What are the symptoms of fallopian tube obstruction?

Fallopian tube blockage also depends on the situation. Fallopian tube blockage does not mean that women have lost the chance of getting pregnant, because there are two fallopian tubes in the body. If only one fallopian tube is blocked and the other fallopian tube is normal, pregnancy is still possible. But if both fallopian tubes are blocked, pregnancy is basically impossible. So the question is, what are the symptoms of fallopian tube obstruction?

Clinical manifestations

Generally speaking, there are no typical symptoms. The most common manifestation is infertility. The fallopian tube plays an important role in transporting sperm, absorbing eggs and transporting fertilized eggs to the uterine cavity. Blockage of the fallopian tube hinders the passage of sperm and fertilized eggs, leading to infertility or ectopic pregnancy. If the fallopian tube obstruction is caused by pelvic inflammation, it may be accompanied by lower abdominal pain, back pain, increased secretions, pain during sexual intercourse, etc.

1. Physical examination

Signs of infection should be checked, and cervicitis should be checked. Signs of PID should be carefully checked, including cervical lifting pain and adnexal tenderness. Increased vaginal discharge should not be ignored, and cervical secretion culture is a good choice. Patients with signs of endometriosis such as uterine sacral tenderness or nodules should be examined rectally and vaginally. If the patient has had this disease, chlamydial antibody (CAT) testing should be performed. Many studies support the relationship between CAT and fallopian tube disease. Retrospective analysis shows that its sensitivity and specificity are 92% and 70%, respectively.

2. Auxiliary examination

If the patient is at low risk for tubal disease or has no other causes of infertility, HSG is the first choice. If the patient is at higher risk or has the potential for disease, laparoscopic evaluation may be considered. The gold standard for fallopian tube assessment is by laparoscopy and methylene blue dye injection.

(1) Tubal peristalsis is a procedure in which methylene blue or saline solution is injected into the uterine cavity from the cervix and then flows into the fallopian tube from the uterine cavity. The resistance during injection and the backflow of the fluid are used to determine whether the fallopian tube is unobstructed. Due to the advantages of simple equipment, easy operation and low price, this method of fallopian tube permeability examination was widely used before the 1980s. However, since the entire process relies on the doctor's subjective feeling and judgment, and the location of the fallopian tube blockage cannot be determined, the tension during the examination can cause fallopian tube spasm and cause false positives. In recent years, surgery can be performed under ultrasound monitoring, which has improved the accuracy rate, but in actual clinical work, it was found that this method has a high misdiagnosis rate, so it is not an ideal examination.

(2) Hysterosalpingography (HSG) was first used in the 1920s. It involves injecting high-density substances composed of high atomic numbers (such as iodine, diatrizoate, etc.) into the uterine cavity through the cervical canal. Under X-ray, they form a clear artificial contrast with the surrounding tissues, making the tubal cavity visible. It can detect tubal occlusion, tubal motility, mucosal damage caused by previous infection or tubal endometriosis, hydrosalpinx, isthmus nodules, adhesions and tubal abnormalities (such as accessory valves and diverticula). It is a fast, economical and low-risk examination. HSG has a sensitivity of 65% for tubal occlusion and adhesions, but painful tubal spasm can cause false positives, while pain, infection, and contrast agent invasion into the vascular system are rare complications.