What are your options if your tubes are blocked? In this video, Mark P. Trolice, M.D., board-certified reproductive endocrinology and infertility specialist and founder of Fertility CARE: The IVF Center shares his insights on the types of procedures that are best depending on the type and severity of the blockage that is present.

“I’d like to talk about something that is rather common in the infertility world - tubal blockages and issues,” says Dr. Trolice. “The basics of infertility are that 40% of the time there is a female problem and 40% of the time there is a male issue. Of the 40% of female problems, 40% are due to ovulation disorders, and 40% are from tubal irregularities.”

How are tubal problems diagnosed?

“The easiest way to do that is with a hysterosalpingogram (HSG),” says Dr. Trolice. “We have a specially-designed machine in our facility called a C-arm. The patient lies on the table, and I inject contrast through the cervix up into the uterus to see if the tubes are open. As we’re doing the procedure, the patient can see the dye going up through the uterus and down the tubes. That will let us know if the uterine cavity is normal and the tubes are open.”

“There are two places where the tubes can be blocked,” Dr. Trolice continues. “Usually at the beginning or proximal portion, or at the end. If the blockage is at the end, called the distal portion, it’s known as a hydrosalpinx, and that is really awful news for the tubes, for two reasons.”

“The first reason is that the tube is blocked and can’t pick up the egg. The second reason is that fluid can accumulate in the tube, seep back, and affect embryo implantation. We’ll do ultrasounds right before ovulation, and you’ll sometimes see a fluid pocket in the upper part of the uterus. That is from the hydrosalpinx. And when you have a hydrosalpinx, even if the other tube is normal, it reduces the success (of conception) by 50%.

So what can be done about tubular blockages?

“Even though it sounds aggressive, the best thing to do is to remove the damaged tube,” says Dr. Trolice. “If you open the impaired fallopian tube and try to spare it, success rates could be anywhere from 15-40% but probably on the lower side, particularly if there is scarring and depending on the degree of dilation of the tube. And if you open the tube, it can increase the risk of a tubal pregnancy, or ectopic pregnancy, which is life-threatening. So if we take the damaged tube out, studies have shown that the pregnancy rate gets a lot better on the healthier side. Of course, if both tubes are damaged then in vitro fertilization (IVF) is going to be your best option.”

“What if the tube is only blocked at the beginning (proximal) end?” asks Dr. Trolice. “What we can do in the procedure room is to put a guide wire down the tube and try to bypass the blockage and open the fallopian tubes. The procedure is called tubal cannulation, and the success rates are somewhere in the 40-60% range. And if not successful, over time it could re-occlude and block up again.”

“Another thing to mention is that if you’ve had your tubes tied and are interested in opening your tubes again - if you had them opened again and the tubes are still blocked, we wouldn’t recommend trying to open them another time. We would recommend doing IVF.”

“To summarize: we first check the fallopian tubes with an HSG right in the office. If the tube is blocked on the end and swollen, a hydrosalpinx - that is bad news - it reduces success by 50%. It’s easiest to remove it by one-day laparoscopic surgery. If the tube is blocked at the beginning portion, you can do a minor procedure to try and open the tubes with a guide wire, called tubal cannulation. If both tubes are damaged, IVF remains the best option.”

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Dr. Mark P. Trolice is the Director of Fertility CARE in Winter Park, Fla., the most comprehensive fertility center in the Southeast. A leader in the field of reproductive endocrinology, Dr. Trolice has helped countless patients become parents in central Florida since 1999.

In addition to his work at Fertility CARE, Dr. Trolice is also the Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Florida in Gainesville and the University of Central Florida in Orlando.

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