Blocked Fallopian Tubes
Blocked fallopian tubes at a glance
- Blocked fallopian tubes can cause infertility by preventing sperm from reaching the woman’s egg for fertilization or by preventing the fertilized embryo from reaching the uterus for pregnancy.
- About 20 percent of female infertility is related to blocked or damaged fallopian tubes.
- The most common causes of blocked fallopian tubes are infection such as sexually transmitted diseases (STDs) and pelvic inflammatory diseases.
- Infertility due to blocked fallopian tubes can only be remedied by surgery to correct the problem, but it is not always successful.
- If surgery is not an option or not successful, assisted reproduction technologies may be needed in order to achieve pregnancy.
What are blocked fallopian tubes?
When the fallopian tubes are blocked, sperm cannot get through the tube to fertilize an egg that has moved there from the woman’s ovary. Nor can a fertilized embryo pass through to implant in the uterus for a pregnancy. This results in what is known as tubal factor infertility, and it can occur in either fallopian tube or both.
It most commonly occurs in preventing the sperm from reaching the egg for fertilization. The fallopian tube is an important part of many reproductive functions. Any damage, obstruction, narrowing or scarring in the fallopian tubes can cause infertility and should be specifically evaluated. About 20 percent of female infertility is related to tubal factors.
Fortunately, there are both surgical and non-surgical options available to either repair or bypass damaged or blocked fallopian tubes in order to get pregnant. The chances of becoming pregnant after tubal surgery depends on three factors, including the amount of damage to the tubes, the age of the woman and the health of the partner’s sperm.
Causes of blocked fallopian tubes
The most common cause of blocked fallopian tubes is inflammatory infection, including pelvic inflammatory disease (PID), STDs and endometriosis. These infections cause scar tissue and adhesions to build up on the walls and thereby block the fallopian tubes.
Other potential causes of blocked fallopian tubes include:
- History of uterine infection caused by an abortion or miscarriage
- History of abdominal surgery
- Previous ectopic pregnancy
- Prior surgery involving the fallopian tubes such as a tubal ligation (“getting your tubes tied”) or tubal ligation reversal.
Symptoms of blocked fallopian tubes
Most instances of blocked fallopian tubes rarely cause noticeable problems. However, in rare cases the damage and blockage at the end of the fallopian tube can cause it to become filled with a clear, watery fluid in a condition called hydrosalpinx.
Although some women experience symptoms such as severe lower abdominal pain and unusual vaginal discharge, most women do not experience symptoms.
In addition, the causes of the blocked fallopian tube may cause symptoms. For example, endometriosis or PIDs can cause pain during sexual intercourse, heavy menstruation, abdominal pain or cramping.
Diagnosis & treatment of blocked fallopian tubes
Blocked fallopian tubes are diagnosed with a specialized x-ray called a hysterosalpingogram (HSG). The most common HSG test involves placing dye through the cervix using a small tube. Once the dye has been given, x-ray images of the pelvic area will show if there is a blockage in the fallopian tubes or if the dye flows freely into the abdomen.
Although this method is widely used, sometimes the procedure can yield a result that is a “false positive,” meaning the tubes appear to be blocked but are not really scarred or blocked and instead have just spasmed during the imaging. In this case, a physician may order another test to be sure.
Women with one functional tube should not have too much trouble getting pregnant. However, if both tubes are blocked or one of the tubes is infected, a woman may experience infertility. The best treatment option will depend on the patient’s specific condition.
Minimally-invasive laparoscopic surgery is often performed to open blocked tubes or remove scar tissue that is causing problems. The success of this is dependent on several factors including the woman’s age, where and how severe the blockage is and the cause of the blockage.
Common laparoscopic procedures include:
- Tubal ligation reversal involves surgically reopening, untying or reconnecting a woman’s fallopian tubes that have been intentionally tied off or closed from tubal ligation. Tubal ligation reversal can enable a woman to become pregnant again, and is generally performed through minimally invasive robotic surgery.
- Salpingectomy is a surgery to address hydrosalpinx (a buildup of fluid in the fallopian tubes) by removing scar tissue around the tube or removing the damaged part of the tube that is causing the fluid buildup.
- Tubal removal may also be the best option to treat infertility. Although removing a fallopian tube sounds drastic, the inflammation from a damaged tube is a constant irritation in the pelvic cavity that can interfere with fertility. By removing the damaged tube causing inflammation, there is a better chance of getting pregnant through the remaining healthy fallopian tube.
- Adhesiolysis is the simultaneous use of laparoscopy and hysteroscopy to remove adhesions or blockages from the origin of the fallopian tube, where it exits the uterus. A fertility surgeon inserts imaging die into the woman’s fallopian tubes to visualize the blockage, and then taps the blockage away from the end of the tube using a wire guide through a slender tube.
After laparoscopic surgery, patients should plan to rest at home for three to five days and avoid strenuous activity, intercourse or heavy lifting for up to two weeks. Typically, patients are prescribed pain medication depending on their previous experience with medications or their individual level of pain.
The biggest risk of tubal surgery is the possibility of an ectopic pregnancy, a serious health condition in which the embryo grows outside of the uterus, most often in the fallopian tube. However, ectopic pregnancy isn’t dangerous if caught and treated early, so patient monitoring while she is trying to conceive is important.
Getting pregnant after treatment
The chances of becoming pregnant after treatment depend on the amount of damage or blockage to the tubes, the age and medical history of the patient and the health of the partner’s sperm.
If the woman is ovulating normally, her doctor might also consider assisted reproduction techniques that bypass the fallopian tubes entirely and avoid surgery.
These can include:
- Intrauterine insemination (IUI) to boost pregnancy chances by placing sperm in the uterus, and thus closer to egg.
- IVF is recommended if the fertility surgeon during surgery finds that both tubes are damaged, or if the patient still cannot get pregnant six to 12 months after tubal surgery.