Fallopian tubes, also known as oviducts or salpinges, are the two thin tubes flanking the uterus that connect it to the ovaries. During ovulation, a mature egg will flow from the ovary and through the fallopian tube. For fertilization to happen, sperm must travel from the cervix, through the uterus, and into the fallopian tube, where the egg waits. Once fertilized, the egg descends into the uterus and attaches to the uterine lining.
Tubal factor infertility, a condition in which the fallopian tubes are blocked or damaged, occurs when an obstruction – such as scar tissue, adhesions, or fluid buildup caused by infection – prevents the egg from traveling down the tube or keeps the sperm from reaching the egg. One or both tubes may be blocked or damaged, resulting in infertility. Sometimes a fallopian tube becomes partially blocked, which increases the risk of an ectopic pregnancy.
Typically, people won’t realize their fallopian tubes are blocked until they try to get pregnant. Infertility is often the first symptom of blocked fallopian tubes, as most people are otherwise asymptomatic. As many as one in four cases of female factor infertility are caused by blocked fallopian tubes. Occasionally, lower abdominal pain and unusual vaginal discharge may indicate a blocked fallopian tube. Some causes of tubal blockage, such as endometriosis and pelvic inflammatory disease (PID), have their own symptoms.
Fallopian tubes can become blocked or damaged in several ways. Untreated infections may cause a buildup of fluid, or hydrosalpinx. Tuberculosis or a ruptured appendix can be a source of these infections, as can sexually transmitted diseases like chlamydia or gonorrhea, which may induce PID. Other causes, such as abdominal surgery and endometriosis, may create scar tissue that blocks the fallopian tube.
Anyone who is sexually active is at risk of contracting an STD since they develop through the passing of microorganisms present in shared bodily fluids. Though stigmatized, STDs are common, with around 20 million new STD infections occurring every year. Gonorrhea and chlamydia are two common STDs that can cause tubal factor infertility.
When bacteria from outside of the body get into the urinary system, they may cause problems like infection and inflammation. This is known as a urinary tract infection (UTI), and if it goes untreated, UTIs may cause hydrosalpinx.
Fluid can build up in a fallopian tube that is blocked or damaged near the ovary, causing the tube to fill and swell. This condition is called a hydrosalpinx and is most often caused by pelvic inflammatory disease, usually as a result of an infection.
Often the result of untreated STDs, pelvic inflammatory disease is one of the most common causes of tubal factor infertility. PID creates permanent scars on the inner lining of the fallopian tubes.
Appendicitis is the inflammation or infection of the appendix. The diseased appendix may rupture if appendicitis goes untreated. A ruptured appendix can cause a serious infection like sepsis, or even death if left untreated.
Endometriosis forms in the body when tissue similar to the tissue that lines the uterus, known as the endometrium, grows on other parts, such as organs, the pelvis, or inside the chest cavity. This tissue is hormonally sensitive and can become inflamed, creating scar tissue and causing cysts to develop.
Hysterosalpingogram (HSG), laparoscopy, and ultrasound are the three most common tests used to diagnose tubal factor infertility. Depending on the results of these tests, a doctor may also order blood work to check for a history of STDs or other infections that could cause blocked fallopian tubes.
An HSG is an X-ray exam that involves placing dye into the cervix with a small tube. A physician takes X-ray images of the pelvis once the dye enters the body. If the fallopian tubes are open, the dye should flow easily through them. If it doesn’t, the tubes are considered blocked. However, it should be noted that of those who undergo an HSG, 15% receive a false positive result.
This is a minimally invasive outpatient procedure where a surgeon inserts a surgical instrument called a laparoscope through a small incision below the belly button. The surgeon will look through the scope to check for any blockages. During this procedure, a physician may also look for other common infertility factors, such as polycystic ovary syndrome (PCOS) or endometriosis.
Doctors can’t usually see fallopian tubes in an ultrasound, so this isn’t typically the first test ordered to check for blockages. In the case of a hydrosalpinx, the tube will be swollen and easier to see. A physician may order additional tests to confirm that hydrosalpinx is the cause of the blockage.
If a physician determines that both fallopian tubes are blocked, they may prescribe one of three methods to address the issue. Laparoscopic surgery to unblock the fallopian tubes will typically be the first option, but it is not always successful. The other two options are IVF and tubal ligation reversal.
Laparoscopic surgery is a minimally invasive procedure where a physician makes a small incision in the abdomen to assess potential causes of infertility and correct any that are identified. This can all take place in a single procedure. But even if surgery is successful, people with severely damaged fallopian tubes may still struggle with infertility. If so, IVF may be the best option, and if it’s selected, the physician will most likely recommend a salpingectomy (laparoscopic removal of one or both fallopian tubes) before IVF treatment begins to avoid further complications.
In vitro fertilization is a procedure in which a person’s eggs are fertilized by sperm outside of the body. After being fertilized, the eggs are placed in the uterus, avoiding the fallopian tubes completely. If a person with blocked fallopian tubes wants to become pregnant, they may choose IVF instead of pursuing surgery or tubal ligation reversal.
Tubal ligation is a permanent form of birth control in which a surgeon intentionally blocks the fallopian tubes. Different options for tubal ligation include surgically cutting the tubes, banding or clamping them, and placing specialized coils inside them. Some people choose to reverse this procedure, which can be a more affordable option than IVF.
While IVF bypasses the fallopian tubes completely, leaving the underlying causes of tubal blockage or damage untreated can lower the chances of IVF success. Many of the causes of blocked tubes also carry other symptoms that impact fertility and reproductive health. Whether the cause is hydrosalpinx, endometriosis, or infections caused by STDs or abdominal surgery, leaving them untreated risks further damaging your reproductive organs. The IVF success rate is heavily dependent on a healthy uterine environment, which is why your fertility specialist will likely recommend addressing any issues before starting IVF. Thankfully, there are many treatment options to address the causes of damaged or blocked fallopian tubes.
It’s important to remember that tubal factor infertility is common. Around one in four women who struggle with infertility have blocked fallopian tubes, and diagnosing the issue is relatively easy. Once tubal factor infertility has been diagnosed, there are many treatment options to consider, including IVF.
