Blocked tubes are one of the most common causes of female infertility and are often the result of prior pelvic infections, endometriosis, or previous pelvic surgery. Damage to the fallopian tubes can interfere with the normal transport of the egg and sperm, significantly reducing the chances of natural conception. Tubal blockage may occur at different locations and is frequently associated with fluid accumulation within the tube, known as hydrosalpinx, which can negatively affect both natural fertility and IVF outcomes. In cases of severe tubal damage, in vitro fertilization (IVF) treatment is often the most effective option to achieve pregnancy.
Causes of Blocked Fallopian Tubes
Damage to the fallopian tubes as a result of prior infection, endometriosis, or previous pelvic surgery is one of the most common causes of infertility. Tubal blockage can occur in several locations. Often, the ends of the tubes are obstructed while the openings into the uterus remain patent (open). In many cases, the tube becomes filled with fluid, a condition known as hydrosalpinx.
Hydrosalpinx and Its Impact on IVF Outcomes
Whereas surgery is generally not indicated to improve fertility outcomes in the era of IVF for patients with significant tubal disease, the presence of hydrosalpinges is an important exception.
Recent medical literature has shown that fluid within the fallopian tubes (hydrosalpinx) contains dead cells and other toxic substances that are highly detrimental to embryo development and implantation. Hydrosalpingeal fluid can leak back into the uterine cavity, creating a mechanical barrier to implantation and reducing the expression of binding proteins, such as integrins, which are essential for embryo attachment to the uterine wall.
In prospective randomized studies, pregnancy rates following IVF were significantly higher in patients who underwent removal of hydrosalpinges compared to those in whom the tubes were left intact. Additionally, the expression of uterine binding proteins improved after surgical removal of hydrosalpinges.
Treatment Options for Hydrosalpinx
Treatment options for hydrosalpinx include reopening the tubes to allow natural conception (neosalpingostomy), proximal ligation of the tubes to prevent fluid leakage back into the uterine cavity, or removal of the diseased tissue (salpingectomy).
Neosalpingostomy
Neosalpingostomy may allow natural conception; however, the chances of spontaneous pregnancy are generally low, and the risk of ectopic (tubal) pregnancy is significantly increased.
For this reason, this procedure is no longer routinely recommended, except in limited cases with a favorable prognosis, such as very young patients with mild tubal disease, unilateral blockage, absence of additional infertility factors, or patients who are unable to pursue IVF treatment.
Women with tubal damage also face an increased risk of ectopic pregnancy, especially after tubal surgery.
Proximal Tubal Ligation
Proximal tubal ligation involves interruption of the communication between the uterine cavity and the fallopian tube, preventing hydrosalpingeal fluid from leaking back into the uterus. This approach is often preferred over salpingectomy in patients with severe pelvic adhesions, where extensive tissue dissection may increase the risk of pelvic organ injury.
However, a potential drawback of this method is the persistence of diseased tubal tissue in the pelvis, which may cause pelvic pain or, in rare cases, twist on its pedicle and result in adnexal torsion.
Salpingectomy
Currently, salpingectomy is considered the preferred treatment for hydrosalpinx. Removal of the affected fallopian tube eliminates diseased tissue that significantly reduces IVF success rates and removes the risk of future pelvic pain or adnexal torsion associated with persistent hydrosalpinges.
Surgical Approach and Patient Counseling
Both proximal tubal ligation and salpingectomy can be performed via laparoscopy, a minimally invasive surgical technique that allows patients to be discharged home on the same day.
It can be emotionally difficult for patients to accept the removal of their fallopian tubes, as this means that natural conception is no longer possible. However, in cases of hydrosalpinx, the tubes are already non-functional, and even if patency could be restored, the likelihood of achieving pregnancy would remain extremely low. Therefore, treatment options should be discussed in detail, and the most appropriate approach should be selected based on individual clinical circumstances and reproductive goals.
Blocked fallopian tubes, particularly when associated with hydrosalpinx, can have a significant negative impact on fertility and IVF success rates. Scientific evidence demonstrates that treating hydrosalpinges prior to IVF improves implantation rates and overall pregnancy outcomes. Selecting the most appropriate treatment strategy requires careful evaluation of the extent of tubal disease, the patient’s reproductive plans, and overall clinical condition.
At Cyprus Hope Fertility | Team-Z, tubal factor infertility is evaluated using an individualized and evidence-based approach under the expertise of Dr. Zehra Onar. Each patient receives personalized counseling and treatment planning to ensure the most effective pathway toward achieving pregnancy while prioritizing safety and long-term reproductive health.