Patients often ask in the clinic, “How do women’s fallopian tubes get blocked? Is it because of a history of miscarriage? In order to dispel your doubts, the following is a brief explanation of the relevant knowledge. 1. What are the functions of the fallopian tubes? The proximal end of the fallopian tube, together with the uterus, is distally enlarged and funnel-shaped, with a finger-like protrusion at the end, which has the function of picking up egg cells. The sperm pass through the uterus, reach the fallopian tubes and swim distally to the abdomen, where they are waiting for the egg cells to be fertilized. After the mature follicle is discharged from the ovary, it enters the fallopian tube through the pick-up action of the umbilical end of the fallopian tube and enters the jugular abdomen. The ciliated cells of the endothelium of the fallopian tube oscillate in the direction of the uterus, helping the fertilized egg to move towards the uterus so that it can reach the uterus for implantation and development. If the fallopian tube is inflamed, it will lead to narrowing of the official cavity and the fertilized egg will not reach the uterus smoothly, but develop in the fallopian tube, resulting in ectopic pregnancy; if the fallopian tube is inaccessible, the sperm will not be able to meet and fertilize the egg, which will lead to infertility. 2.Does it necessarily mean that the fallopian tubes are open because no pregnancy has ever occurred? Not necessarily. The main cause of tubal blockage is due to inflammation of the fallopian tubes caused by the operation of the uterine cavity, but there are also a considerable number of other causes, such as vaginitis, cervicitis, endometritis, appendicitis, tuberculosis pathogenic infection, menstrual intercourse, unclean intercourse, abdominal surgery and other factors can also lead to tubal blockage. Some infertile patients, who have never been pregnant, or who have regular or irregular menstruation, are advised to have an imaging to see if their tubes are patent after several months of ovulation detection (other obstructive factors have been ruled out) and guided intercourse without conception. In most cases, patients and their families refuse to have an imaging test, thinking that they will not have inflammation if they have never been pregnant. In fact, there are still a few patients whose test results show bilateral tubal effusion or obstruction, which requires laparoscopic surgery, tubal intervention or IVF if pregnancy is desired. 3.Does it necessarily mean that the fallopian tubes are open if I have conceived before? Not necessarily. The cause of tubal blockage is tubal inflammation: the tubal lumen is relatively thin, and inflammation can easily cause adhesions and blockage, and tubal blockage is possible in women of childbearing age who have given birth or have not given birth. The cause of 80% of the infertility is caused by blockage of the fallopian tubes, which has a lot to do with women’s abortion, IUD, IUD removal and other uterine operations. Many patients who have had abortions in the past and have not been pregnant for more than one year usually require a hysterosalpingogram to see if there is inflammation in the fallopian tubes, but the patient thinks she has never been pregnant and thinks there is no problem with the fallopian tubes. It is precisely because of the history of previous abortions that hysterectomy is performed, whether the instruments are sterilized and whether the postoperative treatment with antibiotics and anti-infection is adhered to as prescribed by the doctor, and the uncertainty of personal hygiene that leads to tubal and pelvic inflammatory disease is more likely to lead to pelvic infection. Therefore, in those who have had abortions and are not pregnant without contraception, tubal inflammation should be considered first. The most accurate method to diagnose tubal patency is hysterosalpingography, which can clarify the site of tubal obstruction and the degree of patency. 4.Does vaginitis necessarily have tubal infection? Not necessarily. The cervix is a line of defense between the vagina and the uterine cavity. Half of the vaginitis is confined to the vagina and will not easily affect the uterus and adnexa upstream. If vaginitis is not treated effectively for a long time, it can reduce the resistance of the cervix and the lining of the uterus. It can spread directly through the cervix, the uterus, or through the lymphatic involvement of the parametrium, into the fallopian tubes and cause serious damage, leading to blockage of the tubes. Therefore, it is important for women to take effective treatment as soon as possible after contracting vaginitis. 5. Does having tuberculosis affect fertility? No matter what kind of TB you have had (tuberculosis, pelvic TB, peritoneal TB, etc.), it can affect your fertility to some extent. Mycobacterium tuberculosis is transmitted by blood, lymphatic transmission, and also by direct spread, which may cause endometrial tuberculosis, tubal tuberculosis, etc. Endometrial tuberculosis differs from general endometritis in that Mycobacterium tuberculosis often destroys the functional layer of the endometrium, invades the deeper layers of the endometrium (basal layer) and the base of the uterus, and even causes adhesions and deformation of the uterine cavity. The resulting uterine scar does not easily restore its function and affects the implantation of fertilized eggs. Tubal infection with tuberculosis can make the fallopian tube thicker, harder and more adhesive, the mucosal epithelial cilia are destroyed, the wall of the tube is adhered, the official cavity is occluded differently, and the number goes to normal function and infertility. 6.Does ectopic pregnancy necessarily mean inflammation of the fallopian tube? Ectopic pregnancy is a pregnancy in which the fertilized egg is laid and grows outside the uterine cavity. In addition to the common tubal pregnancy, it also includes ovarian pregnancy, abdominal pregnancy, cervical pregnancy, residual horned uterine pregnancy and compound pregnancy. It is generally believed to be related to tubal inflammation, where chronic inflammation of the fallopian tubes leads to narrowing of the tubal lumen and poor peristalsis, which interferes with the normal flow of the fertilized egg in the fallopian tube, causing it to be blocked midway and to implant there. It is true that many ectopic pregnancies are related to inflammation, but there are also ectopic pregnancies that are not related to the fallopian tubes. In recent years, with the use of assisted reproductive technology, some IVF patients have developed ectopic pregnancies, but why is there an ectopic pregnancy when the fertilized egg is clearly placed in the uterine cavity? This is something we should think about. It may be that the poor environment of the uterine cavity causes the fertilized egg to migrate out of the cavity, and from the perspective of Chinese medicine, the cold in the uterus causes ectopic pregnancy in IVF. Because of the theory of this phenomenon, it can also explain that some of the patients who had an imaging or laparoscopy to confirm bilateral tubal patency still had ectopic pregnancy when they got pregnant. Therefore, we should pay attention to the intrauterine environment and improve it to improve the success rate of IVF and reduce the incidence of ectopic pregnancy.