Pathophysiology of the Fallopian Tube

Question 1

Name the 5 part of the fallopian tube, from the section close to the ovary upward.

Answer 1

1. Fimbrae
2. Infundibulum
3. Ampulla
4. Isthmus
5. Intramural

Question 2

What is an oocyte-cumulus complex?

Answer 2

It’s the combination of the oocyte and the cumulus cells, which are designed to keep the oocyte protected and aid with fertilisation.

Question 3

How does the oocyte-cumulus get into the fallopian tube?

Answer 3

The fimbrae are close to the ovary when ovulation occurs, and the finger-like structures move the oocyte toward the fallopian tube. Generally the fimbrae pick up the oocyte from the neighbouring ovary but it is possible for them to pick it up from the pouch of Douglas

Question 4

How long does the oocyte stay in the ampulla, for what reason and what aids with its stay here?

Answer 4

• 72-80h
• The ampulla is where fertilisation generally takes place, so the longer the egg is here, the better the chances of conception.
• The isthmic muscles spasm to keep the egg in place as the isthmic mucus forms a plug to keep it there.

Question 5

Describe sperm transportation in the fallopian tube

Answer 5

The sperm reaches the tube within 5-60 minutes and binds to the epithelium. It stays in the tube for up to 85 hours.

Question 6

What is capacitation?

Answer 6

The maturing process of the spermatozoon - only after capacitation can the sperm remove itself from the epithelium to meet the oocyte

Question 7

What purpose does capacitation serve?

Answer 7

It prevent polyspermy, which would decrease changes of fertilisation due to there being too many sperm cells for the single oocyte,

Question 8

What are the three main causes of abnormal tubal transport?

Answer 8

1. Salpingitis
2. Endometriosis
3. Smoking

Question 9

What causes salpingitis?

Answer 9

Pelvic inflammation, generally through STIs like chlamydia and gonorrhoea

Question 10

What happens to the celia cells in salpingitis?

Answer 10

They disappear or get covered up, so there is not enough flow movement from the celia cells to move the ooctye and sperm.

Question 11

What are the three main outcomes of salpingitis?

Answer 11

1. Infertility
2. Ectopic pregnancy
3. Pelvic pain

Question 12

How does endometriosis cause fallopian tube blockage?

Answer 12

The endometrial tissue in the tubes proliferates and degenerates the same as it does in the uterus, only there is nowhere for the tissue to go when it sheds, meaning there is a build up that can cause scarring and blockages.

Question 13

How does smoking affect the fallopian tubes?

Answer 13

There is a reduction in ciliary beat function and oocyte-cumulus pick up.

Question 14

Salpingectomy reference

Answer 14

Ng et al., (2019) - 25% of infertility is due to tubal issues. Salpingectomy increases chances of IVF working by 100% Salpingostomy may work in a select group.

Question 15

Issues of salpingectomy reference

Answer 15

Schlaff (2019) - long-term antibiotics, not as effective but salpingectomy $$$$$