Table 3.

Main issues in tubal subfertility

• Problems with fallopian tubes are responsible for up to one third of cases of female subfertility

• Major damage to the fallopian tubes can occur after infection or abdominal surgery

• Prophylactic antibiotics given at uterine instrumentation are effective in reducing pelvic inflammatory disease and tubal damage

• Tubal damage cannot be excluded by the lack of a history of pelvic inflammation

• The number and severity of the episodes of pelvic inflammatory disease are strongly correlated with the degree of tubal damage

• Measurement of serum C trachomatis antibody titres may be useful in identifying patients with high likelihood of tubal damage

• Hysterosalpingo-contrast sonography is a useful test to confirm tubal patency and to assess uterine cavity and ovarian morphology without exposure to x rays

• Hysterosalpingography is a simple, safe, inexpensive x ray contrast study for assessing the uterine cavity and fallopian tubes

• The laparoscopy and dye hydrotubation test is useful in the diagnosis of peritubal adhesions and endometriosis, and for the accurate assessment of the optimal management options and prognosis

• Hysterosalpingo-contrast sonography, hysterosalpingography, and laparoscopy and dye hydrotubation tests play complementary roles in the investigation of subfertility in women

• In vitro fertilisation is more effective in all cases of tubal damage than tubal surgery, which is only suitable for peritubal adhesions, reversal of sterilisation, and tubocornual anastomosis in selected cases and selected centres with appropriate expertise