Female infertility, tubal and peritoneal factors

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Le fallopian tubes they are two small tubes that emerge from the uterus and open inside the peritoneal cavity, near the ovaries. They collect the oocyte released every month and host the eventual meeting between the oocyte itself and the spermatozoon (fertilization). If this occurs, always through the fallopian tubes the resulting embryo reaches the uterine cavity.


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Since the tubes are very thin and delicate, they can easily "plug", preventing the meeting between oocyte and sperm or the transfer of the fertilized egg to the uterus. This restriction or closure can occur for several reasons.

Tubal and peritoneal (or pelvic) factors of female infertility

Inflammation due to pelvic infection

It is the most frequent cause and often depends on sexually transmitted diseases, such as Chlamydia trachomatis infection and gonorrhea. These are generally asymptomatic infections, so the woman may not know that she has contracted them and that she has thus damaged the tubes until an infertility problem emerges;

Scarring outcomes following pelvic surgery

For example for appendicitis;

Pelvic adhesions

These are "bridles" of fibrous scar tissue that form in the abdomen and pelvis, usually following surgery. They begin to form as part of the healing process a few days after surgery and bind (ie "stick") organs and tissues that are normally separated. They can affect the ovaries, fallopian tubes, bladder or intestines. When they affect the fallopian tubes and ovaries usually cause infertility;


It can cause lesions on the fallopian tubes themselves or following the onset of a state of ichronic inflammation.

Tubal patency test

There are specific instrumental procedures to determine if the fallopian tubes are free (patent) or closed. The main tests are:

  • Hysterosalpingography X-ray examination to study the fallopian tubes, which involves the use of a radiographic contrast medium introduced through the vagina. If the fallopian tubes are patent, the contrast medium will fill the uterus and tubes and escape into the abdominal cavity. This test accurately shows whether the tubes are blocked, but cannot show the actual state of the tubes (for example, the presence of endometriosis or adhesions). It can, at times, be painful;
  • Isterosonosalpingosonografia o sonosalpingografia Vaginal ultrasound examination similar to hysterosalpingography. In this case, however, a special contrast agent is used which reflects the ultrasounds, making the investigated areas appear in solid white on the screen. After introduction of the contrast medium through the vagina, a transvaginal ultrasound probe is used. The examination is as accurate as hysterosalpingography but is simpler, less expensive, and less invasive. Furthermore, with this examination all the risks associated with exposure to X-rays are avoided;
  • Laparoscopy Direct visualization of the ovaries and the outer part of the fallopian tubes through the use of a laparoscope (a thin tube at the end of which is a tiny video camera). The laparoscope is introduced under anesthesia, through a small incision near the navel; it can show the presence of adhesions, cysts and endometriosis in the ovaries, tubes and fimbriae. The examination can cause discomfort to the patient and swelling; there is a slight risk of bleeding and intestinal perforation.
For a complete guide to fertility and conception go to the series of articles on Fertility and conception, from natural fertilization to assisted reproduction

Sources for this article: Consulting of prof Carlo Flamigni, surgeon, lecturer in the obstetrics and gynecology clinic, member of the National Bioethics Committee; information material from the Ministry of Health.

(revised by Valentina Murelli)

Updated on 20.04.2022

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  • tubal and peritoneal factors
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