Role of Fallopian Tubes in Endometriosis-Related Infertility

Up to 30% of women with endometriosis exhibit some form of tubal involvement. Tubal endometriosis is a heterogeneous disease. It may infiltrate only the tubal serosa or subserosa (peritoneal endometriosis), infiltrate the myosalpinx, and grow into the tubal lumen. Tubal endometriosis lacks specific clinical symptoms, and, in most patients, transvaginal ultrasonography does not allow it to diagnose. In addition, the visualization of the fallopian tube during laparoscopy may not be enough for accurate diagnosis because microscopic tubal endometriosis may be present in macroscopically normal fallopian tubes. Causes of tubal dysfunction in endometriosis may be tubal blockage, adhesions, and hydrosalpinx. These conditions can coexist and are often interlinked; therefore, it is difficult to distinguish the exact contribution of each cause of abnormal tubal function. In addition, the fallopian tubes of women with endometriosis may have an abnormal function (such as altered ciliary activity and peristalsis).