• There are no suggestions because the search field is empty.
« Back to Articles

Top 10 Facts about Tubal Factor Infertility


35% of infertility issues in women can be attributed to tubal factor problems: blocked or otherwise impaired fallopian tubes.

When the fallopian tubes are compromised, eggs are more likely to fail to meet up with sperm to become fertilized and more likely to fail to travel to the uterus for implantation. Tubal disease also raises the risk of tubal or ectopic pregnancy.

Here are 10 facts to know about tubal factor diseases and how they may impact your fertility treatment.

  1. Tubal disease is one of the commonest causes of female infertility. Some researchers have found tubal disease in as many as 35% of cases and the incidence is increasing. This is primarily due to increase in sexually transmitted disease and pelvic inflammatory disease.

  2. A detailed history can give important clues in suspecting tubal disease. Risk factors for tubal disease include a history of pelvic infection (e.g. chlamydia or gonorrhea), intrauterine device usage, previous ectopic pregnancy, history of appendicitis (especially a ruptured appendix), or previous tubal surgery. Tubal disease can be present even when none of these factors are present in the history. Evaluation of the fallopian tubes is therefore a routine part of an infertility work up.

  3. Slide09 Normally, fallopian tubes are not seen on ultrasound. However, if the tubes are dilated (large hydrosalpinx) they sometimes can be seen on ultrasound. It is possible to see if the tubes are open by injecting air, or special solutions that can be seen on ultrasound. Color Doppler has also been used to evaluate tubal patency. The commonest test used worldwide to evaluate the fallopian tube is a hysterosalpingogram (HSG).

  4. Fallopian tubes can be blocked in the proximal (the portion near the uterus) or at the distal (fimbrial) end. Mid-piece obstruction can be present but is relatively uncommon. Another cause of fallopian tube disease is scar tissue around the tubes (peritubal adhesions). These can be caused by infections, endometriosis or previous surgery. The best technique for diagnosing (and treating) peri-tubal adhesions is a laparoscopy.

    Proximal tubal occlusion
  5. Proximal blockage of the fallopian tubes (proximal tubal occlusion, PTO) can be caused by mucus plugs, debris, fibrosis, salpingitis isthmica nodosa, polyps, endometriosis, fibroids, or scar tissue.

  6. “Tubal spasm” can be a cause of PTO. This is when the tubal muscles contract and therefore block the tubes. It is often caused when the HSG dye is forcefully injected. At InVia, we minimize the possibility of tubal spasm by pre-treating patients with Ibuprofen 800 mg, 30 – 60 minutes before the procedure and injecting the HSG dye gently.

  7. Bilateral hydrosalpinges Distal tubal blockage often results in the tubes dilating and appearing like a balloon (hydrosalpinx). The common causes of hydrosalpinx include infections and endometriosis. Mild hydrosalpinges (diameter less than 3 cm, presence of rugae, presence of fimbriae) can be treated surgically. Severe hydrosalpinges (diameter greater than 3 cm, no rugae, accompanied by severe adhesions) cannot be treated surgically. These patients will often need in vitro fertilization (IVF). Removal of the hydrosalpinges (salpingectomy) is often recommended to maximize the chances of success with IVF.

  8. Intra uterine insemination is NOT recommended in cases with severe tubal disease. If the tubes are abnormal, how is depositing the processed sperm in the uterine cavity gong to increase pregnancy rates?

  9. Proximal tubal occlusion (PTO) can be treated with tubal catheterization.

  10. Patients with tubal disease are at risk for a tubal pregnancy regardless of how they conceive. This can happen even with IVF where the embryos can be squeezed back into the tubes with uterine contractions.

Infertility Infertility treatment

Dr. Vishvanath Karande

Dr. Vishvanath Karande

Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.


Schedule an Appointment With Us

Schedule Now