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Infertility can be difficult to talk about, and even more challenging to experience. But if you’re experiencing infertility, know that you’re not alone. About 9% of women around the world experience infertility—nearly 1.5 million women in the United States (Tsevat, 2018)
One of the most common causes of infertility is “tubal factor infertility,” otherwise known as having blocked fallopian tubes. For women in the U.S., this can cause about 30% of all cases of infertility. Fortunately, healthcare providers have developed ways to diagnose and possibly treat fallopian tube blockage (Tsevat, 2018).
What causes blocked fallopian tubes?
Your fallopian tubes are the channels that transport sperm to the egg, provide an environment for fertilization, and then transport eggs from your ovaries to your uterus in your pelvis. Given their important role in your reproductive system, it’s not surprising that the fallopian tubes are a common source of female infertility problems. The following are some of the most common causes of blocked tubes (Han, 2021):
Pelvic inflammatory disease
The most common infectious process that can affect your fertility is pelvic inflammatory disease (PID). This refers to several types of infection in your abdomen that can cause scar tissue and adhesions in your uterus and fallopian tubes. Not all cases of PID lead to infertility, but the more episodes you have and the more severe they are, the higher your risk of developing infertility (Walker, 2021).
Acute or chronic inflammation in your pelvis, which can happen with PID, can cause a condition called a hydrosalpinx. This is when your fallopian tube becomes blocked and filled with fluid. This damages the structural integrity of the tube and can impair your fertility by creating an environment that’s hostile to a fertilized egg (Walker, 2021).
Endometriosis is a condition where the tissue that normally grows only inside your uterus is found in other places in the body, most commonly on your ovaries or fallopian tubes. Endometriosis affects 10% to 15% of reproductive-aged women, and up to half of those affected will experience fertility problems. The American Society of Reproductive Medicine (ASRM) categorizes endometriosis into four stages, but they don’t always correspond to the symptoms you experience (Walker, 2021).
There are a few different ways that endometriosis can affect your fallopian tubes. In the early stages, endometriosis can cause inflammation and increase the production of the compounds your body uses to treat damaged tissues. In later stages, you can develop pelvic adhesions, where the surfaces of the organs stick together, potentially blocking your fallopian tubes (Walker, 2021).
Sexually transmitted infections
One common cause of tubal factor infertility is untreated sexually transmitted infections (STIs). These infections can ascend the reproductive tract and cause inflammation, scarring, or other damage in the fallopian tubes (Tsevat, 2018).
Chlamydia (Chlamydia trachomatis) and gonorrhea (Neisseria gonorrhoeae) are the two infections most often involved in tubal factor infertility and pelvic inflammatory disease. There is some evidence that other microbes such as Mycoplasma genitalium, Trichomonas vaginalis, and other microorganisms could also be involved (Tsevat, 2018).
STI vs. STD: what’s the difference?
Past ectopic pregnancies
Ectopic pregnancies occur when a fertilized egg implants in an area outside the uterus. The most common site for this to occur is the fallopian tube. A fertilized egg can’t survive outside of the uterus and can damage other organs or cause bleeding if not treated. Ectopic pregnancies can be treated with medications or via surgery. Surgical removal can cause a build-up of scar tissue which can block the fallopian tubes and may lead to trouble getting pregnant in the future (Han, 2021).
Can you get pregnant with blocked fallopian tubes?
Having blocked fallopian tubes can impair your ability to get pregnant. How much of an impact it has depends on whether you have blockages in one or both of your tubes.
In vitro fertilization (IVF) is often the first-line treatment if both of your fallopian tubes are blocked. While surgeries are available to correct tubal factor infertility, they don’t have the same success rates as IVF. There is also a greater risk of having an ectopic pregnancy after some surgeries, which can increase the risk of your tubes becoming blocked again (Walker, 2021).
Some women choose to have their fallopian tubes cut or clipped as a form of birth control. This is called a bilateral salpingectomy or tubal ligation. For the most part, this procedure isn’t reversible, which is why healthcare providers urge women to think through the decision very carefully before doing this procedure (Walker, 2021).
A small portion of women who have had a tubal ligation change their minds and want to become pregnant again. The chances of successful tubal ligation reversal vary, but the time to pregnancy is significantly longer following tubal repair surgery as compared to IVF (Walker, 2021).
Retroverted (tilted) uterus: pregnancy, causes, and treatments
What are the signs of blocked fallopian tubes?
There are usually no signs or symptoms associated with blocked fallopian tubes. Many women only find out about the condition when they undergo a workup during fertility treatment.
If you have another condition causing a tubal blockage, such as a hydrosalpinx or a pelvic infection, you might experience other symptoms such as pelvic pain, fever, or vaginal discharge. If you experience any of these signs, you should contact a healthcare provider to find out what is causing them.
How do you diagnose blocked fallopian tubes?
The gold standard for evaluating whether your fallopian tubes are blocked is to have an exploratory surgery called a laparoscopy that uses a special dye to see if the tubes are open and functional. This is often used if you have a history of pelvic adhesions or endometriosis (Walker, 2021).
The downside of laparoscopy is that it’s an invasive procedure with a greater risk of side effects. If you don’t have any specific risk factors, fertility specialists often use a less invasive procedure called a hysterosalpingogram (HSG) to tell them if your fallopian tubes are blocked (Walker, 2021).
During an HSG, your healthcare provider uses a special contrast material that fills up your uterus, flows into the fallopian tubes, and then flows out near the end of the fallopian tube. Your provider will take multiple pelvic x-rays during the procedure to track the progress of the contrast (Mayer, 2021).
The contrast shows up on the x-rays and allows your provider to see if there are any blockages in your fallopian tubes (Mayer, 2021).
How to open blocked fallopian tubes
Assisted reproductive technologies have become more advanced in recent years and have made surgical repair of the fallopian tubes nearly obsolete. IVF has been shown to have a greater chance of a successful pregnancy than most surgeries. There is also a higher than average risk of ectopic pregnancy following tubal surgery to correct tubal factor infertility (Sotrel, 2009; Walker, 2021).
Uterus didelphys: causes, signs, pregnancy, treatments
In some situations, there are laparoscopic surgery procedures that can be safely and effectively used to clear blocked fallopian tubes. These can enhance the chance of natural conception and are more often used in younger women under the age of 35 (Sotrel, 2009).
One of these surgeries is called fallopian tube catheterization. During this procedure, a guidewire and catheter are passed through the obstruction to open up your fallopian tube. The procedure is minimally invasive and has a high chance of unblocking the tube. However, pregnancy rates afterward can be difficult to estimate, and your tubes may become blocked again (Knuttinen, 2014).
Your reproductive medicine specialist can discuss your treatment options and help you decide whether assisted reproductive technology or surgery to open blocked fallopian tubes is more likely to be successful in your specific situation.
- Han, J. & Sadiq, N. M. (2021). Anatomy, abdomen and pelvis, fallopian tube. [Updated 2021, Jul 31]. In: StatPearls [Internet]. Retrieved on Nov. 22, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK547660/
- Knuttinen, M. G., Jajko, R., & Scoccia, B. (2014). Fluoroscopic tubal recanalization in tubal factor-related infertility. Seminars in Interventional Radiology, 31(3), 269–271. doi: o10.1055/s-0034-1382797. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139428/
- Mayer, C. & Deedwania, P. (2021). Hysterosalpingogram. [Updated 2021, Jun 20]. In: StatPearls [Internet]. Retrieved on Nov. 22, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK572146/
- Sotrel, G. (2009). Is surgical repair of the fallopian tubes ever appropriate?. Reviews in Obstetrics & Gynecology, 2(3), 176–185. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760895/
- Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1–9. doi: 10.1016/j.ajog.2016.08.008. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193130/
- Walker, M. H. & Tobler, K. J. (2021). Female infertility. [Updated 2021, Jan 1]. In: StatPearls [Internet]. Retrieved on Nov. 22, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK556033/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.