Tubal Factor Infertility

Tubal factor infertility is difficulty conceiving because the fallopian tubes are blocked or damaged. A tube may be blocked near the uterus (proximal occlusion) or near the ovary (distal occlusion). Peri-tubal adhesions, scar tissue around the tubes, can also pull them out of position. Past infection or past surgery can leave this type of damage.¹ Tubal damage is a common cause of female infertility. Yet the tubes often go unevaluated when couples are directed toward assisted reproduction first.

The fallopian tube performs active work. Cilia are fine, hair-like structures on the cells that line the tube. They move the egg along the tube. The ampulla, the wide outer part of the tube, is where sperm and egg usually meet. Pressure inside the tube also helps eggs and sperm move normally.² Damage to any part of the tube disrupts one of these functions. The location, type, and severity of the damage help the surgeon plan the repair.

Surgery can repair many patterns of tubal damage. A blockage near the uterus may open with fallopian tube recanalization or selective salpingography. A past sterilization can damage the middle of the tube. Microsurgical tubal anastomosis can repair that damage by joining the healthy ends back together.³⁴⁵ Damage at the far end, including the fimbriae (the fringed opening), may be repaired with neosalpingostomy. This repair works when the rest of the tube remains healthy enough.⁶ A hysterosalpingogram (HSG), an X-ray dye test of the tubes, shows their shape. A pressure reading inside the tubes adds information about their function beyond the image alone.²

A tubal diagnosis opens the question of repair. The restorative question is direct: can the tube be repaired, and can it function again? Couples benefit from a full evaluation of the tubes before making any irreversible decision.