Blocked Tubes

The fallopian tubes are small, narrow tubes that connect the ovaries and the uterus. When the ovaries release an egg, it travels down these tubes toward the uterus to be fertilized by sperm. In some cases, the sperm can travel up the tubes and be fertilized there.

However, in some case, one or both of these tubes may be blocked, leading to infertility. This is also known as tubal factor infertility. Unfortunately, there are no symptoms of blocked tubes - you can be diagnosed with them after your reproductive endocrinologist (RE) performs a hysterosalpingography (HSG).[1]

If only one tube is blocked, fertility may be impacted but not severely affected. If the egg travels down the open tube, conception is possible. If both tubes are blocked, conception naturally becomes almost impossible. Additionally, tubes can either be partially blocked or fully blocked. In the case of partial blockage, pregnancy is possible, but the risk of ectopic pregnancy increases.[2]

The reasons for blocked tubes include scar tissue (from pelvic infections or endometriosis), fluid in the tubes called a hydrosalpinx, or pelvic inflammatory disease. In some cases, however, there can be seemingly no reason for blocked tubes.[3]

Treatment for Blocked Tubes

The treatment of blocked tubes can depend on several factors, such as location, severity, maternal age and presence of other fertility factors.

In cases of partial blockage, blockage of the tube near the ovary (distal tubal occlusion), or less severe damage, surgery is the first recommendation before in vitro fertilization (IVF).[4]

Surgical procedures are listed below.

Fallopian Tube Recanalization (FTR)

Fallopian Tube Recanalization (FTR) is a procedure in which a catheter is used to clear out blockages in the fallopian tubes. This is the most non-evasive procedure as it is also non-surgical.

During this procedure, a catheter (a small plastic tube) is passed through the cervix into the uterus. Dye is the passed through the catheter in order to observe the uterine cavity in detail. This process is called a hysterosalpingogram (HSG) and is covered in depth in the HSG page.

While the catheter is in place, a second, smaller catheter is threaded through the first catheter and into the tubes to clear them either by fluid, inflated balloon or a wire.[5]

This process works best for partial blockages. In many cases, at least one tube is able to be opened with this treatment.[6]

Tubal Cannulation

During tubal cannulation, a small tube called a catheter is placed through your vagina. Using X-Ray or ultrasound, the doctor can find the correct spot and open up the blocked area using a balloon or write attached to the catheter.

It is important to note that this procedure is only for those with proximal tubal obstruction (PTO) – that is, blockage closest to the uterus. Those with distal tubal obstruction (DTO) – blockage closest to the ovaries – are recommended to have a laparoscopy instead.[7]

The simplicity of this technique makes it recommended for those with PTO before any other treatment, such as IVF.[8] However, there is still little evidence via trials or research of success rates or effectiveness.[9]

Laparoscopy

A laparoscopy is a minimally invasive surgery where a doctor examines the abdomen, uterus and ovaries with a camera via small incision near the belly button. During this procedure, the doctor can open blocked tubes during micro surgery. This is best for those with DTO as that area can be hard to get to. As this is a surgery, it is important to choose a doctor with experience and training in this area.

In Vitro Fertilization (IVF)

In cases of complete blockage, failure of previous surgeries to unblock tubes, or absence of tubes due to ectopic pregnancies or removal (salpingectomy), in vitro fertilization (IVF) is the remaining option. IVF does not use the tubes during its process, making those with tubal issues perfect candidates. IVF is usually the recommended treatment, but your doctor will ultimately know what is best for your case.[15]

For more information on IVF, please visit the IVF page located in the menu above.[16]

Hysteroscopy

A hysteroscopy is a procedure in which a doctor uses a speculum (more colloquially known as “the duck”) to keep your vagina open to examine it. After, the doctor inserts a hysteroscope – thin, telescope-like instrument – to examine and visualize the uterus and tubal openings.

This procedure is used for investigating problems such as heavy periods or unusual bleeds, fibroids, polyps, and issues getting pregnant.[10]

In terms of PTO, blockages can be removed during the hysteroscopy. Tiny tubes or other devices such as wires can be run through the hysteroscope in order to clear the blockages.[11]

Salpingostomy

A salpingostomy is an incision into the fallopian tube. Although used for ectopic pregnancies as well, in the case of hydrosalpinx (a tube filled with a blocked by fluid), this procedure may be used to create a new opening (called a tubal ostium.)[12]

This procedure is not as common nowadays due to the rise of IVF and ART[13], but in some patients, it may be an effective way to correct the hydrosalpinx.[14]

[1] Gurevich, Rachel, Sadaty, Anita. 2018. “Blocked Fallopian Tubes: Symptoms and Treatment.” Very Well Family. 2018. https://www.verywellfamily.com/all-about-blocked-fallopian-tubes-1959927.

[2] Wilson, Debra Rose. 2017. “What You Should Know About Blocked Fallopian Tubes.” Healthline. October 25, 2017. https://www.healthline.com/health/womens-health/blocked-fallopian-tubes.

[3] Pryor, Elizabeth. n.d. “Blocked Fallopian Tubes.” Parents. Accessed April 26, 2018. https://www.parents.com/getting-pregnant/infertility/causes/blocked-fallopian-tubes/.

[4] Harvard Health. 2009. “Treating Blocked Fallopian Tubes.” Harvard Mental Health Letter. 2009. https://www.health.harvard.edu/diseases-and-conditions/treating-blocked-fallopian-tubes.

[5] Stanford Health Care. n.d. “Fallopian Tube Recanalization.” Stanford Health Care. Accessed April 26, 2018. https://stanfordhealthcare.org/medical-treatments/f/fallopian-tube-recanalization.html.

[6] Thurmond, A S, and J Rösch. 1990. “Nonsurgical Fallopian Tube Recanalization for Treatment of Infertility.” Radiology 174 (2): 371–74. https://doi.org/10.1148/radiology.174.2.2296648.

[7] WebMD. n.d. “Tubal Cannulation.” Accessed April 26, 2018. https://www.webmd.com/infertility-and-reproduction/guide/what-is-tubal-cannulation#1.

[8] Valle, R F. 1995. “Tubal Cannulation.” Obstetrics and Gynecology Clinics of North America 22 (3): 519–40. http://www.ncbi.nlm.nih.gov/pubmed/8524535.

[9] Das, Sangeeta, Luciano G Nardo, and Mourad W Seif. 2007. “Proximal Tubal Disease: The Place for Tubal Cannulation” 15 (4): 383–88. https://doi.org/10.1016/S1472-6483(10)60362-8.

[10] NHS. 2016. “Hysteroscopy.” NHS Choices. 2016. https://www.nhs.uk/conditions/hysteroscopy/.

[11] American Society for Reproductive Medicine. 1996. “Tubal Factor Infertility.” American Society for Reproductive Medicine. 1996. http://www.beachcenter.com/surgical/tubal.shtml.

[12] Encyclopedia of Surgery. 2003. “Salpingostomy.” 2003. http://www.surgeryencyclopedia.com/Pa-St/Salpingostomy.html.

[13] Chu, J., H.M. Harb, I.D. Gallos, R. Dhillon, F.M. Al-Rshoud, L. Robinson, and A. Coomarasamy. 2015. “Salpingostomy in the Treatment of Hydrosalpinx: A Systematic Review and Meta-Analysis.” Human Reproduction 30 (8). Oxford University Press: 1882–95. https://doi.org/10.1093/humrep/dev135.

[14] Taylor, R C, J Berkowitz, and P F McComb. 2001. “Role of Laparoscopic Salpingostomy in the Treatment of Hydrosalpinx.” Fertility and Sterility 75 (3): 594–600. http://www.ncbi.nlm.nih.gov/pubmed/11239547.

[15] USC Fertility. 2015. “Tubal Factor Infertility.” USC Fertility. 2015. http://uscfertility.org/causes-infertility/tubal-factor-infertility/.

[16] WebMD. n.d. “What Fallopian Tube Procedures Help With Fertility?” WebMD. Accessed April 26, 2018. https://www.webmd.com/infertility-and-reproduction/guide/fertility-fallopian-tube-procedures#1.