The pathology of infertility.

In most series of infertility patients, approximately 40 to 60 percent have 
no discernible cause for infertility. No wonder that those working with 
this condition tend to seize upon any demonstrable tissue abnormality as 
related to the infertility. The use of fallible diagnostic tools may 
lead to misdiagnosis and inappropriate treatment. In studies of the accuracy 
of dye injections to demonstrate tubal patency by roentgenogram the large 
errors introduced by these methods were emphasized. Between 30 to 40 
percent of tubes found blocked by using a single dye examination 
and using the criterion of "filling but not spilling" into the 
peritoneal cavity, or with apparent obstruction at the uterotubal junction, were 
subsequently found to be patent. Similar data were offered by others. 
Lesions with less obvious and demonstrable causal relationship to infertility, such 
as pelvic adhesions and endometriosis, are more difficult to judge as 
to their etiologic relation. These are assessed in discussions of male 
and female infertility. 