The fallopian tubes are a fragile, intricate part of a woman’s reproductive system. If the tubes become blocked or otherwise damaged, sperm cannot fertilize the egg and the resulting embryo cannot settle in the uterus.
According to the American Society for Reproductive Medicine (ASRM), tubal problems are responsible for 35 percent of infertility cases.
Tubal damage or obstruction can be produced by a pelvic infection such gonorrhea or chlamydia, pelvic inflammatory disease, endometriosis, other abdominal infections including appendicitis or intestinal infections, and also adhesions from prior surgery, including surgery for ectopic pregnancy. Tubal damage is particularly suspect in women experiencing infertility but have regular ovulatory menstrual cycles and a husband with normal sperm.
When fallopian tubes are severely damaged and full of fluid, they can only be seen on ultrasound. The most common way to evaluate the uterus and fallopian tubes is a uterine x-ray called a hysterosalpingogram (HSG).
Because the uterus and fallopian tubes are made of soft tissue, they cannot be seen on a standard x-ray. An HSG is performed by injecting a small amount of x-ray contrast dye through the cervix and into the uterus while watching on an x-ray machine. A trained expert can almost always tell whether there is an abnormality within the uterine cavity and/or whether the fallopian tubes look normal.
The anatomic relationship between the tubes and the ovaries cannot be diagnosed using this technique because the ovaries are also soft tissues and cannot be seen on an HSG. Nevertheless, an HSG is an excellent technique to diagnose tubal status and is often very helpful in evaluating the uterus.
If the HSG shows blocked fallopian tubes, then another test called a laparoscopy, may be used to assess the amount of damage to the tubes. If the damage is extensive—such as blockages or scarring—surgery may be used to correct the problems in some cases.
However, if the damage is very severe, the likelihood of becoming pregnant without reproductive technologies is very low, and in these cases the woman may consider in vitro fertilization (IVF). There are cases where removal of the fallopian tubes may be recommended prior to IVF procedures.