Tubal Factor Infertility (Blocked Fallopian Tubes)

Tubal factor infertility facts

  • Tubal factor infertility, also known as tubal disease and blocked fallopian tubes, refers to a blockage of one or both fallopian tubes including scarring, dilation (hydrosalpinx), damage or other obstruction.
  • This causes infertility by blocking sperm from meeting and fertilizing an egg in one of the fallopian tubes, two organs that connect the ovaries to the uterus.
  • Tubal factor infertility is a common cause of infertility in women, with 25% to 35% of female infertility due to tubal factors.
  • A blocked fallopian tube often results from a pelvic infection, such as pelvic inflammatory disease (PID), as well as fibroids, scarring from prior surgery or endometriosis.
  • A hysterosalpingogram (HSG) or ultrasound can help diagnose and determine the cause of a fallopian tube blockage.
  • Depending on the type of blockage, tubal surgery may be an option, but as an alternative women can undergo in vitro fertilization (IVF) or INVOcell, in which fertilization occurs in the lab or the INVOcell device, not the fallopian tubes.

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What is tubal factor infertility (tubal disease)?

The fallopian tubes are the passageways in a woman’s body where the sperm meets the egg, and from which that fertilized egg moves to implant in the uterus. Tubal factor infertility refers to a condition damaging one or both of the fallopian tubes, thus preventing fertilization and pregnancy.

Tubal factor infertility is also sometimes referred to as tubal disease or blocked fallopian tubes. The American Society for Reproductive Medicine estimates that 25% to 35% of female infertility is due to tubal factors.

During the menstrual cycle each month, the ovaries release a mature egg that moves into one of the fallopian tubes. That tube must be open to allow sperm to reach and fertilize an egg and for the resulting embryo to move to the uterus. Tubal factor infertility can result from both fallopian tubes being completely blocked, only one blocked fallopian tube with damage to the other, and other combinations of blockage and/or scarring that prevent passage of sperm and/or fertilized eggs.

Furthermore, while a partially damaged or blocked tube may allow sperm to reach an egg for fertilization it may be unable to transport the embryo to the uterus. This can cause an ectopic or tubal pregnancy, where a fertilized egg grows outside the uterus. This is a life-threatening condition that will not result in a child, so the ectopic pregnancy must be ended.

A tubal blockage is classified by its location, which also determines the severity and treatment.

  • Proximal tubal blockage: This is located close to the uterus and may result from tubal spasm, a mucous plug or scarring to the proximal tube.
  • Mid-segment tubal blockage: This refers to damage or scarring in the middle of the fallopian tube, often caused by tubal ligation or the reversal of a tubal ligation.
  • Distal tubal blockage: This involves a partially or entirely blocked end of the tube near the ovary. A distal tube blockage frequently dilates and accumulates toxic fluid (hydrosalpinx).

What is hydrosalpinx?

  • Hydrosalpinx is a specific tubal condition in which the end portion of a woman’s fallopian tube near the ovary becomes fluid-filled and swollen.
  • If the fallopian tube is completely blocked in this manner, an egg cannot travel freely into the fallopian tube where fertilization occurs, causing infertility.
  • Hydrosalpinx can result from pelvic infections (including chlamydia), pelvic surgery, endometriosis, adhesions and some tumors.
  • There are no primary symptoms, but women may experience pain in the lower belly or vaginal discharge.
  • Treatment is to either surgically open or block/remove the hydrosalpinx, as the presence of hydrosalpinx can decrease chances of success with IVF by up to 50%.

Causes of tubal factor infertility

  • Pelvic infections, such as pelvic inflammatory disease (PID), are the most common cause of tubal disease.
  • Endometriosis, which causes tissue to grow outside the uterus, occasionally blocking or damaging fallopian tubes.
  • Pelvic surgery resulting in scarring of the fallopian tubes.
  • Tubal ligation (e.g., tubes tied, which is intentional tubal factor infertility).
  • Sexually transmitted infections (STIs) such as gonorrhea or chlamydia.
  • Ectopic pregnancy.

Patients have a higher risk of tubal factor infertility if they’ve had a ruptured appendix or previous abdominal surgeries.

Symptoms of tubal disease

Often, the only symptom of a tubal blockage is difficulty getting pregnant. Some women may experience lower abdominal pain in addition to infertility, particularly if PID is the cause of the blockage.

What to know about tubal ligation reversal

  • A tubal ligation procedure can be a permanent form of birth control that involves closing off the fallopian tubes. Women who may wish to get pregnant later in life after this procedure can undergo a tubal ligation reversal, which our fertility experts perform.
  • This surgery unblocks the fallopian tubes that were previously altered by a tubal ligation. A surgeon will remove the clip, ring, tie or other method that blocked the fallopian tubes to reattach the tubes to themselves.
  • Tubal ligation reversal is a major abdominal surgery and carries with it all the risks of normal surgery including infection, pain and scarring. Tubal ligation reversals are not always successful, and can cause scar tissue to form, resulting in the fallopian tubes becoming blocked again.
  • Women who become pregnant after a tubal ligation reversal have a higher chance of an ectopic pregnancy.

Diagnosing tubal blockage with ultrasound, hysterosalpingogram & laparoscopy

Doctors can use a variety of tests and procedures to diagnose tubal blockage as the actual problem causing infertility.

  • A transvaginal or abdominal ultrasound may notice a hydrosalpinx, or use with FemVue can look at the fallopian tubes and other areas of the reproductive tract to evaluate for blockages and damage.
  • Hysterosalpingogram (HSG) is a special type of X-ray that uses an iodine-based dye injected through the cervix. It helps a doctor look for blockages in the fallopian tubes.
  • If the extent of tubal damage cannot be clearly determined by HSG, our fertility specialist may recommend laparoscopy. This minimally invasive surgery utilizes a laparoscope inserted through a small incision below the belly button to view the fallopian tubes. This procedure can also be used at the same time to repair fallopian tube damage or remove scar tissue.

Treating tubal infertility

The extent of the tubal damage and its location will determine the type of treatment our fertility specialist may recommend.

If damage to the tube is minor, such as small adhesions or scar tissue, we may recommend surgery. This is typically performed with laparoscopy. A fimbrioplasty surgical procedure can remove a partial blockage or scarring of the fallopian tube’s fimbriae, finger-like structures at the end that sweep the egg released from the ovary into the fallopian tube so it can be fertilized by the sperm.

Tubal surgery comes with specific risks however, including ectopic pregnancy, increased scar tissue on reproductive organs and infection. For this reason, surgery may not be the recommended course of action.

If the damage is significant, or if there is a high risk for ectopic pregnancy, IVF is likely recommended as a surgery alternative. This treatment for tubal factor infertility has a high rate of success.