Tubal Factor Infertility – Causes & Treatment

By MD, PhD (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 04/09/2019

The Fallopian tubes are structures of the female reproductive system that connect the ovaries to the uterus. Its function consists of collecting the ovum released by the ovary, allowing meeting with the sperm and fertilization and, finally, transporting the embryo to the uterus.

Therefore, any injury or obstruction of the Fallopian tubes that prevents their function will be a cause of female sterility.

Today, in vitro fertilization (IVF) is the treatment of choice for women with tuboperitoneal factor because it does not require tubal permeability to be successful.

Causes

Tubal alterations are an impediment to achieving pregnancy in 30-40% of patients with infertility problems.

As stated above, Fallopian tubes must be permeable and able to move in order to perform their function.

Sometimes a woman only has a unilateral tubal factor, i.e. one of the tubes is affected and the other is healthy. In this case, natural pregnancy is possible, although the chances are reduced by half.

When the tubal factor is bilateral, both tubes are damaged and therefore pregnancy will not be possible.

Next, we will comment on the causes of this tuboperitoneal factor.

Pelvic infection

Pelvic infection is the most frequent cause of tubal injury, accounting for 80% of cases.

The microorganisms responsible for most infections in the female reproductive system are Chlamydia Trachomatis (chlamydia) and Neisseria Gonorrhoae (gonorrhea), which are responsible for sexually transmitted diseases (STDs).

It is very important that women take care of their intimate hygiene on a daily basis and be careful with unprotected sex in order to avoid STDs.

Other causes that may produce pelvic infection include curettage after an abortion, puerperal sepsis, or insertion of a copper IUD.

If microorganism infections are not treated properly, they can affect the cells of the cervix and spread to the ovaries, fallopian tubes, or uterus, causing pelvic inflammatory disease (PID) and infertility.

Pelvic Surgery

Surgeries of the pelvis and its scars can cause adhesions in the abdominal tissues that limit the activity of the tubes. Some examples of surgeries that can involve complications are the following:

Pelvic adhesions are bands of scar tissue that form between the organs of the pelvis (ovaries, Fallopian tubes, uterus, bladder, and bowel) and can cause them to attach to each other and lose their function.

Endometriosis

Endometriosis is an invasive disease in which endometrial tissue leaves the uterus and is implanted in other locations.

Therefore, endometriosis is another disorder that can cause pelvic adhesions that damage or block the Fallopian tubes.

The endometrial tissue can be inserted between the ovaries and the Fallopian tubes, making it difficult for the eggs to be received by the outermost part of the tube: the fimbrias.

If you want to read more about this pathology that affects women of reproductive age, you can enter the following post: What Is Endometriosis? – Causes, Symptoms and Treatment

Hydrosalpinx

Hydrosalpinx is an alteration of the Fallopian tubes characterized by the accumulation of fluid inside them. This causes the tube to dilate and become clogged.

The most common cause of hydrosalpinx is usually a previous infection.

It is very important to treat and remove hydrosalpinx before attempting pregnancy, since, in addition to causing tubal obstruction, the fluid that accumulates is toxic to embryos.

Other

There are other problems with the Fallopian tubes that can impair their function. These are discussed below:

Any alteration in the Fallopian tubes that prevents their permeability and freedom of movement is a cause of tubal factor infertility.

Diagnosis

In most cases, problems in the Fallopian tubes do not cause symptoms that a woman can perceive. Therefore, the tubal factor will only be diagnosed when the couple has not conceived for some time and proceeds to fertility tests.

Alterations in the Fallopian tubes can be detected by the following diagnostic tests:

Hysterosalpingography (HSG)
is the most important test to check the permeability of the tubes. It consists of injecting a contrast dye through the cervix to observe its trajectory towards the tubes as x-ray pictures are taken. If there is any obstruction, the contrast dye will become trapped and cause the tube to distention.
Hysterosalpingosonography (HSSG)
is an improved version of the previous HSG. Here, a saline solution or foaming gel is used to inject it through the cervix instead of the contrast dye. In addition, the use of x-rays is replaced by a routine transvaginal ultrasound. To make the HSSG, you can use the ExEm Foam Kit..
Laparoscopy
is a surgical intervention in which two small incisions are made under the navel and a camera is introduced that allows the tubes to be observed from the abdominal cavity, as well as their relationship with the rest of the structures of the reproductive system. It is usually done in case of suspicion of endometriosis or any adhesion that can be removed at the same time.

Treatment

Bacterial infections such as chlamydia should be treated with antibiotics such as azithromycin and doxycycline. However, if the Fallopian tubes are already damaged, the drugs will not be able to fix this condition.

As for the application of surgery to repair the Fallopian tubes, this will be possible depending on the cause of the tubal obstruction and its severity. Endometriosis is usually operated on with laparoscopy.

Despite this, it is quite difficult to recover fertility after tubal surgery because of its complexity. For this reason, specialists recommend assisted reproduction so that women with tubal obstruction can become mothers.

Specifically, the treatment that does not require tubal functionality to achieve pregnancy is in vitro fertilization.

In fact, as Dr. Miguel Dolz tells us:

A few years ago, the problem of tubal obstruction was the fundamental indication for undergoing IVF.

In this case, fertilization does not occur in the tube as naturally, but takes place in the laboratory. First the woman’s eggs are obtained with an ovarian puncture and then they are put in contact with the male’s sperm, overcoming the obstacle of the tubes. The embryos resulting from IVF can then be transferred to the mother’s uterus and/or cryopreserved for future attempts.

For full details of IVF treatment, see the following article: What Is In Vitro Fertilization (IVF)? – Process, Cost & Success Rates

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

FAQs from users

What is the best solution for getting pregnant with blocked Fallopian tubes?

By Zaira Salvador BSc, MSc (embryologist).

IVF treatment is the most appropriate treatment to achieve pregnancy when the woman does not have tubal functionality. Usually, it is the technique of choice in women who have a tubal ligation done and wish to have a child. In addition, the advantage of IVF is that it also offers guarantees of success even if the male’s semen is not of good quality.

What symptoms can a blocked Fallopian tube have?

By Zaira Salvador BSc, MSc (embryologist).

Tubal obstruction usually has no symptoms as such. However, it is possible for a woman to have discomfort when the cause of the obstruction is related to endometriosis or infections. Some of these discomforts are the following:

  • Abnormal vaginal discharge
  • Pain when urinating
  • Bleeding between periods
  • Painful menstruation

Suggested for you

Hysterosalpingography is the most important diagnostic test for tubal permeability. If you’re interested in reading more about this topic, you can read on in the next post: How Is a Hysterosalpingography (HSG) Performed?.

If you’re looking to have another baby, but have a tubal ligation done, you may be interested in the following article: What Are Your Chances of Pregnancy After Tubal Ligation?.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Atri M, Tran CN, Bret PT, Aldis AE, Kintzen G. Accuracy of endovaginal sonography for the detection of fallopian tube blockage. J Ultrasound Med 1994;13:429–34.

Audibert F, Hedon B, Arnal F, Humeau C, Boulot P, Bachelard B, et al. Therapeutic strategies in tubal infertility with distal pathology. Hum Reprod 1991;6:1439–42.

Bahamondes L, Bueno JGR, Hardy E, Vera S, Pimental E, Ramos M. Identification of main risk factors for tubal infertility. Fertil Steril 1984;61:478–82.

Camus E, Poncelet C, Goffinet F, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 1999;14:1243–9.

Gomel V, McComb PF. Microsurgery for tubal infertility. J Reprod Med. 2006;51:177–84

Honore GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999;71:785–95.

Mardh PA. Tubal factor infertility, with special regard to chlamydial salpingitis. Current Opinion in Infectious Diseases 2004;17:49–52.

Mol BWJ, Swart P, Bossuyt PMM, van Beurden M, van der Veen F. Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology. Hum Reprod 1996;11:1204–8.

Friberg B, Joergensen C. Tubal patency studied by ultrasonography. A pilot study. Acta Obst Gynecol Scand 1994;73:53–5.

Gocial G. Primary therapy for tubal disease: surgery versus IVF. Int J Fertil Menopausal Stud 1995;40:297–302.

Heikkinen H, Tekay A, Volpi E, Martikainen H, Jouppila P. Transvaginal salpingosonography for the assessment of tubal patency in infertile women: methodological and clinical experiences. Fertil Steril 1995;64: 293–8.

Papaioannou S, Afnan M, Jafettas J. Tubal assessment tests: still have not found what we are looking for. Reprod Biomed Online 2007;15:376–82.

REPRODUCCIÓNASISTIDA.ORG vídeo: Qué causas llevan a una paciente a someterse al tratamiento de FIV? (What are the causes that can lead a patient to IVF treatment?) by Dr Dolz, on June, 16th 2014 [See original video here in spanish]

Siassakos D, Syed A, Wardle P. Tubal disease and assisted reproduction. The Obstetrician & Gynaecologist 2008;10:00–00.

Suresh YN, Narvekar NN. The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. The Obstetrician & Gynaecologist 2014;16:37–45.

Volpi E, Piermatteo M, Zuccaro G, Baisi F, Sismondi P. The role of transvaginal sonosalpingography in the evaluation of tubal patency. Minvera Ginecol 1996;48:1–3.

FAQs from users: 'What is the best solution for getting pregnant with blocked Fallopian tubes?' and 'What symptoms can a blocked Fallopian tube have?'.

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Authors and contributors

 Miguel Dolz Arroyo
Miguel Dolz Arroyo
MD, PhD
Gynecologist
Bachelor's Degree in Medicine and Surgery from the Medicine Faculty of the University of Valencia (UV) and Doctor in Medicine, finished in 1988 and 1995, respectively. Physician specialized in Obstetrics & Gynecology. Expert in Reproductive Medicine, with more than 20 years' experience in the field. He is the Medical Director and founder of FIV Valencia. More information about Miguel Dolz Arroyo
License: 464614458
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Marie Tusseau
Marie Tusseau
inviTRA Staff
Editorial Director of Babygest magazine in French and English More information about Marie Tusseau

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