Tubal factor infertility

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Tubal factor infertility
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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]

Contents

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]

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

Related Research Articles

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

<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.

Infertility is the inability of an animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. It is the normal state of a human child or other young offspring, because they have not undergone puberty, which is the body's start of reproductive capacity.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

Mycoplasma hominis is a species of bacteria in the genus Mycoplasma. M. hominis has the ability to penetrate the interior of human cells. Along with ureaplasmas, mycoplasmas are the smallest free-living organisms known.

<span class="mw-page-title-main">Fitz-Hugh–Curtis syndrome</span> Medical condition

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the formation of adhesions presenting with the clinical syndrome of right upper quadrant (RUQ) pain.

<span class="mw-page-title-main">Mycoplasmataceae</span> Family of bacteria

Mycoplasmataceae is a family of bacteria in the order Mycoplasmatales. This family consists of the genera Mycoplasma and Ureaplasma.

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

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

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

Salpingitis is an infection causing inflammation in the fallopian tubes. It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, and peritonitis.

<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">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. Fallopian tubes are also known as oviducts, uterine tubes, and salpinges.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

<span class="mw-page-title-main">Fallopian tube</span> Tubes in the human female reproductive system

The fallopian tubes, also known as uterine tubes, oviducts or salpinges, are paired tubes in the human female body that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In other mammals, they are only called oviducts.

<span class="mw-page-title-main">Hysterosalpingography</span> Radiological procedure

Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It is a special x-ray procedure using dye to look at the womb (uterus) and fallopian tubes. In this procedure, a radio-opaque material is injected into the cervical canal, and radiographs are taken. A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. To demonstrate tubal patency, spillage of the material into the peritoneal cavity needs to be observed. Hysterosalpingography has vital role in treatment of infertility, especially in the case of fallopian tube blockage.

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">Tubo-ovarian abscess</span> One of the late complications of pelvic inflammatory disease

A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary. These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. It is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs. A TOA can also develop as a complication of a hysterectomy.

The exact role of Mycoplasma hominis in regards to a number of conditions related to pregnant women and their (unborn) offspring is controversial. This is mainly because many healthy adults have genitourinary colonization with Mycoplasma, published studies on pathogenicity have important design limitations and the organisms are very difficult to detect. The likelihood of colonization with M. hominis appears directly linked to the number of lifetime sexual partners Neonatal colonization does occur, but only through normal vaginal delivery. Caesarean section appears protective against colonization and is much less common. Neonatal colonization is transient.

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.

Pelvic abscess is a collection of pus in the pelvis, typically occurring following lower abdominal surgical procedures, or as a complication of pelvic inflammatory disease (PID), appendicitis, or lower genital tract infections. Signs and symptoms include a high fever, pelvic mass, vaginal bleeding or discharge, and lower abdominal pain. It can lead to sepsis and death.

References

  1. ↑ Bardawil, MD, Tarek. Lucidi, MD, Richard Scott (ed.). "Fallopian Tube Disorders". Medscape. Retrieved 2015-03-31.
  2. 1 2 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 . PMC   4295611 . PMID   25614838.
  3. ↑ Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C, Mbizvo MT, Vogelsong KM (2010). "World Health Organization reference values for human semen characteristics". Hum. Reprod. Update. 16 (3): 231–45. doi: 10.1093/humupd/dmp048 . PMID   19934213.
  4. 1 2 3 Kodaman PH, Arici A, Seli E (June 2004). "Evidence-based diagnosis and management of tubal factor infertility". Current Opinion in Obstetrics and Gynecology. 16 (3): 221–9. doi:10.1097/00001703-200406000-00004. PMID   15129051. S2CID   43312882.
  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. p. 65. ISBN   9780071849081. OCLC   944920918.{{cite book}}: CS1 maint: location missing publisher (link)
  6. ↑ Tay JI, Moore J, Walker JJ (2000). "Ectopic pregnancy". West. J. Med. 173 (2): 131–4. doi:10.1136/ewjm.173.2.131. PMC   1071024 . PMID   10924442.
  7. ↑ Speroff L, Glass RH, Kase NG (1999). Clinical Gynecological Endocrinology and Infertility, 6th Ed. Lippincott Williams & Wilkins (1999). p. 1149ff. ISBN   978-0-683-30379-7.
  8. ↑ "Fact Sheet and Information Booklets: Endometriosis: Does It Cause Infertility?". ASRM. Retrieved 2015-04-01.
  9. ↑ "Pelvic Inflammatory Disease (PID) Partner Management and Public Health Measures". cdc.gov. October 2014. Archived from the original on 22 February 2015. Retrieved 21 February 2015.
  10. ↑ Walker CK, Wiesenfeld HC (2007). "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. doi: 10.1086/511424 . PMID   17342664.
  11. ↑ Ness RB, Soper DE, Holley RL, et al. (2002). "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. 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. ↑ Smith KJ, Ness RB, Wiesenfeld HC, et al. (2007). "Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies". Sex Transm Dis. 34 (12): 960–6. doi: 10.1097/01.olq.0000225321.61049.13 . PMID   18077847. S2CID   31500831.
  14. 1 2 "CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines". cdc.gov.
  15. ↑ Sherbahn MD, Richard. "Fallopian Tube Surgeries for Infertility: Laparoscopy & More". WedMD. Retrieved 2015-03-31.
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