“It’s not you, it’s your tubes.”
It’s a phrase no one expects to hear when trying to grow their family. Picture this: fallopian tubes are supposed to be like those fancy water slides at amusement parks—smooth, open, and ready to whoosh that egg right along to its destination. But for many women, these internal pathways are more like a traffic jam during rush hour.
Tubal factor infertility—the medical term for when your fallopian tubes aren’t cooperating with your baby-making plans—affects about 30% of women dealing with fertility challenges, according to the American Society for Reproductive Medicine (ASRM).
But what does that actually mean? What causes tubal factor infertility? Can it be fixed? And most importantly—what options do you have? Whether you’re navigating this diagnosis yourself or supporting someone who is, understanding tubal factor infertility is the first step toward empowerment and informed decision making. Let’s unpack what’s really going on—and what comes next.
What is tubal factor infertility?
Tubal factor infertility occurs when a woman’s fallopian tubes are blocked, damaged, or otherwise not functioning properly. These small but mighty tubes play a crucial role in conception—they’re the meeting spot where sperm and egg come together, and the pathway that guides a zygote to the uterus.
When these tubes aren’t working correctly, several problems can occur:
- Sperm may be unable to reach the egg
- A zygote might not be able to travel to the uterus
- Partial blockages can increase the risk of ectopic pregnancy (when a newly conceived life implants in the fallopian tube instead of the uterus)
The fallopian tubes are delicate structures, only about the width of a spaghetti noodle, with a complex internal environment. They’re not just passive tunnels between the ovaries and the uterus—they contain specialized cells that help transport both egg and sperm with gentle, wave-like movements, and they secrete substances that nourish and protect both the sperm cells and the egg.
Different types of tubal damage
There are several types of tubal damage that can cause tubal blockages or impair tubal motility, both of which may cause infertility. These can occur in different parts of the fallopian tubes:
- Proximal blockage: Obstruction near where the tube connects to the uterus
- Mid-segment damage: Issues in the middle portion of the tube
- Distal blockage: Problems at the end of the tube near the ovary
There can also be scar tissue damage around the за пределами of the fallopian tubes. Finally, the tube or tubes can be filled with fluid, called hydrosalpinx.
What makes tubal factor infertility particularly challenging is that many women have no symptoms until they try to conceive. Unlike other fertility issues that might cause irregular periods or pain, damaged tubes often don’t send any warning signals. For this reason, tubal blockage or damage is sometimes called a “silent” cause of infertility—you likely won’t know about blockages or damage until you’re trying to conceive.
Unlike other fertility issues that might cause irregular periods or pain, damaged tubes often don’t send any warning signals.
(For more about the parts of the fallopian tube and what can cause blockages, reference our fallopian tubes primer.)
Causes of tubal factor infertility
Воспалительные заболевания органов малого таза
Pelvic inflammatory disease (or PID) is one of the leading causes of tubal factor infertility [1]. It can occur when a sexually transmitted infection (STI) is left untreated, causing irritation or scarring to form on the fallopian tubes. This can also easily lead to damage or blockages within the tubes. Fortunately, chlamydia and gonorrhea are two STIs that can be treated with antibiotics, so it’s important to get tested and treated early on if you could be infected.
Эндометриоз
Endometriosis is a disease in which tissue similar to the endometrium (lining of the uterus or womb) grows за пределами the uterus in or on nearby organs, including the bowel, ovaries, or fallopian tubes [2]. Like endometrial tissue, which is shed during your period each cycle, endometriosis lesions also bleed during “that time of the month.” But because it не located in the uterus, endometriosis tissue is not shed, causing pain and potentially scarring and adhesions (abnormal fusion of tissues to each other or other nearby organs).
Lesions on the fallopian tubes can cause infertility in a few ways—by blocking the tube and/or scarring the tube, negatively impacting tubal motility. Endometriosis affects up to 10% of women of reproductive age and is a major cause of infertility.
Previous surgeries
Previous surgeries—such as surgery to remove endometriosis lesions or фибромиомы матки—could cause tubal infertility as well, due to scarring or damage to the fallopian tubes. Remember, the tubes are the thickness of a string of spaghetti. A small nick or scar could have a big impact.
Ectopic pregnancy
An внематочная беременность occurs when implantation happens outside the uterus. In the case of a tubal ectopic pregnancy (the most common type of ectopic pregnancy), the zygote never leaves the fallopian tube, and instead implants there and begins to grow. These pregnancies are non-viable, as the fallopian tubes are not designed to nourish or sustain a pregnancy. An ectopic pregnancy must therefore be removed, both because the newly conceived life cannot survive and because it could cause fallopian tube rupture, which could be life-threatening for the mother [3].
Ectopic pregnancy can be treated several ways (which are outlined здесь), including surgery. As mentioned above, any surgery on the fallopian tubes runs the risk of damage and/or scar tissue, leading to future infertility. It’s important to share your fertility goals with your physician so the utmost care can be taken to preserve your fertility if surgery is required.
How tubal factor infertility is diagnosed
Гистеросальпингография (ГСГ)
The standard first-line test when a tubal blockage is suspected is a diagnostic exam called a гистеросальпингография (HSG). This is an x-ray procedure that can view inside the fallopian tubes and uterus, and identify any blockages.
For an HSG, your doctor will insert a cannula through your cervix and inject contrast dye to visualize how the fluid travels up from your uterus and through the fallopian tubes, which can show if and where there’s a blockage. And while the procedure is typically considered diagnostic, there is a chance that it may also be therapeutic–that is, the procedure itself may flush away any (minor) debris blocking the tubes. Usually you’ll be given this test if you’ve been trying to conceive for 6-12 months without success.
Sonosalpingography
While HSG is the gold standard for diagnosing tubal blockages, there are cases where it’s not definitive. And the exam can be somewhat painful. Another test is sonosalpingography, a saline-infused ultrasound [4]. This involves flushing saline and air up the uterus and through the fallopian tubes while watching via ultrasound imaging. Sonosalpingography doesn’t use X-rays or contrast dye, but can still be uncomfortable.
Laparoscopy
Finally, a doctor can perform a laparoscopy, where he or she makes a small incision in your abdomen and looks inside with a special camera. This might be required to see the specific cause or type of blockage. However, this is an expensive surgery that requires anesthesia and post-op recovery time, while the aforementioned procedures are typically out-patient.
Fertility treatment options beyond in vitro fertilization
Some doctors may tell you that in vitro fertilization (IVF)—the joining of an egg and sperm in a petri dish and reinsertion of a zygote back into the uterus—is the only way to get pregnant with tubal factor infertility. However, there are several specialized surgeries and procedures to unblock and repair the fallopian tubes, making natural conception possible.
Fallopian tube recanalization
Fallopian tube recanalization is a procedure that can remove debris, mucus, or fluid that’s blocking the fallopian tube. This treats proximal tubal blockages—those closest to the uterus. A physician inserts a catheter up the vagina, through the uterus, and into the affected tube. After removal, a doctor will check the tube with contrast dye to make sure it’s clear. This is a quick procedure, not a surgery, and doesn’t require any anesthesia. Amazingly, this procedure has a pregnancy success rate of up to 90%, though results vary [5]. This сайт for a restorative reproductive medicine-trained OB/GYN who specializes in tubal factor infertility surgeries reports up to 95% success rate in reopening blocked tubes and 60-75% pregnancy rates.
Tubotubal anastomosis
A tubotubal anastomosis can restore the middle of the fallopian tube. It’s commonly performed to обратный a tubal ligation (surgical female sterilization). It also treats blockages in the mid-segment of the fallopian tubes. This is a procedure done under general anesthesia but has a fertility success rate of about 70% [6].
Neosalpingostomy
Finally, a neosalpingostomy is a surgical procedure to treat distal tube blockages—those farthest from the uterus and closest to the ovaries. It can also treat scar tissue on the tubes. This surgery is done laparoscopically (via a small incision in the abdomen with special tools and a camera) and aims to create a new opening in the tube and/or repair or reconstruction of the fimbriae (the finger-like projections on each fallopian tube that “reach out” to receive a newly ovulated egg from the ovary) [7]. Pregnancy rates after this procedure tend to be lower than with other surgical procedures (for other types of blockages), though some врачи, прошедшие обучение по восстановительной репродуктивной медицине report rates as high as 60-70% [8].
All this to say, there это options for you if you are dealing with infertility due to tubal blockage or damage. These procedures aim to restore or maintain your natural fertility so you can conceive.
The bottom line on tubal factor infertility
Tubal factor infertility may be a roadblock on the path to parenthood—but it doesn’t have to be a dead end. Understanding what’s happening inside your body through charting your cycle (be sure to learn how from a trained instructor!) is a great first step to addressing fertility struggles. A healthcare professional обученный восстановительная репродуктивная медицина can use your body’s health data as reflected in your charting to recommend a path forward, utilizing appropriate diagnostic tools and treatment options. With the right information and a supportive medical team, many women facing tubal infertility do go on to have successful pregnancies. You have options on this journey.
