In this video, fertility specialist Dr Lauren Hicks discusses the impact of blocked or damaged tubes on fertility, along with how this condition is diagnosed.

 

So, what causes blocked tubes?

Blockages can occur for a number of reasons. However, typically they are associated with conditions that cause inflammation and scarring.

Pelvic inflammatory disease

One common cause of inflammation is pelvic inflammatory disease (or PID for short). PID is an infection that can affect a woman’s reproductive organs, including the fallopian tubes. The inflammation resulting from PID can affect both the inside and outside of the fallopian tubes. Often internal inflammation is caused by infections that travel from the vagina and uterus into the fallopian tubes. These include infections due to the bacteria normally found in the vagina, as well as at times from sexually transmitted bacteria (like chlamydia and gonorrhea). On the other hand, external inflammation may arise due to trauma or infection inside the abdomen, as might happen following a burst appendix or recent bowel infection. Repeated bouts of PID have been shown to increase the risk of infertility in women.¹ Therefore, it’s important to see a doctor if you have signs of a possible infection like fever or lower abdominal pain, although sometimes symptoms can be mild and go undetected. If an infection is detected, antibiotics will usually be prescribed.

Endometriosis

The endometrium is the tissue that grows on the internal lining of the uterus. In endometriosis, tissue similar to the endometrium grows on tissues and organs outside the uterus such as the fallopian tubes. Over time (particularly in advanced or late-stage endometriosis), tissue that has grown in and around the fallopian tubes can cause inflammation and subsequent scarring, resulting in blockages.

Congenital tubal disease

In extremely rare cases, an obstruction of one or both fallopian tubes may be present at birth. Many women with this condition are not aware that they have a blockage until they try to fall pregnant.

Scar tissue after surgery

Sometimes, excessive tubal scarring can follow abdominal or pelvic surgery, e.g. caesarean section, bowel surgery. This scarring also has the potential to block your fallopian tubes.

Are there any symptoms of blocked tubes?

Tubal obstructions can often slip under the radar – i.e. you may not notice any symptoms at all. In fact, many women do not know they have a blockage until they experience trouble falling pregnant. Some conditions that cause tubal blockages do have their own tell-tale signs. For example, women with PID may experience lower abdominal pain, pain upon urination and intercourse, as well as abnormal vaginal bleeding and/or discharge. For many women with endometriosis, the primary symptoms are pelvic pain at the time of their period and pain with intercourse. In addition, a hydrosalpinx (a collection of watery fluid which may complicate a tubal obstruction) can cause ongoing and mild discomfort on the affected side of the abdomen in some women. If you are experiencing any of these symptoms, it’s important to make an appointment with your doctor.

How can you tell if my tubes are blocked?

There are imaging and surgical tests that we can use to determine whether your tubes are blocked. However, the test that is most appropriate for you will depend on individual factors such as any underlying conditions you may have.

Pelvic ultrasound with contrast

The first port of call is usually a special type of ultrasound called a tubal patency ultrasound. During this imaging test, a fluid which shows up on ultrasound is injected through a thin catheter placed in the cervix. The fluid then runs through the uterus and if no obstruction is present, it will continue to run out the ends of the fallopian tubes (after the test is complete, the fluid is gradually absorbed by the body). At the same time, an ultrasound of your pelvic area is taken so we can see where the fluid travels. This provides a detailed view of your uterus and fallopian tubes, which helps us determine if an obstruction is present.

Hysterosalpingogram (HSG)

Similar to a tubal patency ultrasound, a HSG also involves inserting a special fluid into your uterus and fallopian tubes. However, instead of using ultrasound, x-rays are taken instead.

Laparoscopy with dye

A laparoscopy is a type of keyhole surgery enabling us to look at your uterus, fallopian tubes and ovaries. Following a general anaesthetic, a camera is inserted through some small incisions made in the lower abdomen. A fine catheter is also inserted into the cervix and then a blue dye is injected. It passes up through the uterine cavity and along the tubes, then comes out the ends of the tubes where the blue colour can be seen. If we notice any abnormalities during this procedure, we may be able to treat these at the same time, e.g. remove endometrial growths.

Getting pregnant with blocked tubes

Depending on the cause, location and severity of the obstruction, there are a couple of different treatments that can boost your chances of falling pregnant.

Surgical removal

As mentioned above, laparoscopic surgery can be used to both identify, then remove any growths and/or scar tissue that are blocking your fallopian tubes. This technique is frequently used in women with endometriosis and can improve natural fertility in the months following surgery. It can also increase your chances of pregnancy with IVF. Surgically removing a tube that is full of watery fluid or pus (known as a hydrosalpinx and pyosalpinx, respectively) can also lead to an improvement in IVF treatment success. A hydrosalpinx can be caused by endometriosis, infections within your pelvis or prior surgery, whereas as a pyosalpinx occurs when your fallopian tube becomes severely inflamed and pus is produced, usually as a complication of PID.

In vitro fertilisation (IVF)

Most times, removing a tubal blockage is not possible or the best option for our patients. In these instances, we may recommend IVF if you are trying to conceive. IVF can help you fall pregnant by bringing the egg and sperm together inside a laboratory dish, completely bypassing your fallopian tubes. If fertilisation is successful and an embryo forms, it can be transferred into your uterus. If the embryo is able to successfully implant in the wall of the uterus, a pregnancy results.

What about tubal flushing with oil?

Tubal flushing involves placing a tube through the cervix and flushing an oil-based solution into your uterus and fallopian tubes. It’s not used when a proven tubal blockage is present, e.g. it can’t break down scar tissue or reopen a blocked tube. However, a recent review found that oil-based tubal flushing in women with subfertility (those experiencing an unexplained delay in falling pregnant) may increase their chances of falling pregnant compared to women who do not have a flush.² It’s not really understood how tubal flushing may improve the chances of pregnancy but presumably it works by helping to remove any stray mucus and cellular fragments out of the fallopian tubes. Tubal flushing may sometimes be performed together with diagnostic imaging studies and/or surgical procedures as an ancillary option when no obvious obstruction is detected.

Understanding your options

If you are struggling to conceive, blocked tubes is one of the first things your fertility specialist will want to rule out. To book an appointment with one of our specialists, call (03) 8080 8933 or book online via our appointments page.

References