In order for natural conception to take place, three basic factors need to be come together: ovulation needs to take place, there needs to be an appropriate quantity of spermatozoa with appropriate mobility in the ejaculate and, in third place, the uterine tubes need to be permeable. The latter is essential in order for both gametes to join together (egg and sperm) and for fertilisation to then take place.
When these structures, or fallopian tubes, are obstructed, they cannot receive the egg released by the ovary during ovulation. When they do not work correctly, however, as is the case when they become inflamed, transportation of spermatozoa to the egg or transport of the fertilised egg to the uterine cavity for implantation is affected. In the case of the latter, if the embryo does not reach the cavity, it is at risk of implanting inside the tubes and generating what is known as an ectopic pregnancy or a pregnancy that is ‘out of place’.
Inflammation in the fallopian tubes is known as salpingitis. This generally happens as a result of sexually transmitted infections. The most common pathogens are chlamydia trachomatis, gonococci or mycoplasma hominis. It can, less frequently, be the result of bacteria from the vagina spreading upwards and becoming pathogens (streptococcus, staphylococcus, etc.) The infection can be serious and cause specific symptoms such as pain in the pelvic area; pain during sexual intercourse; pain during ovulation or menstruation; fever; nausea or vomiting; an abnormal, foul-smelling vaginal discharge; and/or unusual bleeding between periods. Acute salpingitis calls for immediate medical attention and this generally comes in the shape of a course of treatment with antibiotics and anti-inflammatories. However, serious cases can turn into a general infection or sepsis or an abscess or build-up of pus in the fallopian tube that requires surgical intervention.
However, many cases of salpingitis can occur gradually and go unnoticed or recover from the serious phase but with consequences. Such cases are known as chronic salpingitis. The consequences of inflammation in the uterine tube can include fibrosis in the lumen of the tube, adherence of the tubes to structures located nearby – for example, the intestines or bladder – or an accumulation of secretion within the lumen, leading to dilation. It is known as hydrosalpinx if the content is hyaline or piosalpinx if the content is purulent. As might be expected, all these processes hinder correct performance of the channel. It needs to be free of obstruction so that spermatozoa, eggs and, later, embryos can reach their destinations. Several studies have also shown how the liquid full of detritus and toxic substances in a hydrosalpinx can decrease the ability of an embryo to implant both naturally and after embryo transfer during in vitro fertilisation treatment (IVF). Damage to the fallopian tubes is, therefore, one of the most common causes of sterility.
Prevention is the best treatment in the field of medicine and, as such, having a healthy sex life, refraining from smoking and visiting the gynaecologist on a regular basis are some of the measures at our disposal in order to avoid salpingitis occurring. However, when a disease does happen, it is equally or more important to recognise the symptoms in time, get a medical assessment and have the necessary treatment as quickly as possible in order to avoid any complications and not reduce chances of getting pregnant naturally. However, when a fallopian tube is part of a reason for issues getting pregnant, we have the option of in vitro fertilisation techniques. In these techniques, the union between the spermatozoa and ovum takes place outside the fallopian tubes and is carried out by specialised staff in a laboratory designed specifically for this purpose. Embryos that can later be transferred to the mother’s uterus are obtained in this way. There is no need for the fallopian tubes to be intact and the chances of getting pregnant, if there are no other associated factors, are high.