Blocked Fallopian Tubes and Fertility: Tests, Surgery, Hydrosalpinx and IVF

Blocked fallopian tubes cause infertility by stopping the egg and sperm from meeting, and because they rarely cause symptoms, most people only find out during fertility tests, at which point the choice is usually between surgery to repair a tube or IVF, which bypasses the tubes altogether. When my own tubes were checked, the result was clear and I barely gave them another thought. Several women I have met since were not so lucky, and what struck me about their stories was how little anyone had explained the word “tubal” before it appeared in a letter. This is the explanation I would have wanted to hand them.

What the fallopian tubes do

The fallopian tubes are the two narrow passages that run from each side of the womb towards the ovaries, and they are where conception normally happens. At ovulation, the fringed end of a tube catches the released egg; sperm swim up through the womb and into the tube, and fertilisation usually takes place there. The tube then carries the early embryo down into the womb over the next few days.

So a tube does not need to be fully blocked to cause a problem. Scarring can stop it catching the egg, slow the embryo’s journey, or leave it open but damaged inside. A completely blocked tube stops conception on that side; a damaged one can raise the chance of a pregnancy implanting in the tube instead of the womb, which is called an ectopic pregnancy¹.

What causes tubal damage

The commonest causes of tubal damage are pelvic inflammatory disease, previous pelvic surgery and endometriosis. The NHS describes pelvic inflammatory disease (PID) as an infection that can damage and scar the tubes, making it virtually impossible for an egg to travel down into the womb, and notes that it is often caused by a sexually transmitted infection². Chlamydia is the best known of these, and it frequently causes no symptoms, which is one reason tubal damage so often comes as a surprise.

Surgery in the pelvis or abdomen, including operations for a burst appendix, can leave scarring around the tubes, and endometriosis can damage the ovaries or tubes directly². If you have endometriosis, our guide to endometriosis and fertility covers how it affects treatment choices. A previous ectopic pregnancy can also leave a tube damaged or removed.

What tubal damage does not usually cause is pain, irregular periods or anything else you would notice day to day. That is why a “normal” history is no reassurance, and why the tubes are checked as a matter of routine in fertility investigations.

How blocked tubes are found

Because the tubes cannot be seen clearly on an ordinary scan, they are checked with a specific test that shows whether fluid passes through them freely. The main options are a HyCoSy, an ultrasound scan that passes a fluid through the womb and tubes; an HSG, an X-ray taken while a dye is passed through; and a laparoscopy, keyhole surgery in which a camera is passed through a small cut in the lower tummy to look at the womb, tubes and ovaries directly, sometimes with dye passed through the cervix to show a blockage³. The NHS notes that a laparoscopy is usually only used when a problem is likely³, for example when endometriosis, previous infection or scarring is suspected.

My HyCoSy was uncomfortable for a few minutes, a strong period-type cramp, and over in about a quarter of an hour. Taking a painkiller beforehand, if the clinic agrees, helps many people. Where these tests sit among the rest of the work-up, from semen analysis to AMH, is set out in fertility tests and investigations.

A test result can say that one tube is open and one is blocked, that both are blocked, or that fluid passes slowly. It is worth asking which end of the tube is affected and whether there is any fluid in it, because those details shape what is offered next.

Treatment option one: tubal surgery

Surgery can repair a blocked or scarred tube in some cases, but it works best where damage is limited, and it brings a higher chance of ectopic pregnancy afterwards. The NHS explains that surgery can break up scar tissue so eggs can pass more easily, that its success depends on the extent of the damage, and that possible complications include an ectopic pregnancy⁴.

The case for surgery is strongest when the damage is small, you are younger with a good ovarian reserve, and the sperm results are normal, because a repaired tube allows you to try naturally month after month rather than cycle by cycle. The case against it grows with the amount of damage, your age, and any other factor that would push you towards IVF anyway. A consultant who sees the full picture is the right person to weigh it.

Treatment option two: IVF

IVF is the usual treatment when both tubes are blocked or badly damaged, because it does not need the tubes at all. The eggs are collected directly from the ovaries, fertilised in the laboratory, and the embryo is placed straight into the womb⁴. IVF was first developed with blocked tubes in mind, and it suits this problem well, because what it bypasses is mechanical.

The steps are the same as for any other IVF cycle, and are explained in IVF explained. The one tubal-specific risk to be aware of is that a pregnancy after IVF can still, occasionally, implant in a damaged tube; the HFEA lists ectopic pregnancy among the risks of treatment, with a higher chance where there is a history of tubal damage⁵. That is one reason clinics scan early, as described in early pregnancy after IVF.

Hydrosalpinx: the tube that matters even when you are having IVF

A hydrosalpinx is a fallopian tube that is blocked at its far end and has filled with fluid, and it is the one kind of tubal damage that can affect IVF itself. The fluid can drain back into the womb, and it is thought to make it harder for an embryo to implant. That is why a clinic may want to deal with a hydrosalpinx before an embryo transfer, even though IVF does not use the tubes.

The evidence on this is reasonably strong. A Cochrane systematic review of surgical treatment for tubal disease before IVF concluded that surgical treatment should be considered for all women with hydrosalpinges before IVF, finding that both laparoscopic removal of the tube (salpingectomy) and blocking it off near the womb (tubal occlusion) increased the odds of pregnancy⁶. The review also noted that the included trials did not report live birth, so the size of the benefit for a baby at the end is less certain than for pregnancy.

Being told a tube should be removed can feel like losing something, even when it is not working. One woman I spoke to put it as giving up on the idea of a natural surprise. Her consultant’s answer, which I thought was kind and true, was that the tube was already making that unlikely, and was now also standing in the way of the treatment that could work.

Questions worth asking your clinic

Tubal results are easier to act on when you know exactly what was found. Useful questions include: which tube is affected, and at which end; is there fluid in either tube; would surgery be likely to help in my case, and what would it involve; how does my age and ovarian reserve change the balance between surgery and IVF; and, if I am having IVF, should anything be done to a tube first.

Tubal damage can bring up difficult feelings, especially when it traces back to an infection years ago that nobody knew about. It is nobody’s fault, and it is one of the most treatable causes of infertility there is. If you want the wider map of causes, causes of infertility sets out how tubal factors sit alongside the others.

This is general information and not medical advice. Whether surgery, IVF or a combination is right for you depends on the details of your tests, your age and your history, and your own fertility team or gynaecologist are the right people to discuss them with.