The fallopian tubes are slender, muscular structures extending from the uterus, with one on each side of the abdomen. Their purpose is to serve as a passageway, collecting a mature egg released by the ovary and transporting it toward the uterus. Fertilization typically occurs within the fallopian tube. The resulting early embryo must then travel through the tube to implant in the uterine lining. When one or both tubes become blocked, this process is interrupted, and tubal factor infertility accounts for a significant portion of female infertility cases.
Recognizing Potential Indications
A blocked fallopian tube is often an asymptomatic condition, causing no noticeable symptoms. The primary indication leading to medical investigation is the inability to conceive after a year of trying, or six months if a person is over 35. Blockage prevents sperm from reaching the egg or stops the embryo from traveling to the uterus for implantation.
While most women have no symptoms from the blockage, some may experience chronic or intermittent pelvic pain. This pain is sometimes associated with a hydrosalpinx, a specific type of blockage where the end of the tube fills with fluid, causing a dull ache or pressure on one side of the lower abdomen. A previous ectopic pregnancy, where a fertilized egg implants within the fallopian tube, also suggests prior tubal damage or blockage.
Common Causes of Blockage
The most common cause of fallopian tube blockage is the formation of scar tissue or adhesions, typically resulting from inflammation within the pelvis. Pelvic Inflammatory Disease (PID) is a frequent culprit, often caused by untreated sexually transmitted infections like chlamydia and gonorrhea. The resulting infection leads to inflammation of the tubes (salpingitis), which causes internal scarring that can narrow or obstruct the passageway.
Endometriosis, where tissue similar to the uterine lining grows outside the uterus, can also cause blockages. This misplaced tissue can cause inflammation and scarring on the outside of the tubes or physically block the tube’s opening. Prior abdominal or pelvic surgeries, especially those involving the uterus or ovaries, may cause adhesions that constrict the fallopian tubes. A history of ectopic pregnancy is also a cause of tubal damage, as the event often requires surgical intervention or causes scarring.
Definitive Diagnostic Procedures
Because tubal blockage rarely presents with distinct symptoms, diagnosis must be confirmed through specialized medical imaging. The primary test used to evaluate fallopian tube patency is the Hysterosalpingography (HSG). This X-ray procedure is typically performed during the first half of the menstrual cycle before ovulation.
During the HSG, a healthcare provider inserts a thin tube through the cervix and injects a contrast dye into the uterus. As the dye fills the uterine cavity, X-ray images track its flow. If the fallopian tubes are open, the dye travels through them and spills into the abdominal cavity, visible on the X-ray film. The absence of this “spill” indicates a blockage, and the location where the dye stops helps identify the obstruction site.
While HSG is the standard initial screening tool, other procedures can provide confirmation or additional detail. A Saline Infusion Sonogram (SIS), also known as a Sonohysterography, uses sterile saline solution and ultrasound imaging to evaluate the uterine cavity, though it is less effective than HSG for confirming tubal openness. Diagnostic laparoscopy is a more invasive surgical procedure involving inserting a small telescope through a tiny incision in the abdomen. This allows the surgeon to directly visualize the exterior of the fallopian tubes and surrounding organs, offering definitive confirmation of blockage and the extent of scar tissue or adhesions.
Next Steps After Diagnosis
Once a tubal blockage is confirmed, treatment options focus on either repairing the tube or bypassing it entirely. The choice depends on the location and severity of the blockage, as well as the person’s age and overall fertility profile. Surgical interventions, such as tubal cannulation or salpingostomy, aim to repair or reopen the damaged tubes.
Tubal cannulation is a non-surgical procedure often used for blockages near the uterus, where a thin wire or catheter is guided through the tube to clear the obstruction. Surgical repair is generally more effective for minor damage or blockages closer to the uterus. However, success rates for pregnancy vary, and there is an increased risk of ectopic pregnancy afterward.
For severe damage, especially when both tubes are blocked or a hydrosalpinx is present, In Vitro Fertilization (IVF) is often the first-line recommendation. IVF completely bypasses the function of the fallopian tubes by fertilizing the egg with sperm in a laboratory setting. The resulting embryo is then transferred directly into the uterus, offering an effective pathway to pregnancy when the fallopian tubes are no longer functional.