Uterine/Tubal Factors

Uterine Factors:

Anatomical abnormalities of the uterine cavity have potentially profound negative effects on fertility. Lesions inside the uterus such as small fibroids or polyps may interfere with embryo implantation. Ideally, the uterus should be in pristine condition at conception. Evaluation may be indirect, through imaging studies or by direct surgical visualization. There are three primary ways that we study the uterus. Which procedure is best depends on many factors.


  1. An x-ray procedure known as a Hysterosalpingogram (HSG) that is performed in the hospital.
  2. Sonohysterogram (SHG) also known as Saline-Infusion Sonogram (SIS) that is performed in the office.
  3. Laparoscopy, a surgical procedure perfomed at the hospital while under anesthesia.

For additional information on these tests and procedures see Office Procedures and Surgical Treatment in the Fertility Treatment section.


Fallopian Tube Factors:

The fallopian tubes pick the egg up just after ovulation and transport it to the uterus. Sperm and egg unite (fertilization) in the fallopian tube. Over the next few days, the fallopian tube transports the embryo toward the uterus. Healthy fallopian tubes are therefore needed for natural conception.


We do not have any good tests of fallopian tube function, but we can assess fallopian tube anatomy. There are two ways to do this:


  1. The most common screening test is an x-ray procedure known as a Hysterosalpingogram (HSG). The test is much less invasive than laparoscopic assessment of the fallopian tubes (see below), but is also less reliable. False positive findings occur in about 5-7% of cases.

  2. The second way to assess fallopian tube anatomy is by direct visualization. This is done typically by laparoscopy, along with a procedure known as chromotubation. Laparoscopic assessment is the gold-standard way to evaluate the fallopian tubes as well as the uterus, ovaries and other structures. The downside of laparoscopy is that it involves major surgery and risk. The upside is that if we find abnormalities, we can usually correct them during surgery.

For additional information on these tests and procedures see Office Procedures and Surgical Treatment in the Fertility Treatment section.