Key points to blocked fallopian tubes
- Blocked fallopian tubes are when one or both are not sufficiently open to allow sperm to reach the egg for fertilization or for the fertilized egg to travel from the fallopian tube (where fertilization occurs) to the uterus.
- Blocked fallopian tubes, also called tubal factor infertility, is a common form of female infertility causing up to 35% of female infertility cases.
- These blockages prevent the pivotal functioning of the fallopian tubes. They can develop in different parts of the tubes and are mostly caused by scar tissue, tubal disease, an obstruction or some type of damage.
- Surgery can repair many tubal blockages, but not all. For women seeking to have biologic children with irreparable fallopian tubes, in vitro fertilization (IVF) can enable them to get pregnant.
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What are blocked fallopian tubes?
A blocked fallopian tube occurs when one or both fallopian tubes are not open, which prevents two important aspects of conception. One is the ability of sperm to enter the fallopian tube to meet the egg for fertilization. The other aspect is that, while sperm may enter the tube, blockages prevent the fertilized egg (developing embryo) from reaching the uterus (womb) to implant for pregnancy.
Either way, female infertility is the result. Moreover, if the embryo can’t travel to the uterus, it may attach to the fallopian tube or somewhere outside the uterus, creating an ectopic pregnancy. Unfortunately, these are never viable and must be terminated for the safety of the mother.
Blocked fallopian tubes, also called tubal factor infertility and tubal disease, are a common cause of female infertility. The American Society for Reproductive Medicine reports that 25%-35% of female infertility cases are due to tubal factor infertility.
Normal functioning of the fallopian tubes
- A woman’s two fallopian tubes are vital reproductive organs.
- They are two-way transit routes between the ovaries and the uterus and provide a site for an egg to be fertilized by sperm.
- Each connects one of the two ovaries to the uterus, and when the egg is released from one ovary, it travels down the connecting fallopian tube toward the uterus.
- Sperm “swim” from the vagina after ejaculation through the uterus and into the fallopian tube. If an egg is present, sperm can fertilize it (eventually creating an embryo).
- Tiny hairs in the fallopian tube then sweep the developing embryo toward the uterus, where it will hopefully implant for pregnancy.
- If fertilization does not happen, the unfertilized egg is absorbed by the body and is shed during the next menstrual cycle.
There are different types of tubal blockages, classified by where they appear. This and other factors affect the type of treatment.
A proximal tubal blockage occurs in the tube near the uterus. A mid segment blockage occurs in the middle of the tube.
A distal tubal blockage occurs toward the end of the fallopian tube near the ovaries.
Damage to the fimbriae, which are the finger-like tissues in the tube that help move the egg from the ovary to the fallopian tube, can also harm tubal function.
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Causes of blocked fallopian tubes
Fallopian tubes are somewhat prone to damage, which is unfortunate given their vital role in conception. Scarring can cause blockages as can damage to the tube and dilation. Primary causes follow.
This is a condition occurring when the tubal portion near the ovary becomes filled with fluid dilating the tube. This causes swelling that can prevent the egg from entering the fallopian tube. Infections, surgery and other diseases can cause hydrosalpinx.
Pelvic inflammatory disease
Infections are the primary cause of tubal factor infertility, and pelvic inflammatory disease (PID) is a major one. PID causes scarring in the fallopian tubes and blockage. Sexually transmitted infections (STIs) often cause PID.
Sexually transmitted infections can cause fallopian tube damage on their own. The main culprits are chlamydia and gonorrhea. The STI must be cleared before attempting treatment to unblock the tubes.
Blocked fallopian tube symptoms
Blocked fallopian tube symptoms are most often actually symptoms of the condition causing the blockages, such as an STI, endometriosis or PID. These may cause pain during periods and intercourse and heavy bleeding. If caused by hydrosalpinx, patients may experience vaginal discharge and pain in the abdomen.
Many times, the symptom that brings women in for evaluation is inability to become pregnant.
Diagnosis of tubal factor infertility
Our fertility specialist has two means of diagnosing tubal disease.
This utilizes dye and X-rays that can show if the tubes are open or blocked. A tube that appears to be open in hysterosalpingogram testing can still have scarring inside that will block sperm, egg and embryo movement. This can lead to the need for laparoscopy.
This is a minimally invasive surgery giving the doctor a view of the fallopian tubes by means of a tiny fiber optic camera inserted through small incisions that sends images to an external video monitor. Tubal damage can often be repaired at this time using special instruments.
Tubal ligation reversal surgery
One form of tubal blockage is intentional: tubal ligation, or having one’s “tubes tied” as a means of permanent sterilization. But Fertility and Sterility reports that up to 30% of women who have had a tubal ligation regret it later. This can result in the need for us to re-open tied off fallopian tubes.
The manner in which the tubal ligation reversal surgery is done depends on how the tubes were blocked/tied/clipped and the length of the remaining tube (if most of the tube is gone, reversal isn’t possible).
Our doctor’s incisions give access to the fallopian tubes and enable him to determine if the tubes can be reconnected and begin that procedure immediately. Also called tubal reanastomosis, this is a major surgery that can take about three hours. Risks are the same as for any surgery, with the additional risk that the procedure may not be successful, and the tubes can become closed again afterward.
Next steps: blocked fallopian tube treatment options
Clearing the blockage is not always the best approach to overcoming the issue of tubal disease. Depending on various factors, our fertility specialist – in discussion with the patient – may recommend that IVF is the best approach, rather than clearing the blockage. Reasons to try IVF first are if the damage is extensive and if other issues impeding fertility are at play.
When it comes to unblocking the tube(s), the method of treatment depends on the location of the blockage and its makeup. There are no medication regimens that can clear it or reverse damage. Our specialist will either surgically open the tube or use tubal cannulation.
Tubal cannulation is a nonsurgical procedure performed to correct a proximal tubal blockage. A balloon inserted into the tube using a catheter is inflated to open the blockage.
Laparoscopic surgery is the most common blocked fallopian tube treatment (see laparoscopy under diagnosis). It is often used to repair or reconstruct the fimbriae (fimbrioplasty) to help restore the function of the fallopian tubes.
A salpingectomy removes a damaged fallopian tube. This is usually done when the other tube is open. Otherwise, IVF would be the only effective treatment option for the patient to achieve pregnancy.