What is it?
Female infertility can be related to many things, including total or partial obstruction in one or both of the Fallopian tubes. When obstructions prevent sperm from reaching an egg to fertilise it, this is called tubal factor infertility.
There are different types of Fallopian tube blockages:
- distal tubal occlusion: This is when the Fallopian tube is blocked at the end closest to the ovary, sometimes due to a hydrosalpinx (which is when fluid collects and builds up after an infection)
- fimbriae issues: This is when the area where an egg is transferred between the ovary and the tube is damaged, preventing the egg from entering the tube
- midsegement tubal obstruction: This is when the Fallopian tube is blocked in the middle, usually as part of tubal litigation surgery (that is performed to prevent pregnancy, at a woman’s request)
- proximal tubal occlusion: This is when a blockage occurs in the lower part of the tube near the uterus, due to fibroids, or occasionally after surgical procedures when there are problems or infections.
What are the risk factors?
Some women are born with blocked Fallopian tubes (this is called congential tubal obstruction).
The following things can also cause adhesions or a build-up of scar tissue somewhere in the Fallopian tube, creating a blockage. The most common risk factors are:
- contracting a sexually transmitted infection (STI), such as chlamydia or gonorrhoea
- undergoing a pelvic procedure that leads to infection such as appendectomy, ovarian cyst or fibroid removal surgery, or a previous ectopic pregnancy
- a miscarriage or an abortion where there were complications (although this is rare)
Having endometriosis or fibroids can also be associated with Fallopian tube blockage.
What are the symptoms?
Women may experience certain symptoms or nothing at all. Strong to mild abdominal pain, fever, painful periods, strange looking or smelling vaginal discharge, or feeling pain while having sex or passing urine are some possible symptoms, but because many women still ovulate, blocked Fallopian tubes can go unnoticed until a woman is trying to get pregnant.
How is it diagnosed?
If fertility tests are being undertaken by couples trying to conceive, blocked Fallopian tubes are usually diagnosed in several ways:
- STI testing: If STIs are found during routine tests (for example during a Pap smear) it’s usually a sign to check for possible fallopian tube damage
- routine Ultrasound: Fallopian tube blockages can sometimes be found during ultrasound, often while looking for something else. Usually a fallopian tube is not visible in an ultrasound but if it is inflamed due to hydrosalpinx fluid, it will be able to be seen
- hysterosalpingogram: This is a special X-ray procedure where an X-ray opaque dye is injected into the uterus which then passes through the fallopian tubes and spills around the ovaries and into the pelvis. If the fallopian tube is obstructed, the location of the blockage can be seen on the X-ray
- hysterosalpingography: Similar to a hysterosalpingogram, a special contrast medium is injected into the uterus which then passes through the fallopian tubes and spills around the ovaries and into the pelvis. This is observed on real-time ultrasound
- during pelvis surgery (usually by laparoscopy keyhole surgery), coloured dye can be injected into the uterus and can be seen directly to flow out into the pelvis.
What's the treatment?
The treatment for blocked Fallopian tubes depends on where the blockage is and how severe it is.
First, any STIs will need to be treated with antibiotics. Next, laparoscopy surgery can be performed to remove any scar tissue on the outside of the Fallopian tube, which can sometimes reduce the obstruction. If the blockage is because of a hydrosalpinx, the surgery may also remove the affected part of the tube, drain any fluid and flush the tubes, to prevent the fluid from making its way back into the uterus.
However surgery does not necessarily mean the tubes won’t become obstructed again by fluid or new scar tissue. Even if the Fallopian tubes are clear, there may also be damage to the inner lining and cilia (fine hairs) which help an egg travel down the tube.
This often means the most effective treatment is to begin IVF, without surgery. However a hydrosalpinx is always best removed through surgery before beginning IVF as it can lower the success of an embryo implanting if the fluid flows out of the fallopian tube and into the uterus.
Does it affect the baby?
Although Fallopian tube blockage surgery and IVF do increase the chances of having an ectopic pregnancy, once a woman is pregnant, Fallopian tube blockages won’t affect her health or the health of the baby. Women should speak to their doctor about their fertility and future pregnancies.
Facts verified by Dr Andrew Zuschmann. Dr Andrew Zuschmann is a Miranda-based fertility specialist, obstetrician and gynaecologist.