Blocked fallopian tubes
Damaged or blocked fallopian tubes are a common cause of female infertility1.
Fallopian tubes are female reproductive organs that connect the ovaries to the uterus. Every month during ovulation, which occurs roughly in the middle of a menstrual cycle, the fallopian tubes carry an egg from one of the ovaries to the uterus. If an egg is fertilized by sperm, it moves through the tube to the uterus for implantation2,3.
If a fallopian tube is blocked, the passage of sperm to the egg and the path back to the uterus for the fertilized egg is blocked. This condition is also called tubal factor infertility. Common reasons for blocked fallopian tubes include scar tissue, infection, and pelvic adhesions3.
Blocked fallopian tubes do not often cause symptoms other than difficulty conceiving4. But sometimes, they may cause pain in the pelvis or belly and foul-smelling vaginal discharge5.
Blocked fallopian tubes can be challenging to identify. The tubes can open and close, so it is not always easy to tell if they are blocked or simply closed4.
In some cases, in vitro fertilization (IVF) will be recommended for women who wish to get pregnant but have damaged or blocked fallopian tubes that cannot be treated1.
The fallopian tubes are two thin tubes, one on each side of the uterus, extending sideways from the uterus and ending near the ovaries. The tube captures the egg after ovulation and transports the sperm from the uterus to the fertilization site in the middle portion of the tube. If a fallopian tube is blocked, the passage for sperm to get to the eggs is blocked2.
Each fallopian tube is divided into four parts: the interstitial or intramural segment, the isthmus, the ampulla, and the infundibulum2.
The lumen of the tube is formed by a complex interlocking system of longitudinal mucosal folds that are lined with mucosal tissue. Complex coordinated contractions of the musculature are thought to be important for the movement of the ovum whilst, at the same time, assisting the movement of sperm2.
Tube blocks can be described in different ways. When one tube is blocked, it is called unilateral block; when both tubes are blocked, it is called the bilateral block6.
Tubal obstruction can involve the outer part, the inner part, or the entire tubal segment and can also be partial or complete. Tubal obstruction that affects the outer part is much more common (70%) than obstruction of the inner part. It can be caused by hydrosalpinges, pelvic adhesions, or fusion of the fimbriae. About 80% of women with mild tubal disease successfully conceive. Patients with moderate and more severe conditions are significantly less likely to become pregnant, and the risk of ectopic pregnancy may be as high as 30%. Tubal obstruction that affects the inner part is most commonly caused by infection, endometriosis, myomas, salpingitis isthmic nodosa, or dried mucus2.
Fallopian tubes can become blocked for a number of reasons, which include1,5:
- Pelvic inflammatory disease (PID), specifically chlamydia or gonorrhoea
- Pelvic adhesions
- Past abdominal surgery
- Previous ectopic pregnancy
Pelvic inflammatory disease (PID) is an infection that can develop when sexually transmitted diseases or other disorders go untreated. It is typically caused by gonorrhoea or chlamydia. PID causes inflammation near the fallopian tubes, which can develop scar tissue and blockages1.
Pelvic adhesions are one of the main reasons for the tube to become blocked3. Surgery may cause scarring that affects an egg’s ability to travel through the fallopian tubes1.
Signs and symtoms
Blocked fallopian tubes do not typically have any associated symptoms. The first “symptom” of blocked fallopian tubes is often infertility. If you don’t get pregnant after one year of trying, your doctor will check your fallopian tubes, along with other basic fertility testing5.
However, many conditions that lead to damaged or blocked fallopian tubes do cause symptoms. For example, endometriosis and pelvic inflammatory disease may cause painful periods, pain during intercourse or heavy bleeding during and between periods1.
In the case of hydrosalpinx (when the fallopian tube is filled with fluid), a woman may also experience abdominal pain and unusual vaginal discharge1.
Diagnosis and treatment
Blocked fallopian tubes usually are diagnosed by4:
- An ultrasound test, known as a sonohysterogram, which is when sound waves are used to build up a picture of the fallopian tubes.
- An X-ray test, known as a hysterosalpingogram. A doctor injects a harmless dye into the womb, which should flow into the fallopian tubes. The dye is visible on an X-ray. If the fluid does not flow into the fallopian tubes, this can indicate a blockage.
- Keyhole surgery, known as laparoscopy. A surgeon makes a small cut in the body and inserts a tiny camera to take pictures of the fallopian tubes from inside.
The treatment for tubal disease will depend on the type of damage or blockage. In some cases, surgery may be recommended to remove the blockage1.
It may be possible to open blocked fallopian tubes surgically. However, this depends on the extent of the scarring and where the blockage is. Surgery aims to open the fallopian tube using one of the following methods4:
- removing scar tissue
- making a new opening on the outside of the fallopian tube
- opening the fallopian tube from the inside
If the damage or blockage cannot be treated, then a woman may still be able to get pregnant through in vitro fertilization (IVF)1. IVF involves placing fertilized eggs directly into the womb, which means that the fallopian tubes are not involved in pregnancy4.
- https://lomalindafertility.com/infertility/women/blocked-fallopian-tubes/ (Last access 20.06.2022).
- https://emedicine.medscape.com/article/275463-overview#a1 (Last access 20.06.2022).
- https://www.healthline.com/health/womens-health/blocked-fallopian-tubes (Last access 20.06.2022).
- https://www.medicalnewstoday.com/articles/321419#diagnosis (Last access 20.06.2022).
- https://www.verywellfamily.com/all-about-blocked-fallopian-tubes-1959927 (Last access 20.06.2022).
- https://www.indoreinfertilityclinic.com/blocked-fallopian-tubes-and-conception/ (Last access 20.06.2022).