Fallopian Tube Agenesis - An Insight

Introduction:

The fallopian tubes are two in number, carrying out the primary function of transporting eggs from the ovary (which produces eggs) to the uterus (womb where the fetus develops) on each side of the female reproductive system. When one fallopian tube is absent, the attached ovary is also missing. When both tubes are absent, the ovaries on either side of the female reproductive system are also not developed. Fallopian tubes are also called uterine tubes or oviducts. The tubes are about 3.9 inches long and lined with ciliated epithelia. There are issues with fertility in women who have fallopian tube agenesis.

What Are the Parts of the Fallopian Tube?

The fallopian tube consists of four parts, and they are as follows:

• Infundibulum:

The infundibulum part is found at the ovarian end. This is a funnel-shaped opening. There are finger-like projections called fimbria.

• Ampulla:

The ampulla is the widest section of the fallopian tube. The fertilization of the egg and the sperm occurs in this part.

• Isthmus:

The isthmus is a narrow part of the fallopian tube. The isthmus connects the ampulla to the uterine cavity.

• Intramural Portion:

The intramural portion is the continuation of the fallopian tube through the uterine wall.

There are three layers of the fallopian tubes:

• Mucosa:

The mucosa is highly folded. The mucosa consists of ciliated columnar epithelium and secretory cells.

• Muscularis Externa:

The muscularis externa consists of inner circular and outer longitudinal smooth muscles.

• Serosa:

The serosa consists of loose connective tissue.

What Role Do Fallopian Tubes Play in the Female Reproductive System?

The fallopian tubes play a significant role in conception and pregnancy.

• Holds a Place for the Released Egg: One of the ovaries discharges an egg every month as a part of the menstrual cycle. Fimbria are finger-like projections near the ovarian end. They sweep the released egg from the ovary into the fallopian tube.

• The Site for Fertilization: When the male ejaculates sperm during intercourse, the sperm moves through the vagina, cervix, uterus, and then to the fallopian tubes. Fertilization occurs in the fallopian tube after the fusion of the egg and sperm.

• Plays the role of transporting the fertilized egg to the uterus. The uterus (womb) is where the fertilized egg develops into the fetus. The fetus grows in the uterus during gestation and increases in size.

What Are the Causes of Non-functioning Fallopian Tubes?

• A Congenital Birth Defect - The absence of one or two fallopian tubes is one of the reasons for fallopian tube agenesis.

• A prior history of infections that led to damage or scarring of the fallopian tube.

• A medical condition is a reason for the removal of fallopian tubes.

• Ectopic Pregnancy: Ectopic pregnancy means the fertilized egg implants on the outer surface of the uterus (womb), which results in permanent tube damage or removal.

• Endometriosis: Endometriosis means the cells similar to those which line the uterus develop on the outer side of the uterus, The fallopian tubes, and the ovaries; on these surfaces, the cells grow, causing pelvic pain and scarring of the fallopian tube.

• Fibroids: Fibroid tumors block the fallopian tubes and also the entrance to the uterus.

• The history of abdominal or pelvic surgery that causes scarring or damage to the fallopian tube,

• Hydrosalpinx: Hydrosalpinx means the fallopian tubes are blocked due to the accumulation of fluids. The fluid deposition is due to infection or injury to the tubes. The chances of getting pregnant are difficult in such cases.

• Paratubal Cysts: The fluid-filled masses develop near the fallopian tubes and ovaries. They are noncancerous. They degenerate without any treatment.

• Pelvic Inflammatory Disease: Pelvic inflammatory disease means they cause inflammation of the fallopian tubes because of infection. The pelvic inflammatory disease leads to infertility if not treated.

What Are the Diagnostic Tests to Check the Health of Fallopian Tubes?

• Hysterosalpingography: This is most commonly done to check for fallopian tube abnormalities. This X-ray dye test is used to detect the problems. During an HSG, an X-ray captures images of the uterine chamber and fallopian tubes while they are filled with a specific dye. The test is done seven days after the period stops and before the ovulation (discharge of an egg from the ovary). This test does not require anesthesia.

In most cases, it gives false positive results of blockage of the fallopian tubes. Detects the structural disorders and reason for the blockage. The fertility in young women appears to be slightly improved if the results are normal. The procedure widens the tubes and also clears the fallopian tube of mucus and debris. There is an observation period after this test.

• Sonohysterography: Sonohysterography is used to detect problems within the fallopian tubes. A saline solution is injected into the interior of the uterus through the cervix during the ultrasonography, so the interiors are distended, and the abnormalities can be visualized easily. They are not blocked if the solution flows freely into the fallopian tubes.

This procedure is quick, and there is no need for anesthesia. This procedure is safer than hysterosalpingography because it does not require radiation or injection of a contrast agent. The accuracy of the sonohysterography depends on the skill of the clinicians who performs this test.

• Laparoscopy: In this procedure, a tube with a camera laparoscope is inserted into the pelvic cavity through a small incision below the navel. General anesthesia is used. The laparoscopy lets clinicians directly view the uterus, ovaries, and fallopian tubes.

• Hysteroscopy: A hysteroscope is placed through the vagina and cervix into the uterus. If polyps or fibroids are in the uterus, they are removed with the help of a hysteroscope.

Will the Menstrual Periods Occur in Fallopian Tube Agenesis Cases?

The menstrual cycle does not have any effect on the condition of the fallopian tubes. The periods depend on the hormones and ovulation (egg discharge from an ovary).

Is There a Chance of Pregnancy in Fallopian Tube Agenesis Cases?

There are chances of conceiving in the absence of one fallopian tube. But if both the fallopian tubes are absent, the chances of getting pregnant are less.

What Is the Treatment for Fallopian Tube Agenesis?

• Unblocking a blocked or scarred fallopian tube through surgery.

• Using fertility medications if ovulating through one tube. This increases the number of eggs released by the ovary (the ovulation process).

Conclusion:

Fallopian tube agenesis can cause infertility in women when both the fallopian tubes are absent. Hence proper diagnosis and early treatment can reduce complications. In instances of fallopian tube agenesis, early detection, and urgent medical intervention are required. These malformations are rare and are occasionally seen clinically, and some complications, such as ectopic pregnancy, can lead to death if not diagnosed. There are plenty of different types of fallopian tube abnormalities, considering their rarity.