Blocked Fallopian Tubes

What are blocked fallopian tubes?

The fallopian tubes carry the egg from the ovary towards the uterus. Fertilisation normally happens inside the tube, and the early embryo then travels to the womb. When one or both tubes are blocked or damaged, the sperm and egg cannot meet, or the embryo may not reach the uterus. Tubal factor is responsible for a significant share of female infertility. A blockage can be near the uterus (proximal), at the far end near the ovary (distal), or along the tube. A blocked tube that fills with fluid is called a hydrosalpinx.

Symptoms and signs

Most women with blocked tubes have no symptoms. Possible signs include:

• Difficulty conceiving despite regular periods
• Pelvic pain or pain during intercourse, in some cases
• Unusual vaginal discharge if there is ongoing infection
• A previous ectopic pregnancy

Causes and risk factors

• Pelvic inflammatory disease (PID), often from sexually transmitted infections such as chlamydia or gonorrhoea
• Genital tuberculosis, an important cause in India
• Endometriosis
• Previous ectopic pregnancy or tubal surgery
• Pelvic or abdominal surgery, such as appendix surgery or caesarean section, causing adhesions
• Infection after miscarriage, abortion or childbirth
• Previous tubal ligation (sterilisation)

How it is diagnosed

• Hysterosalpingography (HSG): an X-ray test in which dye is passed through the cervix to show whether the tubes are open
• Sonosalpingography (HyCoSy or sono-HSG): an ultrasound-based test using contrast fluid
• Transvaginal ultrasound, which may show a hydrosalpinx
• Laparoscopy with dye test (chromopertubation): keyhole surgery that directly views the tubes and can treat some problems
• Tests for tuberculosis or other infections where suspected

An HSG can sometimes show a false blockage due to tubal spasm, so results may need confirmation.

Treatment options

Tubal surgery

Some proximal blockages can be opened with tubal cannulation, where a fine catheter is passed through the tube under X-ray or hysteroscopic guidance. Laparoscopic surgery can release adhesions or open the end of a tube. Surgery is best suited to younger women with mild damage and a good sperm count. It carries a higher risk of ectopic pregnancy afterwards.

Treating hydrosalpinx before IVF

Fluid from a hydrosalpinx can leak into the uterus and lower the chance of implantation. Removing the tube (salpingectomy) or blocking it near the uterus before IVF is commonly recommended to improve results.

IUI

If only one tube is blocked and the other is healthy, ovulation induction with IUI may be tried, particularly when ovulation occurs on the side of the open tube.

IVF

IVF bypasses the tubes completely: eggs are collected from the ovaries, fertilised in the laboratory and the embryo is placed directly into the uterus. It is the main treatment when both tubes are blocked or badly damaged, or when surgery has not worked.

Chances of pregnancy

With IVF, tubal damage itself does not reduce the chance of pregnancy once any hydrosalpinx is dealt with. Results depend mainly on the woman's age, ovarian reserve and sperm quality. Iswarya Fertility reports IVF success of about 75 percent for women under 35, but individual results vary and cannot be guaranteed.

When to see a fertility specialist

See a specialist if you have tried for 12 months (6 months if 35 or older), or sooner if you have had PID, tuberculosis, an ectopic pregnancy or pelvic surgery. Iswarya Fertility has 91+ centres offering tubal testing and IVF.