Blocked Fallopian Tubes (Tubal Factor Infertility)

What is tubal factor infertility?

The fallopian tubes are narrow channels that catch an egg released by the ovary and carry it toward the uterus. Fertilization normally takes place inside a tube, and the embryo then travels to the uterus to implant. If both tubes are blocked or damaged, the egg and sperm cannot meet. If a tube is partly damaged, the risk of an ectopic pregnancy (a pregnancy that implants outside the uterus) rises.

Causes

• Pelvic inflammatory disease (PID), often from untreated chlamydia or gonorrhea
• Endometriosis and the scar tissue it can cause
• Previous pelvic or abdominal surgery, including appendix surgery after rupture
• A past ectopic pregnancy treated surgically
• Fibroids or polyps near the tube openings
• Tubal ligation (“tubes tied”) for those who now want to conceive

Many people have no symptoms. Tubal problems are often found only when testing begins.

How the tubes are checked

• HSG (hysterosalpingogram): contrast dye is injected through the cervix while X-ray images show whether the dye passes through the tubes. It can cause cramping and is usually done in the first half of the cycle.
• Sonohysterosalpingography: saline and air bubbles are viewed on ultrasound.
• Laparoscopy with dye test: a surgical look at the pelvis that also allows treatment.

See our fertility testing guide for how these fit into a work-up.

Treatment

• IVF bypasses the tubes completely and is the standard treatment when both are blocked, when tubes are badly damaged, or after a tubal ligation if reversal is not suitable.
• Surgery may open blockages near the ends of the tubes, remove adhesions or reverse a tubal ligation. Success depends on the type and location of damage. See fertility surgery.
• Removal or clipping of a hydrosalpinx before IVF is often recommended because fluid in the tube can reduce implantation.

Because IUI relies on at least one open tube, it is not suitable when both tubes are blocked.

Risks to keep in mind

Anyone with a history of tubal damage should seek urgent care if they have a positive pregnancy test with one-sided pain or bleeding, because of the ectopic pregnancy risk. See get help now.

How tubal damage happens

The fallopian tube is a delicate structure lined with tiny hair-like cilia that help move the egg and embryo. Infection can inflame and scar the lining, making it narrow or blocked, or damaging the cilia without fully blocking the tube. Endometriosis, adhesions from surgery and fibroids can also distort the tubes or surround them with scar tissue. Because damage may be partial, a tube can be open on a test yet still not function normally.

The HSG in more detail

The HSG is usually scheduled after your period ends and before ovulation, so there is no chance of an existing pregnancy. A clinician places a thin catheter in the cervix and injects contrast dye while taking X-rays. If the dye outlines the uterus and spills out of both tubes, they are considered open. Cramping is common, so many clinics suggest taking an over-the-counter pain reliever beforehand if your clinician approves. After the test, some people notice spotting. Infection is uncommon, but report fever or worsening pain.

Interestingly, some people become pregnant in the months after an HSG, which may relate to flushing of minor debris in the tubes. It is not a reliable treatment.

Hydrosalpinx and IVF

A hydrosalpinx is a tube blocked at the far end and filled with fluid. This fluid can leak back toward the uterus and may interfere with implantation. Studies suggest that treating the affected tube, by removing it or blocking its connection to the uterus, before IVF can improve outcomes. If your HSG or ultrasound suggests a hydrosalpinx, discuss this with your specialist before an embryo transfer.

Ectopic pregnancy risk

When tubes are damaged, an embryo may implant in the tube instead of the uterus. Warning signs include one-sided pelvic pain, vaginal bleeding, shoulder pain, dizziness or fainting. An ectopic pregnancy is a medical emergency. If you have a known tubal history, ask your clinic how early to have an ultrasound after a positive test. See get help now for urgent symptoms.

Reversal of tubal ligation versus IVF

People who have had tubal ligation may consider reversal or IVF. Reversal may suit people who are younger, had a limited type of ligation and have enough healthy tube remaining, and who want the chance of more than one natural pregnancy. IVF may suit older patients, those with additional factors, or those whose tubes cannot be repaired. Both have costs and risks. Consult a surgeon and a reproductive endocrinologist for a comparison suited to you. Read fertility surgery.

Making decisions with limited time

Tubal problems often coexist with other factors, including age. If the tubes are blocked and you are in your late 30s, the clock matters, and IVF is often the most direct route. If you are younger and surgery has a good chance of success, it may be reasonable to try first. In either case, ask for a clear plan and timeline.

Questions to ask

• Are both tubes affected, and how severely?
• Is surgery likely to work for my type of damage, and what are the odds of ectopic pregnancy afterward?
• Should a hydrosalpinx be treated before IVF?
• How soon should we move to IVF if we try surgery first?
• What are the costs and insurance considerations for each path? See fertility costs and insurance.

Next steps

If you have a history of pelvic infection, ectopic pregnancy or pelvic surgery, tell your clinician early and ask whether a tubal check should be part of your first tests. When to see a fertility specialist explains timing.