Fallopian tube

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Fallopian tube
Basic Female Reproductive System (English).svg
Uterus and fallopian tubes labelled as uterine tubes
Details
Precursor Paramesonephric ducts
System Reproductive system
Artery Tubal branches of ovarian artery, tubal branch of uterine artery via mesosalpinx
Lymph Lumbar lymph nodes
Identifiers
Latin tuba uterina
Greek σάλπιγξ (sálpinx)
MeSH D005187
TA98 A09.1.02.001
TA2 3486
FMA 18245
Anatomical terminology

The fallopian tubes, also known as uterine tubes, oviducts [1] or salpinges (sg.: salpinx), are paired tubular sex organs in the human female body that stretch from the ovaries to the uterus. The fallopian tubes are part of the female reproductive system. In other vertebrates, they are only called oviducts. [2]

Contents

Each tube is a muscular hollow organ [3] that is on average between 10 and 14 cm (3.9 and 5.5 in) in length, with an external diameter of 1 cm (0.39 in). [4] It has four described parts: the intramural part, isthmus, ampulla, and infundibulum with associated fimbriae. Each tube has two openings: a proximal opening nearest to the uterus, and a distal opening nearest to the ovary. The fallopian tubes are held in place by the mesosalpinx, a part of the broad ligament mesentery that wraps around the tubes. Another part of the broad ligament, the mesovarium suspends the ovaries in place. [5]

An egg cell is transported from an ovary to a fallopian tube where it may be fertilized in the ampulla of the tube. The fallopian tubes are lined with simple columnar epithelium with hairlike extensions called cilia, which together with peristaltic contractions from the muscular layer, move the fertilized egg (zygote) along the tube. On its journey to the uterus, the zygote undergoes cell divisions that changes it to a blastocyst, an early embryo, in readiness for implantation. [6]

Almost a third of cases of infertility are caused by fallopian tube pathologies. These include inflammation, and tubal obstructions. A number of tubal pathologies cause damage to the cilia of the tube, which can impede movement of the sperm or egg. [7]

The name comes from the Italian Catholic priest and anatomist Gabriele Falloppio, for whom other anatomical structures are also named. [8]

Structure

Each fallopian tube leaves the uterus at an opening at the uterine horns known as the proximal tubal opening or proximal ostium. [9] The tubes have an average length of 10–14 centimeters (3.9–5.5 in) [4] that includes the intramural part of the tube. The tubes extend to near the ovaries where they open into the abdomen at the distal tubal openings. In other mammals, the fallopian tube is called the oviduct, which may also be used in reference to the fallopian tube in the human. [10] [11] The fallopian tubes are held in place by the mesosalpinx a part of the broad ligament mesentery that wraps around the tubes. Another part of the broad ligament, the mesovarium suspends the ovaries in place. [5]

Parts

Each tube is composed of four parts: from inside the proximal tubal opening the intramural or interstitial part, that links to the narrow isthmus, the isthmus connects to the larger ampulla, which connects with the infundibulum and its associated fimbriae that opens into the peritoneal cavity from the distal tubal opening. [12]

Intramural part

The intramural part or interstitial part of the fallopian tube lies in the myometrium, the muscular wall of the uterus. This is the narrowest part of the tube that crosses the uterus wall to connect with the isthmus. The intramural part is 0.7 mm wide and 1 cm long. [12]

Isthmus

The narrow isthmus links the tube to the uterus, and connects to the ampulla. The isthmus is a rounded, and firm muscular part of the tube. The isthmus is 1–5 mm wide, and 3 cm long. [12] The isthmus contains a large number of secretory cells. [10]

Ampulla

The ampulla is the major part of the fallopian tube. The ampulla is the widest part of the tube with a maximal luminal diameter of 1 cm, and a length of 5 cm. It curves over the ovary, and is the primary site of fertilization. [12] The ampulla contains a large number of ciliated epithelial cells. [10] It is thin walled with a much folded luminal surface, and opens into the infundibulum. [12]

Infundibulum

The infundibulum opens into the abdomen at the distal tubal opening and rests above the ovary. Most cells here are ciliated epithelial cells. [10] The opening is surrounded by fimbriae, which help in the collection of the oocyte after ovulation. [4] The fimbriae (singular fimbria) is a fringe of densely ciliated tissue projections of approximately 1 mm in width around the distal tubal opening, oriented towards the ovary. [12] They are attached to the ends of the infundibulum, extending from its inner circumference, and muscular wall. [12] The cilia beat towards the fallopian tube. [12] Of all the fimbriae, one fimbria known as the ovarian fimbria is long enough to reach and make contact with the near part of the ovary during ovulation. [13] [14] [12] The fimbriae have a higher density of blood vessels than the other parts of the tube, and the ovarian fimbria is seen to have an even higher density. [8]

An ovary is not directly connected to its adjacent fallopian tube. When ovulation is about to occur, the sex hormones activate the fimbriae,[ citation needed ] causing them to swell with blood, extend, and hit the ovary in a gentle, sweeping motion. An oocyte is released from the ovary into the peritoneal cavity and the cilia of the fimbriae sweep it into the fallopian tube.

Microanatomy

Micrograph of ciliated columnar epithelium of the fallopian tube Histology of ciliated columnar epithelium of the fallopian tube.jpg
Micrograph of ciliated columnar epithelium of the fallopian tube

When viewed under the microscope, the fallopian tube has three layers. [6] From outer to inner, these are the serosa, muscularis mucosae, and the mucosa. [15] [16]

The outermost covering layer of serous membrane is known as the serosa. [6] The serosa is derived from the visceral peritoneum. [14]

The muscularis mucosae consists of an outer ring of smooth muscle arranged longitudinally, and a thick inner circular ring of smooth muscle. [6] This layer is responsible for the rhythmic peristaltic contractions of the fallopian tubes, that with the cilia move the egg cell towards the uterus. [14]

The innermost mucosa is made up of a layer of luminal epithelium, and an underlying thin layer of loose connective tissue the lamina propria. [16] There are three different cell types in the epithelium. Around 25% of the cells are ciliated columnar cells; around 60% are secretory cells, and the rest are peg cells thought to be a secretory cell variant. [4] The ciliated cells are most numerous in the infundibulum, and the ampulla. Estrogen increases the formation of cilia on these cells. Peg cells are shorter, have surface microvilli, and are located between the other epithelial cells. [6] The presence of immune cells in the mucosa has also been reported with the main type being CD8+ T-cells. Other cells found are B lymphocytes, macrophages, NK cells, and dendritic cells. [16]

The histological features of tube vary along its length. The mucosa of the ampulla contains an extensive array of complex folds, whereas the relatively narrow isthmus has a thick muscular coat and simple mucosal folds. [14]

Development

Stages of development of the Mullerian ducts (paramesonephric ducts) and their normal and abnormal development Mullerian duct development.png
Stages of development of the Müllerian ducts (paramesonephric ducts) and their normal and abnormal development

Embryos develop a genital ridge that forms at their tail end and eventually forms the basis for the urinary system and reproductive tracts. Either side and to the front of this tract, around the sixth week develops a duct called the paramesonephric duct, also called the Müllerian duct. [17] A second duct, the mesonephric duct, develops adjacent to this. Both ducts become longer over the next two weeks, and the paramesonephric ducts around the eighth week cross to meet in the midline and fuse. [17] One duct then regresses, with this depending on whether the embryo is genetically female or male. In females, the paramesonephric duct remains, and eventually forms the female reproductive tract. [17] The portions of the paramesonephric duct, which are more cranial—that is, further from the tail-end, end up forming the fallopian tubes. [17] In males, because of the presence of the Y sex chromosome, anti-Müllerian hormone is produced. This leads to the degeneration of the paramesonephric duct. [17]

As the uterus develops, the part of the fallopian tubes closer to the uterus, the ampulla, becomes larger. Extensions from the fallopian tubes, the fimbriae, develop over time. Cell markers have been identified in the fimbriae, which suggests that their embryonic origin is different from that of the other tube segments. [8]

Apart from the presence of sex chromosomes, specific genes associated with the development of the fallopian tubes include the Wnt and Hox groups of genes, Lim1, Pax2, and Emx2. [17]

Embryos have two pairs of ducts that will let gametes out of the body when they are adults; the Müllerian ducts develop in females into the fallopian tubes, uterus, and vagina.

Function

Fertilization

After ovulation, the egg (oocyte) passes from the ovary (left) through the fallopian tube to the uterus (right). Fertilization.jpg
After ovulation, the egg (oocyte) passes from the ovary (left) through the fallopian tube to the uterus (right).

The fallopian tube allows the passage of an egg from the ovary to the uterus. When an oocyte is developing in an ovary, it is surrounded by a spherical collection of cells known as an ovarian follicle. Just before ovulation, the primary oocyte completes meiosis I to form the first polar body and a secondary oocyte, which is arrested in metaphase of meiosis II.

At the time of ovulation in the menstrual cycle, the secondary oocyte is released from the ovary. The follicle and the ovary's wall rupture, allowing the secondary oocyte to escape. The secondary oocyte is caught by the fimbriated end of the fallopian tube and travels to the ampulla. Here, the egg is able to become fertilized with sperm. The ampulla is typically where the sperm are met and fertilization occurs; meiosis II is promptly completed. After fertilization, the ovum is now called a zygote and travels toward the uterus with the aid of the hairlike cilia and the activity of the muscle of the fallopian tube. The early embryo requires critical development in the fallopian tube. [10] After about five days, the new embryo enters the uterine cavity and, on about the sixth day, begins to implant on the wall of the uterus.

The release of an oocyte does not alternate between the two ovaries and seems to be random. After removal of an ovary, the remaining one produces an egg every month. [18]

Clinical significance

Almost a third of cases of infertility are caused by fallopian tube pathologies. These include inflammation, and tubal obstructions. A number of tubal pathologies cause damage to the cilia of the tube, which can impede movement of the sperm or egg. A number of sexually transmitted infections can lead to infertility. [7]

Inflammation

Salpingitis is inflammation of the fallopian tubes and may be found alone, or with other pelvic inflammatory diseases (PIDs). A thickening of the fallopian tube at its narrow isthmus portion, due to inflammation, is known as salpingitis isthmica nodosa. Like another PID endometriosis, it may lead to fallopian tube obstruction. Fallopian tube obstruction may be a cause of infertility or ectopic pregnancy. [19]

Blockage or narrowing

If a blocked fallopian tube has affected fertility, its repair where possible may increase the chances of becoming pregnant. [20] Tubal obstruction can be proximal, distal or mid-segmental. Tubal obstruction is a major cause of infertility but full testing of tubal functions is not possible. However, the testing of patency – whether or not the tubes are open can be carried out using hysterosalpingography, laparoscopy and dye, or hystero contrast sonography (HyCoSy). During surgery, the condition of the tubes may be inspected and a dye such as methylene blue can be injected into the uterus and shown to pass through the tubes when the cervix is occluded. As tubal disease is often related to Chlamydia infection, testing for Chlamydia antibodies has become a cost-effective screening device for tubal pathology. [21]

Ectopic pregnancy

Implantation sites resulting in normal or ectopic pregnancies Ectopic Pregnancy.png
Implantation sites resulting in normal or ectopic pregnancies

Occasionally the embryo implants outside of the uterus, creating an ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, and are commonly known as tubal pregnancies. [22]

Surgery

Example and location of some surgical procedures performed on the fallopian tubes Fallopian Tube Surgical Procedures.png
Example and location of some surgical procedures performed on the fallopian tubes

The surgical removal of a fallopian tube is called a salpingectomy. To remove both tubes is a bilateral salpingectomy. An operation that combines the removal of a fallopian tube with the removal of at least one ovary is a salpingo-oophorectomy. An operation to remove a fallopian tube obstruction is called a tuboplasty. A surgical procedure to permanently prevent conception is tubal ligation.

Cancer

Fallopian tube cancer, which typically arises from the epithelial lining of the fallopian tube, has historically been considered to be a very rare malignancy. Evidence suggests it probably represents a significant portion of what has previously been classified as ovarian cancer, as much as 80 per cent. These are classed as serous carcinomas, and are usually located in the fimbriated distal tube. [23]

Other

In rare cases, a fallopian tube may prolapse into the vaginal canal following a hysterectomy. The swollen fimbriae can have the appearance of an adenocarcinoma. [24]

History

The Greek doctor Herophilus, in his treatise on midwifery, points out the existence of the two ducts that he supposed transported "female semen". Then Galen, already in the modern era, described that the paired ducts indicated by Herophilus were connected to the uterus.

In 1561, the Renaissance doctor Gabriele Falloppio published his book Observationes Anatomicae. Its contribution is a detailed description of the "tubal" of the uterus and its different portions, with its farthest (distal) end open towards the abdomen, and the other (proximal) connected to the uterus. [25] [26]

Though the name Fallopian tube is eponymous, it is often spelt with a lower case f from the assumption that the adjective fallopian has been absorbed into modern English as the de facto name for the structure. Merriam-Webster dictionary for example lists fallopian tube, often spelt Fallopian tube. [27]

Additional images

Related Research Articles

<span class="mw-page-title-main">Ovary</span> Female reproductive organ that produces egg cells

The ovary is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocrine glands, secreting various hormones that play a role in the menstrual cycle and fertility. The ovary progresses through many stages beginning in the prenatal period through menopause.

<span class="mw-page-title-main">Ectopic pregnancy</span> Female reproductive system health issue

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

The oviduct in vertebrates is the passageway from an ovary. In human females, this is more usually known as the fallopian tube. The eggs travel along the oviduct. These eggs will either be fertilized by spermatozoa to become a zygote, or will degenerate in the body. Normally, these are paired structures, but in birds and some cartilaginous fishes, one or the other side fails to develop, and only one functional oviduct can be found.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of female humans

The human female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The reproductive system is immature at birth and develops at puberty to be able to release matured ova from the ovaries, facilitate their fertilization, and create a protective environment for the developing fetus during pregnancy. The female reproductive tract is made of several connected internal sex organs—the vagina, uterus, and fallopian tubes—and is prone to infections. The vagina allows for sexual intercourse, and is connected to the uterus at the cervix. The uterus accommodates the embryo by developing the uterine lining.

<span class="mw-page-title-main">Paramesonephric duct</span> Paired ducts in the mammalian embryo in the primitive urogenital structures

The paramesonephric ducts are paired ducts of the embryo in the reproductive system of humans and other mammals that run down the lateral sides of the genital ridge and terminate at the sinus tubercle in the primitive urogenital sinus. In the female, they will develop to form the fallopian tubes/oviducts, uterus, cervix, and the upper one-third of the vagina.

<span class="mw-page-title-main">Falloposcopy</span>

Falloposcopy is the inspection of the fallopian tubes through a micro- endoscope. The falloposcope is inserted into the tube through its opening in the uterus at the proximal tubal opening via the uterotubal junction; technically it could also be inserted at the time of abdominal surgery or laparoscopy via the distal fimbriated end.

<span class="mw-page-title-main">Human reproductive system</span> Organs involved in reproduction

The human reproductive system includes the male reproductive system, which functions to produce and deposit sperm, and the female reproductive system, which functions to produce egg cells and to protect and nourish the fetus until birth. Humans have a high level of sexual differentiation. In addition to differences in nearly every reproductive organ, there are numerous differences in typical secondary sex characteristics.

Tuboplasty refers to a number of surgical operations that attempt to restore patency and functioning of the fallopian tube(s) so that a pregnancy could be achieved. As tubal infertility is a common cause of infertility, tuboplasties were commonly performed prior to the development of effective in vitro fertilization (IVF) or repair of any type of tube-like structure, including the Eustachian tube in the head and neck.

<span class="mw-page-title-main">Human fertilization</span> Union of a human egg and sperm

Human fertilization is the union of an egg and sperm, occurring primarily in the ampulla of the fallopian tube. The result of this union leads to the production of a fertilized egg called a zygote, initiating embryonic development. Scientists discovered the dynamics of human fertilization in the 19th century.

<span class="mw-page-title-main">Hydrosalpinx</span> Medical condition

A hydrosalpinx is a condition that occurs when a fallopian tube is blocked and fills with serous or clear fluid near the ovary. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility. A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx.

<span class="mw-page-title-main">Uterine horns</span> Exit of the fallopian tube

The uterine horns are the points in the upper uterus where the fallopian tubes or oviducts exit to meet the ovaries. They are one of the points of attachment for the round ligament of uterus. They also provide attachment to the ovarian ligament, which is located below the fallopian tube at the back, while the round ligament of uterus is located below the tube at the front.

Tubal reversal, also called tubal sterilization reversal, tubal ligation reversal, or microsurgical tubal reanastomosis, is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be re-implanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

<span class="mw-page-title-main">Fallopian tube obstruction</span> Medical condition

Fallopian tube obstruction, also known as fallopian tube occlusion, is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible.

The development of the reproductive system is the part of embryonic growth that results in the sex organs and contributes to sexual differentiation. Due to its large overlap with development of the urinary system, the two systems are typically described together as the genitourinary system.

Ovarian pregnancy refers to an ectopic pregnancy that is located in the ovary. Typically the egg cell is not released or picked up at ovulation, but fertilized within the ovary where the pregnancy implants. Such a pregnancy usually does not proceed past the first four weeks of pregnancy. An untreated ovarian pregnancy causes potentially fatal intra-abdominal bleeding and thus may become a medical emergency.

<span class="mw-page-title-main">Fertility testing</span> Process for assessing human fertility

Fertility testing is the process by which fertility is assessed, both generally and also to find the "fertile window" in the menstrual cycle. General health affects fertility, and STI testing is an important related field.

Endometriosis and its complications are a major cause of female infertility. Endometriosis is a dysfunction characterized by the migration of endometrial tissue to areas outside of the endometrium of the uterus. The most common places to find stray tissue are on ovaries and fallopian tubes, followed by other organs in the lower abdominal cavity such as the bladder and intestines. Typically, the endometrial tissue adheres to the exteriors of the organs, and then creates attachments of scar tissue called adhesions that can join adjacent organs together. The endometrial tissue and the adhesions can block a fallopian tube and prevent the meeting of ovum and sperm cells, or otherwise interfere with fertilization, implantation and, rarely, the carrying of the fetus to term.

<span class="mw-page-title-main">Tubal factor infertility</span> Medical condition

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. Tubal factor is one complication of chlamydia trachomatis infection in women.

Chromopertubation is a method for the study of fallopian tube patency for suspected infertility in women caused by fallopian tube obstruction. Occlusion or pathology of the fallopian tubes is the most common cause of suspected infertility. Chromopertubation is sometimes commonly referred to a "laparoscopy and dye" test. It is currently one of the standard procedures in this field. In most cases, chromopertubation is performed to assess and determine the cause of someone's difficulties in getting pregnant.

<span class="mw-page-title-main">SEE-FIM Protocol</span> Pathology protocol to assess cancer risk

The SEE-FIM protocol is a pathology dissection protocol for Sectioning and Extensively Examining the Fimbria (SEE-FIM). This protocol is intended to provide for the optimal microscopic examination of the distal fallopian tube (fimbria) to identify either cancerous or precancerous conditions in this organ.

References

PD-icon.svgThis article incorporates text in the public domain from page 1257 of the 20th edition of Gray's Anatomy (1918)

  1. ↑ "Uterine Tube (Fallopian Tube) Anatomy: Overview, Pathophysiological Variants". 14 July 2021. Retrieved 15 September 2022.
  2. ↑ Zhao, W; Zhu, Q; Yan, M; Li, C; Yuan, J; Qin, G; Zhang, J (February 2015). "Levonorgestrel decreases cilia beat frequency of human fallopian tubes and rat oviducts without changing morphological structure". Clinical and Experimental Pharmacology & Physiology. 42 (2): 171–8. doi:10.1111/1440-1681.12337. PMC   6680194 . PMID   25399777.
  3. ↑ Han, Joan; Sadiq, Nazia M. (2022). "Anatomy, Abdomen and Pelvis, Fallopian Tube". StatPearls. StatPearls Publishing. PMID   31613440 . Retrieved 22 September 2022.
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  11. ↑ Harris, Emily A.; Stephens, Kalli K.; Winuthayanon, Wipawee (5 November 2020). "Extracellular Vesicles and the Oviduct Function". International Journal of Molecular Sciences. 21 (21): 8280. doi: 10.3390/ijms21218280 . PMC   7663821 . PMID   33167378.
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  22. ↑ "Ectopic pregnancy | RCOG" . Retrieved 2 October 2022.
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  26. ↑ Herrera Calmet, Abelardo (2 July 2015). "Cáncer primitivo de la trompa de falopio". Revista Peruana de Ginecología y Obstetricia. 3 (3): 172–182. doi:10.31403/rpgo.v3i1157. ISSN   2304-5132.
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