Blocked fallopian tubes can make it hard to get pregnant naturally. Tubal factor infertility is often due to infections, endometriosis, or past surgeries.
This post discusses the causes, symptoms, and treatment options for blocked fallopian tubes, including surgery and fertility treatments.
Causes of Blocked Fallopian Tubes
Because they’re so tiny, fallopian tubes can easily get blocked or injured. This usually happens because of scarring or an infection.
Common causes of blocked fallopian tubes include:
Endometriosis
Endometriosis is a chronic condition in which abnormal, endometrial-like tissue grows outside the uterus. It can grow anywhere in the body but is most commonly found in the pelvic area, including the ovaries, fallopian tubes, and the tissue lining the pelvis.
During menstruation, this tissue thickens, breaks down, and bleeds, just like the lining of the uterus. But because it’s outside the uterus, the blood and tissue have nowhere to go. This can lead to inflammation, scar tissue, and adhesions (fibrous bands that can bind organs together).
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is a common cause of blocked fallopian tubes.
PID occurs when bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. This usually happens because of a sexually transmitted infection (STI), like chlamydia or gonorrhea.
PID can cause scar tissue and abscesses (pus-filled pockets, often called tubo-ovarian abscesses or TOAs) within the reproductive organs. This can lead to permanent damage that may result in ectopic pregnancy, infertility, hydrosalpinx (fluid collection in the fallopian tube) and other complications.
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Previous Surgeries
Prior pelvic or abdominal surgeries can also cause scarring that prevents the fallopian tubes from functioning properly.
Examples include:
- Myomectomy for uterine fibroids
- Laparoscopic surgery for endometriosis
- Appendectomy
Complications of Blocked Fallopian Tubes
Hydrosalpinx
Hydrosalpinx occurs when a fallopian tube becomes swollen and filled with fluid, often due to a previous infection or inflammation. This fluid buildup is caused by a blocked tube.
Ectopic Pregnancy
An ectopic pregnancy is when a fertilized egg implants outside of the uterus. When the egg implants in the fallopian tube, it’s called a tubal pregnancy.
This is both a cause of and a complication that can result from blocked tubes.
An ectopic pregnancy can be life-threatening. Surgical removal of the ectopic pregnancy is sometimes necessary and may result in permanent damage to the fallopian tube.
Infection
Having a blocked tube can increase your risk of pelvic infection. This can lead to a circular issue, where the infection causes more tubal damage, further increasing the risk of complications.
Symptoms and Diagnosis
It’s not always easy to tell if a fallopian tube is blocked. Most of the time, there aren’t any symptoms. However, the conditions that cause blocked tubes may have other noticeable signs, such as:
- infertility
- pelvic pain
- spotting between menstrual cycles
- heavy, painful periods
- unusual vaginal discharge
Doctors diagnose tubal blockage using a hysterosalpingogram (HSG). This special X-ray shows if the fallopian tubes are open and working properly.
During an HSG, a contrast dye is injected through the cervix and into the uterus and fallopian tubes. The dye makes the tubes visible on the X-ray images, allowing the doctor to see if they are blocked or damaged.
Treatment Options
The best treatment for blocked fallopian tubes depends on the underlying cause, the extent of the damage, and additional factors like age, fertility goals, and overall health.
Common surgical treatments include:
Salpingectomy
Salpingectomy is the surgical removal of a fallopian tube. This may be done if the tube is fully blocked or severely damaged. It can also treat ectopic pregnancy.
Depending on the severity of tubal disease and treatment goal, one or both tubes may be removed.
Fimbrioplasty
Fimbrioplasty is a reconstructive surgical procedure that can help open up a blocked fallopian tube by removing adhesions around the fimbriae, tiny finger-like projections at the end of the tube.
During this procedure, the surgeon removes scar tissue or adhesions around the fimbriae.
Fimbrioplasty can be beneficial if the adhesions blocking the tube are mild and only present at the ends of the tube. Not everyone is a candidate for fimbrioplasty. Most cases of tubal scarring are too extensive to be repaired in this manner.
Non-surgical treatments include:
Fallopian Tube Recanalization or Selective Tubal Cannulation
Fallopian tube recanalization (FTR), also known as selective tubal cannulation, is a minimally invasive, non-surgical procedure in which an interventional radiologist inserts a thin, flexible catheter (a small tube) or guidewire through the cervix to reach the blockage in the fallopian tube. They then carefully work to open the blockage, restoring the tube’s patency.
Selective tubal cannulation can treat proximal tubal blockage (a blockage located at the beginning of the fallopian tube near the uterus) because it’s easier to access this area with a catheter. Mid-tube or distal blockages cannot be treated with this method.
Infertility and Assisted Reproductive Technologies
Even with treatment, conceiving naturally can be difficult or impossible for women with severely damaged or blocked fallopian tubes. But that doesn’t mean all hope for pregnancy is lost.
Assisted reproductive technologies (ART), like in vitro fertilization (IVF), offer an alternative path to parenthood. IVF is often the most successful option for women with complex tubal disease, especially when tuboplasty is not an option or has been unsuccessful.
The IVF Process
IVF is a multi-step process that begins with a consultation. During this time, the fertility specialist reviews the patient’s medical history and discusses their family-building goals. They’ll also order diagnostic tests, such as a saline sonogram or HSG, to assess the patient’s reproductive health and confirm that IVF is the most suitable treatment option. The specialist may also perform a semen analysis to evaluate the male partner’s sperm health.
Once the specialist confirms that IVF treatment is the best option and both expectant parents are cleared to proceed, the IVF process can begin. Here is an overview of what to expect:
- Ovarian stimulation: This involves taking fertility medications, like follicle-stimulating hormone (FSH) injections (e.g., Gonal-F, Follistim, Menopur, etc.), to help stimulate the ovaries to produce multiple eggs.
- Trigger shot: When the eggs are ready, the fertility specialist may administer a “trigger shot” of human chorionic gonadotropin (hCG) or leuprolide (Lupron) to prep the eggs for retrieval.
- Egg retrieval: The fertility specialist uses a minor surgical procedure, usually an ultrasound-guided transvaginal needle aspiration, to retrieve the eggs from the ovaries. This procedure typically takes about 15 to 20 minutes.
- Fertilization: The mature eggs are combined with the sperm in a lab, through conventional insemination or an advanced technique called intracytoplasmic sperm injection (ICSI).
- Embryo development: The fertilized eggs (embryos) are then monitored and cultured in the lab for several days to allow them to develop. Some may be biopsied or sampled for genetic testing.
- Embryo transfer: A thin catheter carefully transfers one genetically normal (euploid) embryo back into the woman’s uterus. If all goes well, the transferred embryo will implant and develop into a viable pregnancy.
IVF and Tubal Factor Infertility
Here’s what the research says about IVF success rates for tubal factor infertility:
A 1995 study published in Fertility and Sterility found that over 70% of women with tubal factor infertility achieved a live birth within four IVF cycles. This suggests that IVF can be an effective treatment method for women with blocked or damaged fallopian tubes, with success rates comparable to or even exceeding those of tubal reconstructive surgery.
More recent research supports this positive outlook. A 2023 review in Cureus specifically examined women with hydrosalpinx and found that IVF, in conjunction with hydrosalpinx treatment, resulted in a 61% cumulative pregnancy rate.
Other Fertility Treatment Options
Other treatment options for women with tubal infertility are possible ONLY if one tube is still fully functioning. These include:
- Clomiphene citrate (Clomid): Clomid is an oral medication used to treat ovulatory disorders and unexplained infertility. Success rates vary, but studies suggest that about 50% of women taking Clomid will ovulate, and approximately 10-15% will conceive per cycle.
- Gonadotropins: These injectable medications are usually used in combination with intrauterine insemination (IUI) or IVF. Success rates with gonadotropins depend on factors such as age and the underlying cause of infertility.
- Letrozole (Femara): Femara is an alternative to Clomid for ovulation induction. It may be particularly beneficial for women with polycystic ovary syndrome (PCOS). Studies suggest that letrozole may have comparable or even higher success rates than Clomid in some instances.
Pregnancy and Blocked Fallopian Tubes
The most serious risk for women with blocked or damaged fallopian tubes is an ectopic pregnancy. Ectopic pregnancies can cause life-threatening complications and require immediate medical intervention.
Even with partially blocked tubes, the risk of ectopic pregnancy is elevated. The fallopian tubes may not be able to properly guide the fertilized egg into the uterus, causing it to implant outside the uterus, usually in the fallopian tube itself.
Women with tubal factor infertility should be closely monitored for signs of ectopic pregnancy, especially in early pregnancy.
In cases of complete bilateral tubal blockage, natural conception is impossible.
Takeaway
If you’ve been diagnosed with blocked fallopian tubes, there are treatment options available to help you build your family.
Early diagnosis and treatment are key. If you suspect you may have blocked fallopian tubes or are experiencing difficulties conceiving, speak to your primary care doctor or OB-GYN about getting a proper evaluation and discussing your best path forward.
A Word From RMA
At RMA, we specialize in helping individuals and couples with complex fertility challenges, including tubal factor infertility.
Our team of experienced fertility specialists is here to provide compassionate care and personalized treatment plans to give you the best chance of achieving your reproductive goals.
We offer a comprehensive range of diagnostic and treatment options, including advanced surgical techniques and assisted reproductive technologies like IVF.
If you’re ready to take the next step, we’re here to help. Contact us today to schedule a consultation and explore your options with our dedicated team.
