Fallopian Tube Function And Fertility
Checking whether fallopian tubes are open enough to allow a gush of dye to flow through is a critical part of a fertility work-up, and it’s important to know that a woman has at least one open tube for a couple to have a good chance of securing a natural conception. But fallopian tubes are more complicated than many people realize and simply knowing that a tube is open may not be enough information to go on to know if a tube is truly fertile.
Surprisingly, fallopian tubes play a very active role in conception. Tubes have a lot of ‘moving parts’ which must all work harmoniously together for an embryo to reach the uterus within the critical fertile window.
Once ovulation has occurred progesterone secretion kicks in and the clock begins ticking. Progesterone primes the uterus for a very tight window of conception.
If an embryo takes too long to get to it’s destination it’s arrival may well be out-of-synch with the uterus lining. If so, conception of even the most perfect embryo may be a no-go because the uterus may have had too much progesterone exposure. For successful conception, timing is everything.
A key determinant of the speed with which an embryo reaches the uterus is peristaltic wave activity within the muscular walls of the fallopian tubes.
Peristaltic waves are responsible for moving food through the intestines, and similarly, rhythmic peristaltic waves in the tube walls are vital to move an embryo along in a timely fashion. Tiny cilia - which are hair-like projections from the tube walls - also help by wafting the embryo along.
Interestingly, it is possible to observe the rhythm of peristaltic waves in fallopian tubes during a procedure called hysteroscopy when it’s performed with an injection of methylene blue dye into the tubes.
A 2018 study (1) set out to examine whether the presence or lack or rhythmic peristaltic activity could be linked with unexplained infertility. When hysteroscopy was performed in groups of women with and without unexplained infertility it was discovered that when tubes were patent or open almost twenty percent of women with unexplained infertility had no tubal peristaltic activity compared to just 3.7% of fertile women who had open tubes.
The researchers suggest that lack of peristaltic activity may be a hidden cause of unexplained infertility and call for more studies to be done.
“In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.”
Woman with unexplained fertility often fail to conceive after multiple attempts at conception with various forms of ovulation induction - when male fertility is stellar - and IVF often becomes the last resort. When conception via IVF happens speedily with good quality embryos it makes sense that fallopian tube dysfunction may have been the cause of the problem all along.
Hopefully, by paying greater diagnostic attention to tube function women with tubal dysfunction can be identified sooner in their infertility journey to offer IVF sooner and bypass cycles of ovulation induction which may have little chance of success.
In the meantime, it’s interesting to note that some animal research has found caffeine can have a paralyzing effect on the muscles which control fallopian tube peristalsis. It’s also possible that acupuncture is able to influence tubal peristalsis in the same way that it affects intestinal peristaltic waves in disorders such as dysentery.
When I’m working with women with unexplained infertility I usually offer tho or three abdominal acupuncture treatments between ovulation and implantation to encourage healthy tube function. And it makes sense to keep caffeine consumption in check.
(1) J Obstet gynecol. 2018 Mar 20:1-5. doi: 10.1080/01443615.2017.1303469. [Epub ahead of print] Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility.
Yücel B1, Demirel E2, Kelekci S2, Shawki O3.
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