Physiotherapy

1. Tubal factors of infertility

2. Definition
• Infertility is defined as a failure to conceive
within one or more years of regular
unprotected coitus.

3. Types of infertility
• Primary infertility:
• It denotes those patients who have never conceived.
• Secondary infertility:
• It indicates previous pregnancy but failure to
conceive subsequently.

4. Etiology in female

5. Etiology in female
• Endometriosis
• Tubal Blockage
– Scarring (PID)
– Fibroids
• Uterine Problems
– Tumors
– Congenital Anomalies

6. Etiology
• Anovulation
– Genetic: Turners Syndrome, Hypogonadism
– Problems with the Hypothalamus
• Pituitary-ovarian hormonal feedback mechanisms
– Hypothyroidism
– Stress

7. Etiology
• Cervical Mucus Problems
– Vaginal Infections
– Hormone Deficiencies

8. Etiology in male
• Varicocele: varicose of swollen vein in the
testicle
• Cryptorchidism: undescended testicle at birth
• Restrictive undergarments
• Occupational exposure to heat
• Working in a seated position

9. Tubal factors of infertility
• Most common cause of female infertility
• Diagnosed in approximately 30% to 35% of younger
and older infertile women.

10. Etiology
• Pelvic inflammatory disease (PID): MC cause
• Chlamydia trachomatis, Neisseria gonorrhea, and
anaerobic organisms are the most common
organisms that infect the lower genital tract and
cause PID.
• The incidence of infertility is 10% to 12% after one
episode, 23% to 35% after two episodes, and 54% to
75% after three episodes.

11. Etiology
• Tubal damage from PID causes inflammation and long-term
tubal changes, such as fimbrial agglutination, tubal
obstruction, and nodular thickening of the muscularis layer of
the isthmic portion of the fallopian tube.

12. Other causes
• Endometriosis
• Tuberculosis
• Scarring from abdominal and pelvic surgeries.
• Ruptured appendix increases the risk of tubal infertility
• Myomas near the tubal ostium
• Bilateral tubal ligation is an iatrogenic cause of tubal
occlusion.

13. Investigations
• Laparoscopy and Chromopertubation
• It is considered the definitive test for evaluating tubal disease.
• Laparoscopy is performed under general anesthesia, and is
often combined with chromopertubation (injection of a dilute
blue dye though a cannula that passes through the cervix into
the uterus, allowing the dye to enter the uterine cavity and
fallopian tubes) to evaluate tubal patency and hysteroscopy to
evaluate the interior of the uterus.
• Laparoscopy provides a panoramic view of the abdomen and
pelvis and allows surgeons to diagnose and treat various
pathologies.

14. Management