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Tubal Factor Infertility

The fallopian tube is the passageway for the egg to enter the uterus.  During ovulation, the egg is released from the ovary and picked up by the fimbriae, which look like fingers at the end of the fallopian tube.  The egg then starts its 3-day journey to the uterus.  It stays in the end of the tube for the first day, where it can be fertilized if it meets sperm that traveled up through the cervix, through the uterus, and out into the fallopian tube.  The fertilized embryo begins dividing and travels in the fallopian tube to enter the uterus, where it will stay for another 3 days or so before implanting.

The test to determine whether your fallopian tubes are open is called a hysterosalpingogram, or HSG.  This test is usually done by a radiologist or gynecologist, and places dye through the cervix, into the uterus, and out through the tubes.  An x-ray is used to see whether the dye was able to travel out through the tubes, showing that they are open.  If both fallopian tubes are damaged or blocked, the egg and sperm cannot find each other.  This is called tubal factor infertility, and is basically a mechanical barrier that prevents fertilization.  Blocked fallopian tubes prevent natural conception, but in vitro fertilization (IVF) can bypass the tubes.  During IVF, the ovaries are stimulated to produce several eggs, which are then retrieved using a short procedure under anesthesia.  The eggs are then fertilized in the laboratory, and fertilized embryos are placed into the uterus through the cervix where they can implant and grow, so the fallopian tubes are bypassed all together.

Fallopian tubes can be damaged in many different ways.  If the furthest end of the tube is blocked, then the tube cannot pick up an ovulated egg.  This may also cause the tube to collect fluid and dilate, creating what is known as a hydrosalpinx.  It is important to know if your blocked tubes created a hydrosalpinx, because the fluid that collects inside can decrease your chance of successful pregnancy with IVF by about 50%.  If your doctor finds a hydrosalpinx, they may recommend that you have the tube removed or blocked using a surgical procedure, so that the fluid from the hydrosalpinx does not communicate with the uterus.  Damaged fallopian tubes may sometimes be partially open.  This can increase your risk of an ectopic pregnancy, or a pregnancy that implants outside the uterus.  The fallopian tube is the most common place for an ectopic pregnancy to grow.  An ectopic pregnancies can be dangerous if it grows large enough to cause heavy bleeding, and so in almost all cases it should be removed using surgery or medication.

Patients who have had a tubal ligation (“tubes tied”) in the past have intentional tubal factor infertility.  If you have had a tubal ligation and would like to become pregnant again, your options include IVF or surgery to rejoin the tubes.  This surgery is called tubal reanastomosis, and is only done in certain centers.  USC Fertility does not currently perform tubal reanastomosis.  If you have had a tubal ligation and would like to become pregnant, we recommend a consultation to discuss your options.  IVF is often the recommended course, but the final determination of the correct treatment may depend on your age and ovarian reserve.