Hunter R H
Department of Clinical Studies - Reproduction, Royal Veterinary and Agricultural University, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 1998 May;77(5):475-86.
Diverse lines of evidence suggest that the Fallopian tubes make no overwhelming contribution to human reproduction other than as a conduit for gametes and embryos. Even so, bearing in mind global success rates for in vitro fertilization (IVF) coupled with uterine transplantation of embryos (20% fruitful pregnancies), the Fallopian tubes may make a subtle contribution to reproductive performance. The experimental evidence from monkeys and man arguing against an essential rôle for the tubes -- at least in individual instances -- would include (1) the results of Estes' operation, when ovaries are autotransplanted into the uterine lumen in women with blocked or missing Fallopian tubes and pregnancy ensues; (2) asynchronous embryo transfer when newly fertilized (pronucleate) eggs transplanted to the uterus can generate a pregnancy; (3) the transcervical transfer after IVF of early cleavage stage human embryos into the uterus, with subsequent establishment of pregnancy; (4) the trans-cervical transfer of human spermatozoa and oocytes into the uterus to give pregnancy, indicating that capacitation, fertilization and the earliest stages of embryonic development can be achieved in the uterus. In endeavoring to explain contrasts between these successful procedures in primates and their failure in non-primates, perhaps the simplex uterus in primates compared with a bicornuate or bipartite uterus in laboratory and farm species has relevance: there is lack of a clear-cut distinction between the endometrium and endosalpinx in the intra-mural segment and potential mixing of uterine and tubal fluids. Indeed, the latter may explain in part a susceptibility to tubal ectopic pregnancy, coupled with proliferating endometrial fragments in the Fallopian tube.
多方面的证据表明，输卵管对人类生殖的贡献并不显著，其作用主要是作为配子和胚胎的输送通道。即便如此，考虑到体外受精（IVF）与胚胎子宫移植的全球成功率（20%的妊娠成功率），输卵管可能对生殖表现有微妙的贡献。来自猴子和人类的实验证据表明输卵管并非必不可少——至少在个别情况下如此——这些证据包括：（1）埃斯蒂斯手术的结果，即把卵巢自体移植到输卵管堵塞或缺失的女性的子宫腔内后，仍能成功妊娠；（2）异步胚胎移植，即把新受精（原核期）的卵子移植到子宫后能成功妊娠；（3）体外受精后将早期卵裂期人类胚胎经宫颈移植到子宫，随后成功妊娠；（4）将人类精子和卵母细胞经宫颈移植到子宫后成功妊娠，这表明子宫能够实现精子获能、受精以及胚胎发育的早期阶段。在试图解释这些灵长类动物中的成功操作与非灵长类动物中的失败操作之间的差异时，或许灵长类动物的单子宫与实验室和农场物种的双角子宫或双子宫有关：子宫肌层段的子宫内膜和输卵管内膜之间缺乏明确区分，子宫液和输卵管液可能会混合。事实上，后者可能部分解释了输卵管易发生宫外孕以及输卵管内子宫内膜碎片增生的原因。
