Blocked Fallopian Tubes? Here’s how we can help.

What do you do when you are diagnosed with blocked fallopian tubes?

It is normal to be worried when you have been diagnosed with blocked fallopian tubes. The fallopian tubes are where the egg and sperm meet and the act of fertilization occurs there as well. It is a place where the initial development of the embryo occurs until the embryo migrates to the uterus before it implants in the endometrium. In short, the fallopian tubes are natural incubators and escalators. The diagnosis of tubal blockage occurs following one of the common non-invasive tests for tubal patency such as a hysterosalpingogram (see Figure 1) or a sonohysterogram.

These are not perfect tests and the apparent blockage may not be real thereby requiring the need for additional testing. If one tube is blocked and the other is open, usually women are still be able to have normal or near normal fertility as the open tube with a normal ovary can still be functioning properly. Once the diagnosis is made of a bilateral tubal occlusion, then it is of paramount importance to follow through on additional testing depending upon the circumstances with either a fluoroscopic tubal cannulation procedure or a laparoscopy. In some instances it is clear from the patient’s history that IVF therapy should be pursued rather than additional testing or surgical treatment. Immediate consideration for IVF therapy for patients diagnosed with tubal obstruction should be considered when they have a concomitant diagnosis of severe endometriosis, severe pelvic adhesive disease, severe male factor, and/or diminished ovarian reserve.

1. Fluoroscopic Guided Tubal Cannulation Procedure. (See Figure 2)

This procedure is meant for patients who have been diagnosed with a proximal tubal occlusion (See Figure 3) and is done under fluoroscopic or x-ray guidance. The proximal obstruction can be overcome with the initial HSG catheter and anesthesia or with a hockey stick shaped catheter directed towards each tubal opening that follows the initial catheter. If a blockage is still noted after the use of the hockey stick shaped catheter then a guide wire is cannulated through the tubal openings to open them and dilate them further. Once the tubes are opened the pregnancy rate over the next 1-year is 45-50%, if all other infertility evaluation of the couple is normal. If the procedure fails to open either of the tubes then the patient usually considers IVF treatment as a next step.

2. Laparoscopy (See Figure 4)

A laparoscopy is considered if a patient has been diagnosed with a distal
tubal occlusion (See Figure 5). Depending upon the severity of the tubal damage or the size of the hydrosalpinx (fluid filled tube), the tube can be opened or removed. Severely damaged tubes have a low chance of functioning even after opening them and will decrease the chance of subsequent IVF success, that it is best to have them removed before the patient considers an IVF treatment. Tubes that maintain their rugal folds and fimbria or are mildly damaged can be opened and patients can attempt pregnancy with a modest success rate. The patient who has had a tubal repair is at risk for a ectopic tubal pregnancy. Therefore, she must be followed very carefully from the time she misses her menses to the first OB ultrasound when an intrauterine pregnancy can be confirmed.

If you have been diagnosed with tubal disease please discuss this further with any of our experienced Board Certified Infertility Specialists, who can help you decide which testing and ultimate treatment is right for you.