Fallopian Tubes & Fertility: What to do when they are blocked?

Hey y'all,

I've had multiple clients with tubal issues. Some had their fallopian tubes removed or damaged during an ectopic pregnancy or ovarian torsion, and others had scarring and damage. Let's talk about fallopian tubes, how they affect fertility, and what you need to know about your own fertility health.

Some people are born without fallopian tubes. Sometimes, the tubes don't develop properly before birth. Normally, they start as Mullerian ducts, which develop into the reproductive system. In some cases, these ducts don't form into tubes. Some women are born with ovaries but no uterus. These women seem to go through puberty because the ovaries still produce hormones, but they never start their period because they don't have a uterus to shed the lining (i.e. a period).  These women might be candidates for a uterus transplant to support a pregnancy, after which the uterus is removed to avoid long-term medication to prevent organ rejection. Pretty cool, huh? I mean, not ideal but what a world we live in that this is an option if you want kids. 

Some women are born with a bifid uterus, meaning they have two cervixes, two tubular uteruses, two tubal uteruses and two ovaries. Often, this isn't discovered until a pap smear or ultrasound. It can make getting pregnant more challenging, but it doesn't mean pregnancy is impossible. These women will still have normal puberty and periods.

Fallopian tubes are crucial for fertility. About 30% of infertility cases are due to tubal issues. Fallopian tubes are muscular and attached to the uterus. They can move a lot, even compensating if one tube is missing by moving to collect the egg from the opposite ovary.  Each month a different ovary (left then right) releases an egg, so we used to think you could only get pregnant every other month if you were missing a tube. But nope!, your body compensates. Eggs are released from the ovaries into the abdominal cavity, and the fallopian tubes "suck" them up.

Anatomy of the Tubes

Damage to the tubes often occurs due to inflammation. Fertilization happens inside the fallopian tubes, so if there's damage, sperm may not reach the egg. Different types of tubal disease include:

• Spasming Tubes: Hard to diagnose because it doesn't show up easily. During testing, dye may not move correctly if the tubes are spasming. This may present at a proximal obstruction on a HSG
• Inflammation: Caused by a ruptured appendix, abdominal surgery, sexually transmitted diseases (like chlamydia and gonorrhea), endometriosis, or abdominal trauma. This can lead to scarring, which changes the shape and function of the tube.
• Hydrosalpinx: A blocked and dilated fallopian tube at the end closer to the ovary (distal) This can affect both tubes, even if only one is visibly damaged.

Testing for Tubal Issues

1. HSG (Hysterosalpingogram): A catheter inserted into the cervix then dye is released  into the uterus to flow through the tubes, usually done on days 6-10 of the cycle. This is helpful to see if tubes are open. 
2. Saline Test (FemVue Test): Saline and air are injected into the uterus, observed with ultrasound, also done on days 6-10. Better for viewing the uterus. 
3. Surgery (Laparoscopy): Involves a small incision at the belly button to assess the organs and observe dye flow through the tubes. Requires anesthesia.

What to Do if You Have a Blocked Tube

If a blockage is found, the treatment depends on the location of the blockage:

• Proximal Blockage (near the uterus): Could be due to spasms. If you have one blocked tube with a proximal blockage, you have similar chances of getting pregnant as someone with unexplained infertility. Options include IUI with superovulation (taking Clomid) or IVF.
• Distal Tubal Obstruction (middle or end of the tube): Often related to inflammation from endometriosis or STDs. If one tube is damaged where it collects the egg, the other tube might also be affected. The success rate with IUI and superovulation is low; IVF is recommended.
• Hydrosalpinx: The tube gets blocked and filled with fluid, which can backflow into the uterus, creating a toxic environment. This can reduce IVF success by 50%. Surgery to remove or disconnect the tube from the uterus is often needed to improve the chances of a successful pregnancy.

Understanding these issues can help you make informed decisions about your fertility health. None of these mean you can’t get pregnant but they can help you create a timeline to discuss with your healthcare provider regarding what you want to do and when you want to do it. All of this can feel daunting, but if you want someone to help you navigate, advocate, and create a plan- let’s find a time to discuss YOUR case! 

Take Control of your Fertility today

Tubal issues may be a bump in the road, but nothing we cannot work on together. Understanding these issues can help you make informed decisions about your fertility health. None of these mean you can’t get pregnant but they can help you create a timeline to discuss with your healthcare provider regarding what you want to do and when you want to do it. All of this can feel daunting, but if you want someone to help you navigate, advocate, and create a plan- let’s find a time to discuss YOUR case!