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Fallopian Tube Blockage on Friday, April 07, 2017 11:19 PM
Overview The human oviduct, also known as the fallopian tube, is an essential component of the normal reproductive process. The tube, which connects the peritoneal space to the endometrial cavity, captures the egg after ovulation and transports the sperm from the uterus to the fertilization site in the ampulla (the middle portion of the tube). The ampulla serves as the physiologic site for final gamete maturation, fertilization, and early embryonic development. This article reviews the morphologic, physiologic, functional, and pathologic aspects of the human oviduct. Embryology Early in the embryologic life, 2 sets of paired genital ducts exist: the wolffian ducts (mesonephric duct) and the müllerian ducts (paramesonephric duct). At about 6 weeks' gestation, the wolffian ducts regress in females because testosterone and müllerian inhibiting substance (MIS) are not secreted in the absence of testis. The müllerian ducts develop into the female genital tract in a cephalocaudal fashion. The more cephalad ends of the paired paramesonephric ducts are opened to the peritoneal cavity and develop into the fallopian tubes, while the more caudal portion fuses in the lower midline to form the uterovaginal primordium, which later develops into the epithelium and glands of the uterus and cervix. If one müllerian duct fails to develop (usually associated with lack of development of the mesonephric system on the same side), a unicornuate uterus results, which consists of one uterine horn with only one fallopian tube. Complete failure of the müllerian system results in the absence of the fallopian tubes, the uterus, the cervix, and most of the vagina (Rokitansky-Küster-Hauser syndrome). Also see Mullerian Duct Anomalies. Remnants of the paramesonephric or mesonephric ducts may persist in the female as paratubal cysts or hydatid cysts of Morgagni. Anatomy The paired fallopian tubes extend laterally from the cornua of the uterus on each side and end near the ovaries. They range in length from 10-14 cm and are about 1 cm in external diameter, connecting the peritoneal space to the endometrial cavity. The ostia or openings of the tube are about 1.5 mm in diameter at the cornual end and 3 mm in diameter at the peritoneal end. The tubes sit within the abdominal cavity and are suspended by the mesosalpinx, a free edge of the superior portion of the broad ligament that contains the blood supply and nerves. Except for their intramural part, the tubes are covered by the peritoneum. For descriptive purposes, each fallopian tube is divided into 4 anatomic regions. The infundibulum, from the Latin word meaning funnel, is the funnel-shaped most distal end of the tube and is in close relation to the ovary. The peritoneal ostium lies at the base of the infundibulum and is surrounded by 20-30 irregular fingerlike projections (fimbriae), which spread over the surface of the ovary, and a single large fimbria (the fimbria ovarica), which is attached to the ovary. The fimbriae trap the ovulated ovum and sweep it through the tubal ostium into the ampulla. The infundibulum is surrounded by a thin longitudinal muscular layer. The ampulla is about 4-6 cm in length and is the longest region of the tube, comprising about half its length. It is also the widest region, about 6 mm in inner diameter, and the most tortuous region. Its luminal diameter is wider at its distal end than its proximal end. It is relatively thin walled and surrounded by 2 smooth muscle layers, an inner longitudinal layer and an outer circular layer. Fertilization occurs in this region. The isthmus is short, about 2.5-4 cm, and begins as the tube exits the uterus. Its lumen is narrow, about 1-2 mm in diameter, and the muscular wall is thick and well developed, consisting of 3 well-defined layers: an inner longitudinal layer, an outer longitudinal layer, and a middle circular layer. The interstitial or intramural segment is 1-2 cm long and constitutes the uterine-tubal junction. This section extends through the wall of the uterus and the ostium opens within the uterine cavity. Complex coordinated contractions of the musculature are thought to be important for movement of the ovum from the distal end to the proximal end of the tube, while at the same time aiding in the movement of sperm from the proximal end to the distal end of the oviduct. Arterial supply to the tubes is derived from the uterine and ovarian arteries, with the uterine branches supplying the medial two thirds of the tube. The tubal branches traverse and anastomose between the layers of the mesosalpinx. The venous system follows a similar path, draining into the uterine and ovarian veins. The lymphatic system follows the lymphatic drainage of the uterine fundus and the ovary, ascending along the ovarian veins and draining into the internal iliac and the aortic lymph nodes in the lumbar region. The tubes are innervated by both sympathetic and parasympathetic nerves, derived partly from the ovarian plexus and partly from the uterine plexus, and by afferent nerves contained in T11, T12, and L1 nerves. Physiology The lumen of the oviduct is formed by a complex interdigitating system of longitudinal mucosal folds (plicae), lined by mucosal and underlying stromal connective tissue. Plicae are most prominent in the ampullary region and least prominent in the isthmic region. The stroma is thin, but the lamina propria is thick, with vascular channels between the epithelial and muscular layers. The adventitia contains blood vessels and nerves between the muscular layer and the peritoneal surface. Three different cell types are present in the mucosa of the oviduct. Columnar ciliated epithelial cells are most prominent near the ovarian end and constitute 25% of the mucosal cells. Secretory cells constitute 60% of the mucosa and are mostly in the isthmic region. Narrow peg cells are located between secretory and ciliated cells and are believed to be a variant of secretory cells. The morphology of the epithelium is controlled by female hormones. During the follicular phase, rising estrogen levels stimulate differentiation of the epithelium into secretory and ciliated cells. At the time of ovulation, approximately half of the epithelial cells lining the oviductal lumen are secretory cells. The apical tips of these cells contain secretory granules that release their secretory products by exocytosis. Estrogen induces both hypertrophy as well as hyperplasia of the oviductal epithelium. It stimulates the differentiation of the secretory cells, the development of the secretory organelles, and ciliogenesis. Progesterone antagonizes these processes, resulting in atrophy, regression, and loss of cilia and secretory activity. As with other reproductive tract tissues, estrogen and progesterone regulate these processes in part by regulation of their own receptor levels. Estrogen stimulates the production of both estrogen and progesterone receptors while progesterone has an opposite, suppressive effect on both receptors in the oviduct. Oviduct glycoprotein The lumen of the oviduct is filled with fluid composed of a complex mixture of oviduct-specific secretory proteins, selective serum transudate, and electrolytes. Albumin, immunoglobulins, and transferrin are the primary serum proteins present within oviductal fluid. While a number of other proteins, such as growth factors, enzymes, protease inhibitors, and cytokines, have also been identified in oviductal fluid, only one oviduct-specific molecule has been well characterized to date. At the time of ovulation, the major oviduct-specific protein present in oviductal fluid is oviductal glycoprotein (OGP). OGP is an estrogen-dependent glycoprotein that is synthesized and secreted by the secretory cells of the human oviduct. OGP is species-specific but shares a certain homology. Studies suggest that OGP is a sialomucin involved in forming a protective barrier due to its relative resistance to proteolytic degradation. The physiologic function of OGP is not known; however, evidence suggests that OGP is involved in fertilization and potentially in the early embryonic development processes. It has been found to be associated with the zona pellucida (ZP) and the flocculent material present within the perivitelline space of oviductal eggs and embryos but not associated with ovarian eggs. Also, inclusion of OGP in in vitro sperm binding and in vitro fertilization (IVF) assays enhances sperm binding to the ZP, increases sperm penetration through the ZP, and increases the fertilization rate. Addition of antibodies directed specifically against OGP has reversed or inhibited the effects of OGP on sperm binding and fertilization. A limited number of reports are available on OGP effects on embryonic development. These studies suggest that OGP may enhance embryo cleavage rates and blastocyst formation. As a whole, the functional studies on OGP strongly support the contention that OGP may play a role as an enhancing factor in key reproductive events. Moreover, some hypothesize that the addition of OGP to procedures may lead to better overall outcomes. Sperm reservoir In addition to its contribution of oviductal secretions, the oviduct serves as an important reservoir for sperm. Numerous studies have shown that sperm are retained within the isthmic portion of the oviduct. Of the millions of sperm present within a normal ejaculate, only thousands enter the isthmus and only a select few reach the site of fertilization in the ampulla. As sperm enter the isthmus, many of them adhere to the epithelium. This adherence may be promoted by the extremely narrow lumen at the uterine end of the isthmus, thus providing a greater chance of contact between the sperm and the mucosa. Studies have shown that incapacitated sperm bind with higher affinity than capacitated sperm. In both in vivo studies and in vitro studies, the interaction of sperm with oviductal epithelial cells has been shown to enhance sperm viability, stabilize the acrosomal membrane, and potentially prevent or reduce polyspermy. Sperm-epithelial interaction decreases as sperm become capacitated. This may be due to changes in molecules present on the sperm plasma membrane as well as hyperactivated motility of sperm in a capacitated state, which allows them to detach more easily. Soluble factors produced by oviductal cells may in part account for some of the positive effects of epithelial cells on sperm. Sperm appear to bind to species-specific carbohydrates present on the surface of oviductal cells via a lectinlike mechanism. As sperm capacitate, this lectin appears to be lost or masked.
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Fallopian Tube Damage on Friday, April 07, 2017 11:20 PM
the müllerian ducts (paramesonephric duct). At about 6 weeks' gestation, the wolffian ducts regress in females because testosterone and müllerian inhibiting substance (MIS) are not secreted in the absence of testis. The müllerian ducts develop into the female genital tract in a cephalocaudal fashion. The more cephalad ends of the paired paramesonephric ducts are opened to the peritoneal cavity and develop into the fallopian tubes, while the more caudal portion fuses in the lower midline to form the uterovaginal primordium, which later develops into the epithelium and glands of the uterus and cervix. If one müllerian duct fails to develop (usually associated with lack of development of the mesonephric system on the same side), a unicornuate uterus results, which consists of one uterine horn with only one fallopian tube. Complete failure of the müllerian system results in the absence of the fallopian tubes, the uterus, the cervix, and most of the vagina (Rokitansky-Küster-Hauser syndrome). Also see Mullerian Duct Anomalies. Remnants of the paramesonephric or mesonephric ducts may persist in the female as paratubal cysts or hydatid cysts of Morgagni. Anatomy The paired fallopian tubes extend laterally from the cornua of the uterus on each side and end near the ovaries. They range in length from 10-14 cm and are about 1 cm in external diameter, connecting the peritoneal space to the endometrial cavity. The ostia or openings of the tube are about 1.5 mm in diameter at the cornual end and 3 mm in diameter at the peritoneal end. The tubes sit within the abdominal cavity and are suspended by the mesosalpinx, a free edge of the superior portion of the broad ligament that contains the blood supply and nerves. Except for their intramural part, the tubes are covered by the peritoneum. For descriptive purposes, each fallopian tube is divided into 4 anatomic regions. The infundibulum, from the Latin word meaning funnel, is the funnel-shaped most distal end of the tube and is in close relation to the ovary. The peritoneal ostium lies at the base of the infundibulum and is surrounded by 20-30 irregular fingerlike projections (fimbriae), which spread over the surface of the ovary, and a single large fimbria (the fimbria ovarica), which is attached to the ovary. The fimbriae trap the ovulated ovum and sweep it through the tubal ostium into the ampulla. The infundibulum is surrounded by a thin longitudinal muscular layer. The ampulla is about 4-6 cm in length and is the longest region of the tube, comprising about half its length. It is also the widest region, about 6 mm in inner diameter, and the most tortuous region. Its luminal diameter is wider at its distal end than its proximal end. It is relatively thin walled and surrounded by 2 smooth muscle layers, an inner longitudinal layer and an outer circular layer. Fertilization occurs in this region. The isthmus is short, about 2.5-4 cm, and begins as the tube exits the uterus. Its lumen is narrow, about 1-2 mm in diameter, and the muscular wall is thick and well developed, consisting of 3 well-defined layers: an inner longitudinal layer, an outer longitudinal layer, and a middle circular layer. The interstitial or intramural segment is 1-2 cm long and constitutes the uterine-tubal junction. This section extends through the wall of the uterus and the ostium opens within the uterine cavity. Complex coordinated contractions of the musculature are thought to be important for movement of the ovum from the distal end to the proximal end of the tube, while at the same time aiding in the movement of sperm from the proximal end to the distal end of the oviduct.
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Blocked Fallopian Tube on Friday, April 07, 2017 11:21 PM
The müllerian ducts develop into the female genital tract in a cephalocaudal fashion. The more cephalad ends of the paired paramesonephric ducts are opened to the peritoneal cavity and develop into the fallopian tubes, while the more caudal portion fuses in the lower midline to form the uterovaginal primordium, which later develops into the epithelium and glands of the uterus and cervix. If one müllerian duct fails to develop (usually associated with lack of development of the mesonephric system on the same side), a unicornuate uterus results, which consists of one uterine horn with only one fallopian tube. Complete failure of the müllerian system results in the absence of the fallopian tubes, the uterus, the cervix, and most of the vagina (Rokitansky-Küster-Hauser syndrome). Also see Mullerian Duct Anomalies. Remnants of the paramesonephric or mesonephric ducts may persist in the female as paratubal cysts or hydatid cysts of Morgagni. Anatomy The paired fallopian tubes extend laterally from the cornua of the uterus on each side and end near the ovaries. They range in length from 10-14 cm and are about 1 cm in external diameter, connecting the peritoneal space to the endometrial cavity. The ostia or openings of the tube are about 1.5 mm in diameter at the cornual end and 3 mm in diameter at the peritoneal end. The tubes sit within the abdominal cavity and are suspended by the mesosalpinx, a free edge of the superior portion of the broad ligament that contains the blood supply and nerves. Except for their intramural part, the tubes are covered by the peritoneum. For descriptive purposes, each fallopian tube is divided into 4 anatomic regions. The infundibulum, from the Latin word meaning funnel, is the funnel-shaped most distal end of the tube and is in close relation to the ovary. The peritoneal ostium lies at the base of the infundibulum and is surrounded by 20-30 irregular fingerlike projections (fimbriae), which spread over the surface of the ovary, and a single large fimbria (the fimbria ovarica), which is attached to the ovary. The fimbriae trap the ovulated ovum and sweep it through the tubal ostium into the ampulla. The infundibulum is surrounded by a thin longitudinal muscular layer. The ampulla is about 4-6 cm in length and is the longest region of the tube, comprising about half its length. It is also the widest region, about 6 mm in inner diameter, and the most tortuous region. Its luminal diameter is wider at its distal end than its proximal end. It is relatively thin walled and surrounded by 2 smooth muscle layers, an inner longitudinal layer and an outer circular layer.
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Female Infertility on Friday, April 07, 2017 11:21 PM
If one müllerian duct fails to develop (usually associated with lack of development of the mesonephric system on the same side), a unicornuate uterus results, which consists of one uterine horn with only one fallopian tube. Complete failure of the müllerian system results in the absence of the fallopian tubes, the uterus, the cervix, and most of the vagina (Rokitansky-Küster-Hauser syndrome). Also see Mullerian Duct Anomalies. Remnants of the paramesonephric or mesonephric ducts may persist in the female as paratubal cysts or hydatid cysts of Morgagni. Anatomy The paired fallopian tubes extend laterally from the cornua of the uterus on each side and end near the ovaries. They range in length from 10-14 cm and are about 1 cm in external diameter, connecting the peritoneal space to the endometrial cavity. The ostia or openings of the tube are about 1.5 mm in diameter at the cornual end and 3 mm in diameter at the peritoneal end. The tubes sit within the abdominal cavity and are suspended by the mesosalpinx, a free edge of the superior portion of the broad ligament that contains the blood supply and nerves. Except for their intramural part, the tubes are covered by the peritoneum. For descriptive purposes, each fallopian tube is divided into 4 anatomic regions. The infundibulum, from the Latin word meaning funnel, is the funnel-shaped most distal end of the tube and is in close relation to the ovary. The peritoneal ostium lies at the base of the infundibulum and is surrounded by 20-30 irregular fingerlike projections (fimbriae), which spread over the surface of the ovary, and a single large fimbria (the fimbria ovarica), which is attached to the ovary. The fimbriae trap the ovulated ovum and sweep it through the tubal ostium into the ampulla. The infundibulum is surrounded by a thin longitudinal muscular layer.
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