Infertility Caused by Damaged or Blocked Fallopian Tubes

Damaged or blocked fallopian tubes overview

• Damaged or blocked fallopian tubes is a common cause of female infertility, because inside the fallopian tube is the location where sperm fertilizes the woman’s egg.
• Tubal blockages or damage may be caused by pelvic inflammatory disease, endometriosis, previous surgeries, ectopic pregnancy or tubal ligation.
• Most women with damaged or blocked fallopian tubes do not experience any symptoms.
• If tubal damage or blockages cannot be corrected through surgery or tubal cannulation, which involves a doctor clearing the blockage with a medical instrument, a woman may still be able to get pregnant through in vitro fertilization (IVF).

What causes damaged or blocked fallopian tubes?

Due to their small size, the fallopian tubes are easily damaged or blocked. The fallopian tubes are most commonly blocked or damaged because of scarring on the walls of the tubes caused by infection. Aside from infection, which can be due to various causes, tubes may be blocked by disease or damaged from surgery. The more frequent causes of tubal occlusion follow.

Pelvic inflammatory disease (PID)

PID is an infection that can develop when sexually transmitted diseases (STDs) or other infections go untreated. It is typically caused by gonorrhea or chlamydia. PID causes inflammation near the fallopian tubes, which can lead to the development of scar tissue and blockages.

Endometriosis

Endometriosis is when tissue from a woman’s endometrium, the lining of the uterus, begins to grow outside of the uterus on other pelvic organs. During menstruation the endometrium is typically shed and released from a woman’s body as flow from her period. However, the endometrium tissue that is growing outside of the uterus does not shed like normal tissue. This causes inflammation and can lead to the development of scar tissue.

Endometriosis that develops on or near the fallopian tubes may scar or block the tubes, which can cause tubal infertility.

Surgery

Past surgeries can also be a cause of damaged or blocked fallopian tubes. In particular, surgery for medical problems like uterine fibroids or endometriosis and other types of abdominal surgery may cause scarring that affects an egg’s ability to travel through the fallopian tubes.

Ectopic pregnancy

An ectopic pregnancy is when a fertilized egg implants in the fallopian tubes, rather than in the uterus. Because fallopian tubes are small and narrow, the fertilized egg does not have the room it needs to grow. This can cause the fallopian tubes to rupture, which is life threatening and also renders the woman infertile.

If a doctor identifies an ectopic pregnancy before the fallopian tube ruptures, then surgery can be performed to remove the fertilized egg. Surgery can lead to fallopian tube scarring and sometimes removal.

Tubal ligation

Tubal ligation is an elective surgery in which a woman decides to have the ends of her fallopian tubes cut or blocked to prevent any future pregnancies. This procedure is sometimes referred to as “having your tubes tied.” Tubal ligation can be reversed in some cases, but it requires additional surgery.

Diagnosing and treating damaged or blocked fallopian tubes

Doctors usually diagnose tubal blockage and damage using a hysterosalpingogram (HSG) test. During a HSG procedure, a doctor fills the uterus with a solution containing dye to provide visual contrast, then uses an X-ray to look at the uterus and fallopian tubes. If the doctor determines that a woman’s fallopian tubes are blocked, laparoscopy, a kind of minimally invasive surgery, may be performed to investigate the blockage.

The treatment for tubal disease will vary depending on the type of damage or blockage. In some cases, surgery may be recommended to remove the blockage. However, surgery is not always beneficial. If the damage or blockage cannot be treated, then a woman may still be able to get pregnant through IVF.

Types of treatment for damaged or blocked fallopian tubes

Hydrosalpinx treatment and surgery

In order to treat hydrosalpinx, which is when the fallopian tubes have a blockage causing fluid buildup, a doctor generally performs either a salpingectomy or a salpingostomy. In a salpingectomy, a doctor removes part of the blocked fallopian tube. This procedure improves the likelihood of conceiving through IVF more than other possible surgical treatments.

During a salpingostomy, a doctor creates a new opening in the fallopian tube near the ovary. Eggs from the ovaries can then travel through the new opening to the fallopian tubes. Over time, scar tissue can sometimes grow over this new opening, causing a new blockage. A variation of the salpingostomy is the fimbrioplasty, which involves creating a new opening and rebuilding the fimbriae (tissue near the ovaries). Doctors may recommend either procedure depending on the placement of the blockage.

Each of these surgeries typically requires a two- to three-day stay in the hospital and a four- to six-week recovery time. Risks of the surgeries include growth of new fallopian tube scar tissue, increased chance of ectopic pregnancy and such complications of surgery as blood loss, pain, and damage to organs or tissue.

Tubal cannulation

Tubal cannulation is a nonsurgical treatment for fallopian tube blockages, especially blockages closest to the uterus. During this procedure, a doctor guides a catheter through the vagina and uterus until it reaches the blockage. X-rays or ultrasound helps the doctor find the exact position of the blockage during the procedure. The doctor will then inflate a small balloon or use a thin wire to remove the blockage.

Tubal cannulation has minimal risks and downtime. Risks include infection and creating a tear in the fallopian tube wall.

Tubal ligation reversal

During tubal ligation reversal, a doctor surgically removes blockages from the fallopian tubes that were placed or added during a previous tubal ligation procedure. In many cases a doctor performs a tubal ligation reversal by removing the parts of the fallopian tubes with the blockages and reconnecting the two ends of each tube in a procedure called tubal reanastomosis.

Before scheduling the procedure, a doctor will evaluate if the woman is a good candidate for tubal ligation reversal. Women who had tubal ligation using tubal rings or clips have the best chance of achieving pregnancy naturally after tubal ligation reversal.

The procedure is considered an abdominal surgery and has a two-week recovery time. Risks of the tubal ligation reversal include infection, bleeding, scarring and increased chance of ectopic pregnancy.

Fertility after treatment for damaged or blocked fallopian tubes

Age, length of fallopian tubes, amount of tubal scarring and severity of associated fertility conditions all play a role in a woman’s ability to get pregnant after having fallopian tube blockage treatment. Between 10 and 80 percent of women whose treatments are successful are able to get pregnant in the future.

While there is no guarantee that a woman will be able to achieve pregnancy after tubal blockage treatment, certain factors do make pregnancy more likely. Women who had blockages near their uterus, rather than structural blockages or scarring, are more likely to be able to get pregnant after treatment. Additionally, women whose fallopian tubes are at least 7.5 cm in length after tubal surgery have a better chance of conceiving than women with shorter fallopian tubes.

Age can also factor into a woman’s fertility. Women who are over the age of 35 may have decreased fertility and need to consider undergoing intrauterine insemination (IUI) or IVF after fallopian tube blockage treatment.

IVF with damaged or blocked fallopian tubes

IVF is recommended for women who wish to get pregnant but have damaged or blocked fallopian tubes that cannot be treated. Even in instances where a woman no longer has fallopian tubes, she may be able to get pregnant through IVF. This is because during an IVF procedure, a fertilized egg at the embryo stage is placed directly into a woman’s uterus, bypassing the need for the sperm and egg to travel to the fallopian tubes or of a resulting embryo to travel to the uterus.

Risks of IVF include ovarian hyperstimulation syndrome caused by fertility medications, increased chance of multiple pregnancy (twins or more), and egg retrieval complications, such as infection, internal bleeding and damage of pelvic organs.

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