The uterus must allow the passage of sperm: a few days after fertilisation, the embryo reaches the uterus and implants in its inner layer, called the endometrium. This must offer adequate conditions for the foetus to develop.
A blocked or damaged fallopian tube can prevent sperm from reaching the egg or the fertilised egg (zygote) from passing into the uterus for implantation.
Anomalies in the uterus or pelvis can prevent the egg from adhering to the uterine lining and block the tubes. If tubal damage is confirmed, the necessary treatment is In Vitro Fertilisation.
The initial assessment of the uterus is done with a vaginal ultrasound. This allows us to observe the morphology of the uterus, the endometrial cavity and the ovaries. Anomalies such as fibroids, uterine polyps and ovarian cysts can be diagnosed, which in some cases will require surgery. Some patients will need a more in-depth study of the endometrium if there is a history of miscarriages or pelvic infections or when alterations are observed in the ultrasound, in which case a hysteroscopy is performed.
The hysteroscopy is carried out in the doctor’s surgery. A thin cannula connected to a screen is inserted through the cervix to visualise the endometrial cavity. Samples are also taken for biopsy (study of the cells that make up the endometrium) and for cultures of Chlamydia, Mycoplasmas and Ureaplasmas that allow us to rule out endometritis.
Endometritis is an infection that does not cause symptoms in the patient but can prevent embryo implantation. In these cases, antibiotic treatment is indicated.
To study the vascularisation of the endometrium, a vaginal Doppler ultrasound is performed, which allows us to rule out alterations in blood flow.
To study the permeability of the fallopian tubes, a hysterosalpingography is performed. This is carried out in the Radiology Department. It involves injecting a contrast medium through the cervix that fills the uterine cavity and the tubes and exits into the abdomen. This x-ray requires the patient to be prepared so that it does not cause them pain.
If the result of the test is normal, the tubes are considered to be permeable, although it does not assure us that they perfectly fulfil all their functions of nutrition and transport of gametes and embryos.
If the result is pathological, a tubal factor can be diagnosed, for example, if the passage of the contrast or hydrosalpinx is obstructed (pathological dilation of the tubes).
In some cases, the result is inconclusive and a diagnostic laparoscopy is advised to better assess the tubal function.
The tubes can be affected by pelvic infections (currently the most common agents are Chlamydia), endometriosis or the condition may be secondary to gynaecological surgery.
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