Tubal Factor Infertility (Fallopian Tube Obstruction)

What is tubal factor infertility?

Tubal factor infertility occurs when a blockage in the fallopian tubes will not allow the egg and sperm to meet. Tubal factor infertility accounts for about 25-30% of all cases of infertility. The condition includes cases of completely blocked fallopian tubes and cases where just one is blocked tube or scarring narrows the tubes.

What causes tubal factor infertility?

Infections, abdominal surgery, and diseases such as endometriosis can cause scarring between the end of the fallopian tube and ovary. Infections may be, but are not necessarily, sexually transmitted. Chlamydia and gonorrhea are two common sexually transmitted infections that can cause tubal infertility. Tuberculosis, uncommon in North America, and a ruptured appendix can both cause a tubal infection. Surgery can also damage your fallopian tubes.

Pelvic Inflammatory Disease (PID) can also travel from the cervix through the uterus to the tubes, which can ultimately cause the delicate inner lining of the tubes to become permanently scarred. The opening of the tube next to the ovary may become partially or completely blocked; scar tissue will often form on the outside of the tubes and uterus.

What are the symptoms of tubal factor infertility?

Most women with tubal infertility are asymptomatic. Often they don’t realize their fallopian tubes are blocked until they consult a doctor for infertility, though women with extensive tubal damage may experience chronic pelvic pain.

How is tubal factor infertility diagnosed?

To confirm whether or not one or both fallopian tubes are blocked, your doctor may perform one of these two procedures:

• Hysterosalpingogram (HSG): Tubal factor infertility is usually investigated first with an HSG which is an X-ray examination performed by a radiologist. A speculum is used to open the vagina, then a catheter is inserted to inject liquid through your cervix (the opening into the uterus) into the uterus. If liquid comes out the ends of one or both of your tubes, then you can determine if one or both tubes are open. If the liquid does not enter or flow completely through one or both of your tubes, then the affected tube is considered blocked. It’s important to realize that if the test finds the fallopian tubes open, it does not mean that tubal function is normal. The inside lining of the fallopian tube may be severely damaged even though the liquid flows through the tube on the HSG. In addition, this test may falsely suggest that the tubes are blocked if blockage appears in the area where the tubes insert into the uterus (false positive). This false positive finding can occur in 15% of women.
• Laparoscopy: In this minimally-invasive outpatient procedure, a surgical instrument called a laparoscope is inserted through a very small incision below your belly button. The surgeon can look through the laparoscope to see if one or both of your tubes are open. The laparoscope can also be used to look for other problems that may affect fertility, such as scar tissue (adhesions) or endometriosis.

How is tubal factor infertility treated?

If your tubes are found to be blocked, scarred, or damaged, your treatment options include in vitro fertilization (IVF) or surgery.

• In vitro fertilization (IVF): Although some tubal problems are correctable with surgery, women with severely damaged tubes have such poor chances of achieving pregnancy naturally that IVF offers them the best option for a successful pregnancy. Because very badly damaged tubes may fill with fluid (hydrosalpinx) and lower IVF success rates, your physician may recommend removal of damaged tubes prior to IVF.
• Surgery: If your tubes are not badly damaged, surgery might help you get pregnant naturally. Your chance of conceiving after surgery is better if you are young, having minimal amount of scar tissue blocking the tubes, and if your male partner has healthy sperm. The biggest risk after tubal surgery is the possible development of an ectopic (tubal) pregnancy. An ectopic pregnancy is a serious health problem that is more likely to occur after tubal surgery or tubal disease. If you have had tubal surgery or tubal disease, you should tell your doctor as soon as you think you are pregnant or have missed your period.