If you’re struggling to conceive, but know for certain that you’re ovulating on a regular basis, it’s possible that the source of your fertility problems can be found in your fallopian tubes. But let’s be honest; it’s been a minute since we sat in sex ed class. So, what do “blocked fallopian tubes” even mean?
Quick primer: your fallopian tubes are narrow ducts that connect your ovaries to your uterus. Every month, an ovary releases an egg into the fallopian tube so it can move into your uterus; if you’ve had sex recently, it may wind up running into sperm and possibly becoming fertilized. Or at least that’s what’s supposed to happen.
Since your tubes are basically a highway for your eggs, if you’ve got a blockage somewhere, it’s kind of like being stuck in gridlock traffic (i.e. it’s pretty hard your eggs to get where they need to go). Hard, but not impossible—here’s all the info you need.
Why are my tubes blocked, doc?
“Blockages close to the uterus are not as well understood, but could be because of prior infection or even endometriosis,” says Dr. Mark Trolice, infertility specialist at Fertility CARE: The IVF Center in Florida. A blockage at the end of the tubes, he says, could be due to endometriosis, but more commonly, it’s because of a prior STD. Any abdominal surgery—an appendectomy, for example—can also result in scarring related to the tubes.
Why don’t I have any symptoms?
Unfortunately, there aren’t many. Having trouble conceiving may be the biggest warning sign that something is up. Occasionally with distal disease, a backup of fluid can cause some pain as well as watery vaginal discharge, but according to Dr. Anthony Propst, reproductive endocrinologist at Texas Fertility Center, most patients with a blockage might never even know. Crazy, right?
So…am I blocked or not?
To figure out if your tubes are blocked, your doctor might perform a:
- Saline hysterogram/hysterosalpingogram (HSG): Smile, you’re on camera! Well not you—your uterus. An HSG involves a contrast dye injection into your cervix; once the dye is moving through your uterus and tubes, X-ray images are taken to see if there are any blockages. It’s a simple outpatient procedure that only takes about 30 minutes.
- Laparoscopy: This type of surgery can evaluate and even treat some mild tubal disease with the insertion of a thin viewing device into your abdomen to get a better look around your reproductive system. You’ll need general anesthesia for this, but usually not an overnight hospital stay—more invasive than an HSG, but the incision is small, so you’ll be back home before you know it to Netflix binge for the rest of the day.
I know I have blocked fallopian tubes. What’s my next step?
You’ve got options if your tubes are blocked, but choosing the right one for you will depend on where your blockage is and if there’s a lot of damage to your tubes.
- If your blockage is close to the uterus: This is called a proximal occlusion, and it’s easily treated with an outpatient procedure to open up the tubes. These blockages, Dr. Trolice says, are usually either mucus plugs or inflammation from scarring. If the tubes are successfully opened, you may be able to conceive naturally; if your tubes cannot be opened or cleared (or natural conception still isn’t possible), your doctor may recommend IVF.
- If your blockage is towards the end of your fallopian tube: This is known as distal disease, and your doctor will need to assess the damage and decide whether to repair or remove the tube. Because surgical outcomes of repairing tubes vary, the standard has become to either remove the damaged tube or clip it, explains Dr. Paula Brady, fertility specialist at Columbia University Fertility Center. Real talk? Things can get a bit complicated here. Some docs prefer to jump right into IVF instead of spending time trying to fix tubes that may be unfixable.
Yes, we know we just gave you a long list of “ifs.” Tubal blockages are kind of unpredictable like that. One thing is definite, though—if you have fluid backed up at the ends of your tubes (also called a hydrosalpinx), that has to be addressed before any other treatments can be done.
The effects of a hydrosalpinx on IVF success rates have been well-studied, and if the inflammatory fluid leaks back into the uterus, it can easily affect egg implantation.
What’s all this buzz about “tubal flushing”?
Tubal flushing is technically the same as an HSG, says Dr. Propst, because it involves the injection of contrast dye into the uterus and fallopian tubes. In other words, it’s not a separate procedure, but a benefit of the diagnostic testing.
But it might be a pretty big benefit: a 2017 study published in the New England Journal of Medicine revealed that when more than 1,000 infertile women in the Netherlands were given an HSG with either oil-based or water-based contrast dye, 38 percent of the women who received the oil-based dye went on to have a live birth (compared with the 28 percent who received a water-based dye). Researchers don’t quite know why it works yet, and it’s not a guaranteed path to conception—however, it could be worth trying before you jump into IVF.
Ready for your anatomy pop quiz? Just kidding…there’s no quiz. But if fallopian tube knowledge is power, you should be feeling pretty strong right about now.