The sperm must be able to reach the released oocyte (egg) through the uterus and the fallopian tubes. A few days after the fertilisation, the embryo reaches the uterus and implants in its inner membrane layer, called the endometrium. Suitable conditions of the endometrium are required 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, IVF.
The initial assessment of the uterus is done with a vaginal ultrasound. This allows careful observation of the uterine structures, 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 evaluation of the endometrium. A history of miscarriages or pelvic infections or abnormalities in the ultrasound evaluation may necessitate a hysteroscopy to appropriately estimate the likelihood of a pregnancy.
The hysteroscopy may carried out at the doctor’s office but more commonly at a separate dedicated procedure room. A thin cannula connected to a screen is inserted through the cervix to visualise the endometrial cavity. Samples (biopsies) may also be taken for detailed evaluation of the endometrium (to rule out infections, immunological imbalances and ensure appropriate hormonal milieu).
Endometritis is a chronic infection that does not cause symptoms in the patient but can prevent embryo implantation. In these cases, antibiotic treatment is indicated.
Open fallopian tubes are necessary for natural conception, as fertilization typically occurs within the tube. The cilia inside functioning tubes actively guide sperm toward the released egg during ovulation.
A fallopian tube patency test is performed to assess whether sperm and fertilized eggs can move freely through the fallopian tubes. A patency test is especially recommended if you have a history of chlamydia infection, endometriosis, or abdominal surgery.
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