delayed treatment. Appropriate treatment depends on the infectious agent and utilizes antibiotic therapy. Treating the sexual partner for possible STIs helps in treatment and prevents reinfection.[9] Antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease.[10]

For women with infections of mild to moderate severity, parenteral and oral therapies are prescribed.[11][12][13] Typical antibiotics used are cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin.[14] An alternative parenteral regimen is ampicillin/sulbactam plus doxycycline.[14] Once infection has been eliminated, surgery may be successful in opening the lumen of the fallopian tubes to allow a successful pregnancy and birth.[15]

## See also

* Peritonitis
* Mycoplasma hominis

## References

1. ↑ Bardawil, MD, Tarek. "Fallopian Tube Disorders". in Lucidi, MD, Richard Scott. Medscape. http://emedicine.medscape.com/article/275463-overview#aw2aab6b7.
2. ↑ 2.0 2.1 Ljubin-Sternak, Suncanica; Mestrovic, Tomislav (2014). "Review: Chlamydia trachonmatis and Genital Mycoplasmias: Pathogens with an Impact on Human Reproductive Health". Journal of Pathogens 2014 (183167): 183167. doi:10.1155/2014/183167. PMID 25614838.
3. ↑ "World Health Organization reference values for human semen characteristics". Hum. Reprod. Update 16 (3): 231–45. 2010. doi:10.1093/humupd/dmp048. PMID 19934213.
4. ↑ 4.0 4.1 4.2 "Evidence-based diagnosis and management of tubal factor infertility.". Current Opinion in Obstetrics and Gynecology 16 (3): 221–9. June 2004. doi:10.1097/00001703-200406000-00004. PMID 15129051.
5. ↑ Schorge, John O.; Halvorson, Lisa M.; Schaffer, Joseph I.; Corton, Marlene M.; Bradshaw, Karen D.; Hoffman, Barbara L. (2016-04-22). Williams gynecology. Schorge, John O.,, Hoffman, Barbara L.,, Bradshaw, Karen D.,, Halvorson, Lisa M.,, Schaffer, Joseph I.,, Corton, Marlene M. (Third ed.). New York. pp. 65. ISBN 9780071849081. OCLC 944920918.
6. ↑ "Ectopic pregnancy". West. J. Med. 173 (2): 131–4. 2000. doi:10.1136/ewjm.173.2.131. PMID 10924442.
7. ↑ Clinical Gynecological Endocrinology and Infertility, 6th Ed.. Lippincott Williams & Wilkins (1999). 1999. p. 1149ff. ISBN 978-0-683-30379-7.
8. ↑ "Fact Sheet and Information Booklets: Endometriosis: Does It Cause Infertility?". ASRM. http://www.asrm.org/FACTSHEET_Endometriosis_Does_It_Cause_Infertility/.
9. ↑ "Pelvic Inflammatory Disease (PID) Partner Management and Public Health Measures". October 2014. http://www2a.cdc.gov/stdtraining/self-study/pid/pid_partner_management_self_study_from_cdc.html.
10. ↑ "Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines". Clin. Infect. Dis. 44 (Suppl 3): S111–22. 2007. doi:10.1086/511424. PMID 17342664.
11. ↑ "Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial". Am J Obstet Gynecol 186 (5): 929–37. 2002. doi:10.1067/mob.2002.121625. PMID 12015517.
12. ↑ Ness RB, Hillier SL, Kip KE et al. Bacterial vaginosis and risk of pelvic inflammatory disease" Obstet Gynecol 2004; 44 (Supp 3): S111–22.
13. ↑ "Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies". Sex Transm Dis 34 (12): 960–6. 2007. doi:10.1097/01.olq.0000225321.61049.13. PMID 18077847.
14. ↑ 14.0 14.1 "CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines". cdc.gov. https://www.cdc.gov/std/treatment/2010/pid.htm#a2.
15. ↑ Sherbahn MD, Richard. "Fallopian Tube Surgeries for Infertility: Laparoscopy & More". WedMD. http://www.webmd.com/infertility-and-reproduction/fallopian-tube-procedures-for-infertility.

## External links

Classification|

* ICD-10: N70 -N77
* ICD-9-CM: 614-616
* MeSH: D000292

|

External resources|

* MedlinePlus: 000888

* v
* t
* e

Female diseases of the pelvis and genitals (N70–N99, 614–629)

Internal|

| Adnexa|

| Ovary|

* Endometriosis of ovary
* Female infertility
* Anovulation
* Poor ovarian reserve
* Mittelschmerz
* Oophoritis
* Ovarian apoplexy
* Ovarian cyst
* Corpus luteum cyst
* Follicular cyst of ovary
* Theca lutein cyst
* Ovarian hyperstimulation syndrome
* Ovarian torsion

|

Fallopian tube|

* Female infertility
* Fallopian tube obstruction
* Hematosalpinx
* Hydrosalpinx
* Salpingitis

Uterus|

| Endometrium|

* Asherman's syndrome
* Dysfunctional uterine bleeding
* Endometrial hyperplasia
* Endometrial polyp
* Endometriosis
* Endometritis

menstruation|

* flow
* Amenorrhoea
* Hypomenorrhea
* Oligomenorrhea
* pain
* Dysmenorrhea
* PMS
* timing
* Menometrorrhagia
* Menorrhagia
* Metrorrhagia

* Female infertility
* Recurrent miscarriage

Myometrium|

* Adenomyosis

Parametrium|

* Parametritis

Cervix|

* Cervical dysplasia
* Cervical incompetence
* Cervical polyp
* Cervicitis
* Female infertility
* Cervical stenosis
* Nabothian cyst

General|

* Hematometra / Pyometra
* Retroverted uterus

Vagina|

* Hematocolpos / Hydrocolpos
* Leukorrhea / Vaginal discharge
* Vaginitis
* Atrophic vaginitis
* Bacterial vaginosis
* Candidal vulvovaginitis
* Hydrocolpos

Sexual dysfunction|

* Dyspareunia
* Hypoactive sexual desire disorder
* Sexual arousal disorder
* Vaginismus

* Urogenital fistulas
* Ureterovaginal
* Vesicovaginal
* Obstetric fistula
* Rectovaginal fistula
* Prolapse
* Cystocele
* Enterocele
* Rectocele
* Sigmoidocele
* Urethrocele

* Vaginal bleeding
* Postcoital bleeding

Other / general|

* Pelvic congestion syndrome
* Pelvic inflammatory disease

External|

| Vulva|

* Bartholin's cyst
* Kraurosis vulvae
* Vestibular papillomatosis
* Vulvitis
* Vulvodynia

|

Clitoral hood or clitoris|

* Persistent genital arousal disorder

* v
* t
* e

Sexually transmitted infections (STI) (primarily A50–A64, 090–099)

Bacterial|

* Chancroid (Haemophilus ducreyi)
* Chlamydia, lymphogranuloma venereum (Chlamydia trachomatis)
* Donovanosis (Klebsiella granulomatis)
* Gonorrhea (Neisseria gonorrhoeae)
* Mycoplasma hominis infection (Mycoplasma hominis)
* Syphilis (Treponema pallidum)
* Ureaplasma infection (Ureaplasma urealyticum)

Protozoal|

* Trichomoniasis (Trichomonas vaginalis)

Parasitic|

* Crab louse
* Scabies

Viral|

* AIDS (HIV-1/HIV-2)
* Cancer
* cervical
* vulvar
* penile
* anal
* Human papillomavirus (HPV)
* Genital warts (condyloma)
* Hepatitis B (Hepatitis B virus)
* Herpes simplex
* HSV-1 & HSV-2
* Molluscum contagiosum (MCV)

General
inflammation|

female
Cervicitis
Pelvic inflammatory disease (PID)

male
Epididymitis
Prostatitis

either
Proctitis
Urethritis/Non-gonococcal urethritis (NGU)

* v
* t
* e

Reproductive health

Rights|

* Compulsory sterilization
* Contraceptive security
* Genital integrity
* Circumcision controversies
* Genital modification and mutilation
* Intersex

Education|

* Genetic counseling
* Pre-conception counseling
* Sex education

Planning|

* Assisted reproductive technology
* Birth control
* Childfree/Childlessness
* Parenting
* Adoption
* Childbirth
* Foster care
* Safe sex

Health|

* Men's
* Women's
* Vulvovaginal
* Research
* Self-report sexual risk behaviors

Pregnancy|

* Abortion
* Birth spacing
* Maternal health
* Obstetrics
* Options counseling
* Pregnancy from rape
* Pregnant patients' rights
* Prenatal care
* Teenage pregnancy
* Preteen pregnancy
* Unintended pregnancy

Medicine|

* Andrology
* Genitourinary medicine
* Gynaecology
* Obstetrics and gynaecology
* Reproductive endocrinology and infertility
* Sexual medicine

Disorder|

* Disorders of sex development
* Infertility
* Reproductive system disease
* Sexual dysfunction
* Sexually transmitted infection
* Clinic

By country|

* China
* India
* Iran
* Ireland
* Pakistan
* Philippines
* Singapore
* United Kingdom
* Teen
* United States
* Teen pregnancy
* Birth control

History|

* Birth control movement in the United States
* History of condoms
* Social hygiene movement
* Timeline of reproductive rights legislation

Policy|

* One-child policy
* Two-child policy
* Financial
* Baby bonus
* Bachelor tax
* Child benefit
* Tax on childlessness

* v
* t
* e

Assisted reproductive technology

Infertility|

* Female
* Male
* Fertility clinic
* Fertility testing
* Fertility tourism

Fertility medication|

* Estrogen antagonists
* aromatase inhibitor
* clomifene
* FSH
* GnRH agonists
* Gonadotropins
* menotropins
* hCG

In vitro fertilisation (IVF)
and expansions|

* Assisted zona hatching
* Autologous endometrial coculture
* Cytoplasmic transfer
* Embryo transfer
* Gestational carrier
* In vitro maturation
* Intracytoplasmic sperm injection
* Oocyte selection
* Ovarian hyperstimulation
* Preimplantation genetic diagnosis
* Snowflake children
* Transvaginal ovum retrieval
* Zygote intrafallopian transfer

Other methods|

* Artificial insemination
* Ovulation induction
* Cryopreservation
* embryos
* oocyte
* ovarian tissue
* semen
* Gamete intrafallopian transfer
* Reproductive surgery
* Vasectomy reversal
* Selective reduction
* Sex selection
* Surrogacy

Donation|

* Donor registration
* Donor Sibling Registry
* Egg donation
* Embryo
* Sperm
* Semen collection
* Sperm bank
* Ova bank

Ethics|

* Accidental incest
* Genetic diagnosis of intersex
* Religious response to ART
* Mitochondrial donation
* Sex selection

In fiction|

* See subsection in sperm donation
* Reproduction and pregnancy in speculative fiction

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