The Fallopian tubes are two thin tubes, one on each side of the uterus, which help lead the mature egg from the ovaries to the uterus. When an obstruction prevents the egg from traveling down the tube, a woman has a blocked Fallopian tube, also known as tubal factor infertility. This can occur on one or both sides and is the cause of infertility in 40 percent of infertile women. It’s unusual for women with blocked Fallopian tubes to experience any symptoms. Many women assume that if they are having regular periods, their fertility is fine. This isn’t always true.
Each month, when ovulation occurs, an egg is released from one of the ovaries. The egg travels from the ovary, through the tubes, and into the uterus. The sperm also need to swim their way from the cervix, through the uterus, and through the Fallopian tubes to get to the egg. Fertilization usually takes place while the egg is traveling through the tube. If one or both Fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg, preventing fertilization and pregnancy. It’s also possible for the tube not to be blocked totally, but only partially. This can increase the risk of a tubal pregnancy, or ectopic pregnancy.
Unlike anovulation, where irregular menstrual cycles may hint to a problem, blocked Fallopian tubes rarely cause symptoms. The first “symptom” of blocked Fallopian tubes is often infertility. If you don’t get pregnant after one year of trying (or after six months, if you’re age 35 or older), your doctor will order a specialized X-ray to check your Fallopian tubes, along with other basic fertility testing. A specific kind of blocked Fallopian tube called hydrosalpinx may cause lower abdominal pain and unusual vaginal discharge, but not every woman will have these symptoms. Hydrosalpinx is when a blockage causes the tube to dilate (increase in diameter) and fill with fluid. The fluid blocks the egg and sperm, preventing fertilization and pregnancy. However, some of the causes of blocked Fallopian tubes can lead to other problems. For example, endometriosis and pelvic inflammatory disease may cause painful menstruation and painful sexual intercourse, but these symptoms don’t necessarily point to blocked tubes. The most common cause of blocked Fallopian tubes is pelvic inflammatory disease (PID). PID is the result of a sexually transmitted disease, but not all pelvic infections are related to STDs. Also, even if PID is no longer present, a history of PID or pelvic infection increases the risk of blocked tubes. Other potential causes of blocked Fallopian tubes include:
- Current or history of an STD infection, specifically chlamydia or gonorrhea
- History of uterine infection caused by an abortion or miscarriage
- History of a ruptured appendix
- History of abdominal surgery
- Previous ectopic pregnancy
- Prior surgery involving the Fallopian tubes
Fallopian tubes can become blocked for a range of reasons, which include:
- a history of pelvic infection
- a previous burst appendix
- having had a sexually transmitted disease, such as gonorrhea or chlamydia
- endometriosis, a condition that causes the lining of the womb to grow outside of the uterus
- history of abdominal surgery
- hydrosalpinx, which is swelling and fluid at the end of a Fallopian tube
All of these conditions can affect the Fallopian tubes directly or this area of the body. In most cases, these conditions or procedures create scar tissue that can block the tubes.
Effects on fertility.
The female reproductive system is made up of the ovaries, uterus, and Fallopian tubes. If a medical problem has affected any of these three areas, it may make getting pregnant more difficult. Each of the two ovaries is connected to the uterus by a Fallopian tube. The ovaries store eggs and release them randomly, with one ovary releasing an egg each month. For example, the right ovary might release an egg for 3 months in a row, and then the left ovary might release an egg the following month. If one Fallopian tube is blocked, it may still be possible for an egg to be fertilized. If both are blocked, this is less likely.
Blocked Fallopian tubes can be difficult to identify. The tubes can open and close, so it is not always easy to tell if they are blocked or just closed. There are three key tests to diagnose blocked Fallopian tubes:
- An X-ray test, known as a hysterosalpingogram or HSG. A doctor injects a harmless dye into the womb, which should flow into the Fallopian tubes. The stain is visible on an X-ray. If the fluid does not flow into the Fallopian tubes, they may have a blockage.
- An ultrasound test, known as a sonohysterogram. This is very similar to the HSG test but uses sound waves to build up a picture of the Fallopian tubes.
- Keyhole surgery, known as a laparoscopy. A surgeon makes a small cut in the body and inserts a tiny camera to take pictures of the Fallopian tubes from inside.
A laparoscopy is the most accurate test for blocked tubes. However, doctors may not recommend this test as an early diagnosis because it is invasive and cannot treat the issue. A doctor may be able to suggest a possible diagnosis based on medical history. For example, a woman may have had a burst appendix in the past. If the woman has had difficulty conceiving, this could suggest blocked Fallopian tubes as a likely cause.
Laparoscopic Surgery for Blocked Fallopian Tubes
In some cases, laparoscopic surgery can open blocked tubes or remove scar tissue that is causing problems. Unfortunately, this treatment doesn’t always work. The chance of success depends on how old you are (the younger, the better), how bad and where the blockage is, and the cause of blockage. If just a few adhesions are between the tubes and ovaries, then your chances of getting pregnant after surgery are good. If you have a blocked tube that is otherwise healthy, you have a 20 percent to 40 percent chance of getting pregnant after surgery. Your risk of ectopic pregnancy is higher after surgery to treat tubal blockage. Your doctor should closely monitor you if you do get pregnant and be available to help you decide what’s best for you. Surgery isn’t right for everyone. If thick, multiple adhesions and scarring are between your tubes and ovaries, or if you have been diagnosed with hydrosalpinx, surgery may not be a good option for you. Also, if there are any male infertility issues, you might want to skip surgery. Other reasons to forgo surgery include additional fertility factors besides blocked fallopian tubes (like serious problems with ovulation) or advanced maternal age. In these cases, IVF treatment is your best bet.
IVF for Blocked Fallopian Tubes.
Before the invention of IVF, if repair surgery didn’t work or wasn’t an option, women with blocked tubes had no options to get pregnant. IVF makes conception possible. IVF treatment involves taking fertility drugs to stimulate the ovaries. Then, using an ultrasound-guided needle through the vaginal wall, your doctor retrieves the eggs directly from the ovaries. In the lab, the eggs are put together with sperm from the male partner or a sperm donor. Hopefully, some of the eggs fertilize and some healthy embryos result. One or two healthy embryos are chosen and transferred to the uterus. IVF completely avoids the fallopian tubes so blockages don’t matter. That said, research has found that an inflamed tube can significantly decrease the odds of IVF success. If you have a hydrosalpinx (fluid-filled tube), your doctor may recommend surgery to remove the tube. Then, after recovering from surgery, IVF can be tried.
Tubal Ligation Reversal.
Tubal ligation surgery is a “permanent” form of birth control. There are different kinds of tubal ligation. Possibilities include a surgeon cutting the tubes, “banding” them, clamping them, or placing specialized coils inside them. The idea is to intentionally block the Fallopian tubes so the sperm can’t reach the egg. A significant number of women later regret “getting their tubes tied”—anywhere from 20 to 30 percent. The good news is that even though this kind of birth control is considered permanent, it can be reversed for many women. Surgical repair of a tubal ligation is more likely to be successful than women having tubal surgery to repair disease-based blockages. Micro-surgical repair is often less expensive than IVF, costing as much as half per delivery. Success rates are generally excellent for micro-surgical tubal reversal. For women younger than 40 years of age, pregnancy rates after two years are 90 percent. For women over age 40, success rates vary between 40 and 70 percent. However, surgical repair isn’t always the best option. Situations that may be better for IVF include the presence of significant scaring, moderate to severe endometriosis, or moderate to severe male factor infertility. Your doctor can help you review whether surgical repair or going straight to IVF would be best for your situation.
The majority of blocked Fallopian tubes are caused by pelvic infections. Most—but not all—of these infections are caused by a sexually transmitted infection. Other possible causes (and risks) of pelvic infection include previous pelvic surgery, having a dilation and curettage (D&C), or complications after a miscarriage, abortion, or childbirth. Regular screening of STIs, as well as getting worrisome symptoms checked out right away, is an important step in preventing tubal infertility. If the STI or pelvic infection is caught early enough, treating the infection may help prevent the development of scar tissue.
Symptoms to be aware of are…
- general pelvic pain
- pain during sexual intercourse
- foul smelling vaginal discharge
- fever over 101 (in acute cases)
- nausea and vomiting (in acute cases)
- severe lower abdominal or pelvic pain (in acute cases)
Acute pelvic infections can be life-threatening. If you have a high fever or severe pain, contact your doctor immediately, or go to the nearest emergency room. However, often times, a woman doesn’t have any signs or symptoms of an infection. Most infections are not acute. “Quiet” doesn’t mean harmless. The longer the infection is present, the higher the risk of scar tissue forming and creating inflamed tubes. Once an infection has been detected, quick antibiotic treatment is important. Treating the infection doesn’t guarantee the tubes will be clear. The antibiotics can only kill the bacteria. Any damage or scar tissue that has formed will not be helped by antibiotic treatment. That said, treating the disease can help prevent further damage, and may make fertility treatment or later surgical repair more likely to succeed. Using condoms and getting regular STI testing (especially if you engage in high-risk sexual behavior) is recommended to prevent Fallopian tube damage from STI.