Anatomy and physiology of the fallopian tube.

Abstract

The anatomy and physiology of the human fallopian tube are described and discussed; then, these facts are correlated with clinical considerations as they relate to tubal factor infertility. Anatomically the human oviduct is a tubular, seromuscular organ attached distally to the ovary and proximally to the lateral aspect of the uterine fundus. Its length averages 11-12 cm. The oviduct can be divided into 4 main segments: 1) the infundibulum, whose terminal end contains the tubal ostium; 2) the ampullary region; 3) the isthmic portion; and 4) the intramural or interstitial portion, which is contained in the wall of the uterus. 4 electron micrographs illustrate these areas. Also discussed in this reveiw are the vascular analtomy, the lymphatics, and neuroanatomy of the fallopian tubes. Physiologic functions discussed in this article include the role of the fallopian tube in sperm transport, its part in sperm maintenance and capacitation, and the tube's function in ovum transport, fertilization, and embryo transport. Clinically, the role of the myosalpinx is undetermined, although it may affect tubal motility and ovum transport. The dense adrenergic innervation of the oviductal isthmus, along with the myosalpinx, suggests that innervation may be required for sphincter-like activity, although again no evidence exists for innervation being required in normal reproduction. The mucosa provides nutrients which may or may not be essential to normal reproduction, and its cilia seems uncritical in gamete transport and embryogenesis. Evidence shows that the uterotubal junction and the ampullary-isthmic junction are not necessary for conception (based on success rates of implantation procedures). Reversal of fimbriectomy is the most difficult and up to 1-cm of ampulla may be removed and resected and still maintain fertility.