Tubal and pelvic diseases are the main causes of female infertility. Infertility epidemiological survey it accounts for 1/3 of female infertility. in recent years, the increase of unplanned pregnancies, improper abortion surgery and the increase of sexually transmitted diseases and other factors make the proportion of female tubal and pelvic disease factors leading to infertility accounted for more than 46% of the total causes of infertility. Xiao Hongmei et al. from CITIC Xiangya Reproductive and Genetic Hospital reported that tubal and pelvic inflammatory diseases accounted for the majority of female infertility factors, amounting to 72.7% of female factors. It has been reported that the tubal factor accounts for 49.17% of the causes of female primary infertility. I. Etiology Adhesion of pelvic organs or tubal inflammation caused by various factors leads to changes in the structure and function of the fallopian tubes, obstruction, incompetence or reduced peristalsis leading to infertility. Inflammation 1.Non specific inflammation 2.Specific inflammation 3.Surgery related inflammation Especially abortion, cesarean section, IUD, ring removal may cause pelvic infection and infertility. Appendicitis and appendectomy are also causes of infertility due to tubal or pelvic adhesions. When the perforated appendix forms a periappendiceal abscess involving the fallopian tubes, the tubes can be blocked when inflammatory exudation and other damage occurs. II. Diagnosis Tubal factors include tubal incompetence, tubal obstruction, partial or distal tubal adhesion, hydrosalpinx, epiphora, and peritubal inflammation. (A) examination methods 1, tubal fluids is currently more commonly used clinical methods, the patient is easier to accept, for infertility can be used as a preliminary screening. 2.X-ray hysterosalpingography (1)HSG with oil can determine whether there is fluid in the fallopian tube and pelvis.1h or 24h film can determine whether there is fluids. The 1h or 24h film can determine whether there is incomplete or not. 15 minutes after the aqueous agent to determine whether there is incomplete or not. (2) Uterine catheter selective tubal insertion angiography. 3.Uterine tube ultrasonography (1)Tubal ultrasonography patency test (2)Uterine tube ultrasonography Bubbling liquid preparation is used as contrast agent. (3) Selective tubal cannulation under ultrasound 4. Endoscopy (1) Laparoscopy: Laparoscopy occupies an increasingly important position in the treatment of infertility, and many fertility centers in foreign countries have listed laparoscopy as a routine step in infertility diagnosis. Laparoscopic dye test is the “gold standard” for evaluating the patency of fallopian tube. (2) Hysteroscopy, selective intubation for fluid passage or imaging. (3) Tuboscopy: can visualize the tubal lining of the tubes on the tubal infertility patients, in the choice of decision-making treatment methods to make an evaluation. Hysteroscopy and laparoscopy and tuboscopy and hysteroscopy, laparoscopy of the joint application, can make up for their respective shortcomings, so that the diagnosis is more comprehensive, accurate, and laparoscopic surveillance for hysteroscopy, tuboscopy of the surgery is more secure. 5.Radionuclide hysterosalpingography:It opens a new way to study the function of fallopian tubes. Its characteristic is to use the superior physical and chemical properties of tracer to simulate the movement of sperm in the inner reproductive tract by injecting into the uterine cavity or dropping into the vagina, so as to show the smoothness of fallopian tubes and its transport function under physiological conditions. 6, open abdominal exploration Infertile women for open abdominal exploration, routine inspection of the fallopian tube line fluid test. (B) application evaluation 1, HSG can provide the internal structure of the fallopian tube, whether the fallopian tube is patent or not, especially in determining the site of tubal obstruction, better than laparoscopic fluid, but in the clear pelvic disease and adhesion, not as good as laparoscopic fluid, the two combined application, can make the diagnosis accurate and comprehensive, because HSG has potential therapeutic effect, should be six months or one year after the HSG for laparoscopic examination. China has not yet popularized laparoscopy, X-ray hysterosalpingography is still an important method of evaluating the patency of fallopian tube, which cannot be replaced by other methods yet. 2.Abdominal ultrasound evaluation of tubal patency is better than common tubal fluid test. 3, vaginal color Doppler hysterosalpingography and laparoscopic fluids with no significant difference in diagnostic compliance rate, in the evaluation of tubal patency and HSG accuracy is at least the same, and safer (no iodine allergy and exposure to radiation concerns). The examination time is usually 3.5-10 min, about 15 min in difficult cases, and the dosage of contrast agent is 10-40 ml. Ultrasonographic diagnosis of the uterus and adnexa can be made on the basis of a pre-contrast scan. However, the diagnostic accuracy of unilateral tubal obstruction is low, and the internal structure of the fallopian tube can not be observed, the exact location of tubal obstruction can not be clarified, and it is not easy to get a satisfactory picture. Third, treatment The treatment of tubal infertility is faced with the choice of tubal function reconstruction or in vitro fertilization-embryo transplantation. Successful tubal function repair is undoubtedly beneficial to the patients, which is not only conducive to the psychological treatment of infertile couples, but also enhances the ability of the patients to get pregnant naturally, and also provides the patients with the chance of getting pregnant more than once. The choice of tubal infertility treatment program should take into account the patient’s age, ovarian function, type and severity of tubal lesions, whether combined with male infertility factors and socio-economic conditions, and choose the most appropriate treatment program for the patient according to his actual situation. (A) proximal tubal obstruction (mesenchymal or isthmus) in HSG diagnosis of obstruction accounted for 10 – 30 1, uterine tubal ligation 2, hysteroscopic insertion of fluids for the first choice, relatively economic and can be operated under the direct vision of the hysteroscope, high accuracy, high pressure through the catheter pressurized injection of fluids, adhesions are easy to be washed away after the operation of the ectopic pregnancy rate of 2.63%. It is suitable for interstitial obstruction and isthmus obstruction. 3.Selective tubal ligation under X-ray fluorescence fluoroscopy or ultrasound guided by non-invasive fiber guidewire through the trocar, mechanical crushing of tubal obstruction. The risk of tubal puncture is 3–11. 4. Tubal-uterine anastomosis is indicated for those with tubal interstitial and isthmus obstruction. Observational studies have reported that the pregnancy rate of hysteroscopic tubal insertion is higher than that of elective tubal angiography intervention, reaching 49. For proximal tubal obstruction that is not combined with other tubal pathologies, hysteroscopic tubal insertion, which is less invasive and inexpensive, can be preferred. (B) distal tubal obstruction accounted for 85% of tubal infertility 1, tubal ligation 2, salpingo-oophorectomy refers to the incision and stoma performed for complete obstruction of the distal fallopian tube, HSG shows adhesion at the umbilical end of the tubes, which can be used for pelvic adhesion, tubo-ovarian abscess, hydrosalpinx, and treatment of tubal pregnancy. The overall postoperative pregnancy rate was 30, but 1/4 of them were ectopic. The pregnancy rates after ostomy in patients with mild, moderate and severe distal tubal obstruction were 81, 30 and 16 respectively. The incidence of ectopic pregnancy was higher in moderate and severe patients than in mild patients, but not in severe patients than in moderate patients, which might be due to the impaired egg-picking function of the fallopian tube in severe patients. (4) When laparoscopic salpingo-oophorectomy was compared with open microscopic salpingo-oophorectomy, the rate of intrauterine pregnancy was significantly lower in the former than in the latter. Laparoscopy can check and visualize the whole pelvic and abdominal cavities, and it can see the dynamic condition of the fallopian tubes, including whether there are adhesions around, the appearance of each section of the fallopian tubes, the degree of patency, the site of obstruction and the scope of lesions, and so on. 3.Tubal umbilicoplasty refers to the umbilical end of the umbrella partially buried and the umbilical end of the umbilical end to restore the normal umbilical end of the separation surgery. It is mainly used for those with simple adhesion of umbilical opening. (C) Tubal effusion Distal tubal obstruction caused by infection can lead to tubal effusion, and ultrasound shows that there are irregular or tubular liquid dark areas in the adnexal area next to the uterus. Oil HSG shows oil beads of contrast buildup in the tubal lumen. 1.Tubal stoma, after the operation, about 1/3 of those with tubal effusion can have natural pregnancy. 2.IVF-ET ①Transvaginal needle aspiration of fluid under ultrasound guidance before IVF-ET or at the time of egg retrieval is a less damaging treatment method, but fluid may accumulate again. ② Tubectomy or proximal tubal ligation before IVF-ET. IVF-ET after proximal tubal ligation has a higher pregnancy rate than IVF-ET after tubectomy. (D) Sterilization after reproduction 1, tubal anastomosis The length of the residual fallopian tube, the degree of damage to the fallopian tube by sterilization, the anastomosis site, the patient’s age and whether or not to combine with other tubal pathology will affect the efficacy of the anastomosis, and the length of the residual fallopian tube (cm) is multiplied by 10, which is approximately equal to the rate of full-term pregnancy, and the pregnancy rate of the fallopian tube isthmus – isthmus anastomosis was the highest, about 81, with a silicone ring, the pregnancy rate was higher than that of IVF-ET after tubalectomy. It was about 81. Sterilization with silicone rings and titanium clips resulted in better anastomosis results than in patients with electrocoagulation sterilization. Especially, the incidence of ectopic pregnancy after anastomosis is high in patients with monopolar electrocoagulation sterilization. 2.IVF-ET All types of tubal infertility patients can choose, its success rate is affected by the patient’s age, infertility time, and previous pregnancy history. The pregnancy rate is about 30 per cycle, and the success rate decreases with age, from 50 for those younger than 30 years old, 28 for those 35-38 years old, and less than 9 for those older than 41 years old. The cumulative pregnancy rate in 4 cycles for tubal infertility patients, regardless of other infertility co-morbidities, is greater than 70. Randomized controlled trials have shown that conventional treatment is less costly and has a higher overall pregnancy rate. In conclusion, when there is no combination of other tubal pathology, proximal tubal obstruction can be treated preferably with hysteroscopic intubation. For distal tubal obstruction, laparoscopic salpingo-oophorectomy is the preferred treatment option for these patients. Those with tubal effusion should have surgical removal of the lesion, such as ostomy or salpingectomy, prior to IVF-ET.