Diagnosis and Management of Tubal Factor Infertility

As a tubal factor is a common cause of infertility, evaluation of the infertile couple should include assessment of the fallopian tubes for patency. Hysterosalpingography, sonohysterography, and chlamydia serology can be used for diagnosing tubal disease, though laparoscopy with chromopertubation remains the "gold standard". Tubal disease can be unilateral or bilateral, and proximal or distal in nature. Surgical repair is an option for some patients, while in-vitro fertilization, which completely bypasses the tubes, is the best option for others, particularly those with diminishing ovarian reserve. Although the approach to the diagnosis of tubal factor is fairly standard, management decisions need to be individualized to the patient based on age, ovarian reserve, the presence or absence of other infertility factors, and insurance coverage for assisted reproductive technologies.