Tubal Disease
Damage to the fallopian tubes affects the passage of both egg and sperm through it. The egg and sperm meet in the fallopian tube and fertilise. Normally the fertilised egg then passes into the womb ready for implantation. There are discrete currents of fluid in the fallopian tube which are essential to assist the movement of sperm, the egg and the fertilised egg (embryo)
Damage to the fallopian tubes may be unilateral (one side) or Bilateral (both sides). Damage by infection is usually bilateral.
If the fallopian tubes are both blocked then conception is highly unlikely. Rarely does healing occur. Blockage can occur anywhere but the commonest is at the end next to the ovary.
If the fine micro hairs inside the fallopian tubes are damaged then the currents wafting the egg and sperm in the appropriate direction are hindered and function is affected.
If the fallopian tube end is tethered down it will work less well, even if the tube micro hairs are normal and the tube is open. It appears that movement of the tubal end is necessary for good function.
Causes of tubal disease are beyond the scope of this document but include infection such as chlamydia, gonorrhoea, appendicitis, previous surgery and endometriosis but to name a few.
Management is either correction of the occlusion or IVF where the egg is removed, fertilised outside the body and replaced through the cervix avoiding the fallopian tube altogether.
Unfortunately fewer than 20% of women with tubal disease are suitable for surgery. In the majority of cases surgery carries a very low chance of success. If the fallopian tubes are open, the tethering is by fine adhesions and the tube is not swollen then there is some chance of success.
Only tubal surgery using microsurgical techniques has any real chance of success.
The only exception to this is tubal surgery for reversal of sterilisation where sterilisation has been by filshie clips. In our hands this carries a 70-80% success rate in women under 38 and therefore may be preferred to IVF. Unfortunately health authorities and the NHS do not fund this procedure so it can only be carried out in the private sector.
Investigation of tubal function
See section on procedures
HyCoSy
This is an ultrasound test and is useful for screening the fallopian tube for patency. It is useful mainly as a screening test as it can be done in outpatients but the pictures require some interpretation.
View our document on 
HyCoSy
Hysterosalpingogram
An x-ray based technique where dye is placed through the cervix and the fallopian tubes are outlined by the dye
View our document on Hysterosalpingogram
Laparoscopy
This test involves putting a fine telescope into the abdomen. It is carried out under general anaesthetic. It is the most invasive test but the most accurate
View our document on Laparoscopy