Many people believe that regular periods always indicate healthy fertility. This isn’t necessarily the case.
The female body normally has two uterine tubes, one on each side of the uterus. These thin tubes help lead the egg from the ovaries to the uterus. Sperm swims from the cervix to the uterus and through the uterine tubes to get to the egg. When the egg is traveling through the tube, fertilization can take place.
In some cases, an obstruction prevents the egg from traveling down the tube; this is called a blocked uterine tube. Tubal blockage is one of the most common causes of female factor infertility, along with ovulatory disorders, endometriosis, and pelvic adhesions. Tubal blockage is responsible for about 25 percent of infertility cases.
The primary cause of tubal blockage is pelvic inflammatory disease, which is often caused by a sexually transmitted infection like chlamydia or gonorrhea. Other conditions that may prevent normal transport of the egg and sperm through the uterine tube are endometriosis; adhesions in the pelvis from previous surgery; or a non-tubal infection like appendicitis, pelvic tuberculosis, and salpingitis isthmica nodosa (scarring of the tube).
Medical experts use different terms to describe the types of obstruction. Tubal obstruction can involve the distal, proximal, or entire tubal segment and can be partial or complete.
Distal tubal obstruction is much more common than proximal obstruction and makes up about 70 percent of cases. With this type of blockage, the tube is obstructed at the end near the ovary. It can be caused by hydrosalpinges (a blocked tube that fills with liquid), pelvic adhesions, or fusion of the fimbriae (the finger-like structures at the end of the tube that connect it to the ovary).
Proximal tubal obstruction is most commonly caused by infection, endometriosis, tumors, salpingitis isthmica nodosa, or dried mucus. In some cases, only one uterine tube gets blocked. People with one blocked tube can still get pregnant because an egg can still travel through the unaffected tube. However, if both tubes are completely blocked, pregnancy won’t be possible without intervention.
To diagnose tubal blockage, your health care provider can perform procedures that may include:
- Hysterosalpingography — Liquid dye that can be seen on an X-ray is injected through a catheter and fills the uterus and uterine tubes so X-ray scans can be taken.
- Chromopertubation — Dye is injected into the uterine tubes during laparoscopy.
- Sonohysterography — Ultrasonography is used to visualize the uterus and adnexa after an infusion of fluid through a transcervical catheter.
Here are a few ways to get pregnant with blocked uterine tubes.
Your health care provider might recommend laparoscopic surgery. There are three common reasons it’s recommended:
- In some cases, infertility can only be diagnosed through this type of surgery.
- It can treat some causes of infertility and allow you to get pregnant naturally or with treatment.
- Laparoscopic surgery might be recommended if you’re experiencing pelvic pain.
During the surgery, the health care provider makes a small cut around the belly button and fills the abdomen with carbon dioxide gas. Once there is enough room in the abdomen to use surgical instruments, the laparoscope is passed through the incision to look around at the pelvic organs. They will look for cysts, hydrosalpinges, fibroids, scar tissue, pelvic adhesions, and endometrial growths.
Sometimes, it may be necessary to make two or three incisions in the body. This makes it possible to use more instruments and temporarily move the organs for a better view.
During laparoscopic surgery, the surgeon may try to open blocked uterine tubes or remove scar tissue that is causing issues. However, the procedure isn’t always successful because of other factors such as age and the location and cause of the blockage.
In cases of an ectopic pregnancy, the surgeon will remove the abnormal pregnancy. They may also need to remove the entire uterine tube.
After the surgery, your health care provider will explain your options. If the uterine tube was repaired, pregnancy may be possible without any further treatment.
There is a specific case when laparoscopic or ordinary surgery may be needed – tubal ligation reversal:
Tubal ligation reversal
Tubal ligation reversal is an option for getting pregnant with blocked uterine tubes, if tubal ligation was the reason for blockage in the first place. If there were other underlying reasons, this procedure is not helpful. Tubal ligation reversal is a procedure that can restore fertility for someone who has had their tubes tied.
During the procedure, the blocked segments of the tubes are reconnected to the remainder of the uterine tubes. After this is done, the eggs can again move freely through the tubes, and sperm can travel up the tubes to join an egg.
The chances of conception after a tubal ligation reversal are greater for people who have a large portion of a healthy uterine tube remaining. Although a tubal ligation reversal may make pregnancy possible without further treatment, it’s not recommended for everyone. There are several factors that your health care provider must take into consideration, including:
- Body mass index
- Type of tubal ligation
- Sperm and egg quality
- Damage to the uterine tubes
- The length of the remaining tubes
Although it’s hard to predict the chances of pregnancy after the procedure, people under 35 tend to have better success rates.
IVF makes getting pregnant possible if repair surgery didn’t work or if it wasn’t an option. During IVF treatment, a person with blocked tubes takes fertility drugs to stimulate the ovaries. Then, a procedure retrieves the egg from the ovaries using an ultrasound-guided needle through the vaginal wall.
Once the eggs are retrieved, they are combined with sperm from a partner or sperm donor. One or two healthy embryos are then transferred to the uterus. The good thing about IVF treatment is that it completely avoids the blocked uterine tubes, so the blockages don’t matter.