BLOCKED FALLOPIAN TUBES


Quick Bites

  • Tubal blockage is one of the major causes of female infertility
  • Pregnancy is still possible in complete tubal blockage through In vitro-fertilization
  • Most common cause of fallopian tube blockage is (PID) Pelvic Inflammatory Disease
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Introduction

Blockage_of_fallopian_tubes_symptoms

Many times, you may have thought as from where does new life in the form of your baby begins! It starts in thin fine tubes called fallopian tubes of your reproductive system, where sperm of your partner and egg from you combine to form an “embryo”, which is the beginning of that new life. For this pregnancy to occur naturally your fallopian tubes should be opened and clear without any blocks or scars. If they are blocked, you may have issues with conception.

A blocked fallopian tube is a widely known common cause of infertility in women. There are other names for your Fallopian tubes like oviducts, salpinx, and uterine tubes.

Fallopian tube: The long, slender, and muscular “J-shaped” tube that connects your ovaries to the uterus is called a fallopian tube. The female reproductive system has one ovary and one fallopian tube on each side of the uterus. Your eggs after being released from the ovaries pass through these fallopian tubes into the uterus.

Structure of fallopian tubes: Tubes have 4 parts namely

  1. Fimbriae- are finger-shaped and they catch hold of your egg from the ovary,
  2. Infundibulum- is funnel-shaped opening and fimbriae are attached to it,
  3. Ampulla- the widest part of fallopian tubes where fertilization occurs, and
  4. Isthmus- a narrow part that joins ampulla to the uterine cavity.[1]

In this article

 

Causes of blocked fallopian tubes

Your fallopian tubes may be blocked due to various reasons. The blockage of the tubes may be due to an abscess, scar tissue formation, or pelvic adhesion formation. Blockages make it harder for the sperm of your partner to travel, meet and fertilize your egg. If the cilia of fallopian tubes are damaged then they can’t help sperm and eggs move through your tubes. According to a study, globally [2], about 30% of infertile women have associated fallopian tubes pathology.

Some of the most possible factors that cause fallopian tubes blockage and result in troubled pregnancy are:

  • Infections: Blocks in your tubes may occur as a result of an infection following surgery or from sexually transmitted diseases. These diseases can be:
    • (PID) Pelvic Inflammatory Disease: This is the bacterial infection that starts from the cervix, passes towards the uterus, and then to fallopian tubes. Untreated or severe PID results in permanent scarring of the inner lining of fallopian tubes. Scars that are resulted from PID are seen in the outer walls of the uterus and may cause blockage of distal ends of tubes.
    • (STI)Sexually Transmitted Infections: Tubal infertility may also be due to infections from chlamydia, gonorrhea. Chlamydia [3] is said to cause half of the cases of acute pelvic inflammatory disease in developed countries.
    • (TB)Tuberculosis: Tubal blockage is also seen when your tubes are inflamed with tuberculosis infection. This results in a tubo-ovarian abscess or dense pelvic adhesions.
  • Salpingitis: This is a type of pelvic inflammatory disease that causes the tubal inflammation and thus blocks in the tubes.
  • Fibroids of the uterus: Small or large-sized tumours that grow on the inner side or around the wall of the uterus are called uterine fibroids. If these fibroids grow near the opening of fallopian tubes at the uterine end, they cause blockage of tubes.
  • Ectopic pregnancy: A pregnancy where the embryo starts growing outside of the uterus, most commonly in the fallopian tubes is called an ectopic pregnancy. This is also called a tubal pregnancy. If you have a past surgical history of ectopic pregnancy, then there is an increased chance of formation of blocks in your fallopian tubes.
  • Endometriosis: The inner lining of your uterus is lined with endometrial tissue. Endometriosis occurs if this tissue starts growing outside of your uterus in other parts like ovaries, fallopian tubes, and other organs of the pelvic cavity. This misplaced endometrial tissue responds to menstrual hormones but has no place to go out of the body and thus results in inflammation and scars with adhesion formation leading to blockages of tubes and preventing egg transfer.
  • Past history of abdominal surgery: pelvic or abdominal surgeries for ectopic pregnancy and ruptured appendix or a cesarean section can cause scar formation at the distal (away from point of attachment) end of ovary.
  • Use of IUD intrauterine device: Intrauterine device for contraceptive purposes can also cause damage to the opening of the fallopian tube.
  • Congenital defects: In a few women, birth defects cause abnormal development of fallopian tubes or uterus. Abnormally developed fallopian tubes may be blocked causing difficulty in getting pregnant.
  • Primary fallopian tube carcinoma and Benign tumours of fallopian tubes: Sometimes, a tubal tumour of benign origin like adenomatoid tumours may cause obstruction of the tubes.

Sometimes your fallopian tubes are blocked due to build-up of liquid. Such conditions include:

  • Hydrosalpinx: When you have a past history of the pelvic or sexually transmitted disease, endometriosis, or any previous surgery, your fallopian tubes may be blocked with fluid. This is called hydrosalpinx. Pregnancy is prevented by hydrosalpinx as fluid flows back into the uterus preventing implantation [4].
  • Pyosalpinx: When there is a collection of pus in tubes, they get blocked. This is mostly treated with antibiotics.
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Types of blockage in Fallopian Tubes:

Depending on the portion of the fallopian tube that is affected, 3 levels of blockages can be identified namely distal (away from the point of attachment), proximal (near to the point of attachment), and mid-segment (at the middle part).

  • Distal: This is the most common and accounts for 70% of blockage cases. The part of the Fallopian tube that is nearer to the ovary is blocked in this type. Such blockage may be due to hydrosalpinx, pelvic adhesions, or blending of fimbriae.
  • Proximal: It occurs in the isthmus part of tubes and is caused by infection after a septic abortion, endometriosis, tumours, salpingitis, or dried mucus.
  • Mid-segment: This type of blockage involves the middle part of fallopian tubes i.e. the ampullary part which is the most common site for tubal ligation, a female sterilization procedure.
  • Unilateral and bilateral tubal blockage: Tubal blockage is considered as unilateral blockage if the fallopian tube on one-side is blocked and as bilateral blockage if fallopian tubes of both sides are blocked.
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Symptoms of blocked fallopian tubes

Blocked fallopian tubes rarely show symptoms. Often you face problems of getting pregnant, your tubal blockages remain undiagnosed. However few symptoms can be associated with tubal bocks like:

  • Infertility: The major symptom seen with blocks in tubes is infertility. If you are not able to achieve pregnancy after one year of trying or after six months, in case if you are above 35 years, then your doctor will suggest checking your fallopian tubes.
  • Pain in the pelvic region: You may experience pain in your pelvis or belly region due to tubal blocks during periods, or the pain may be constant.
  • Painful intercourse: You may feel pain while having intercourse when your tubes are obstructed.
  • Uncomfortable urination: Difficulty in passing urine is seen due to tubal blockages.
  • Other symptoms: Other symptoms that can be noticed are Unpleasant bowel movements, lower abdominal pain ranging from mild to severe, smelly substance that is discharged from the vagina, Low back pain, irregular menstrual cycle, and heavy menstrual bleeding or spotting between menstrual periods and fatigue.
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Diagnosis of blocked fallopian tubes

Diagnosis of blocks in tubes is difficult to identify, as the tubes can open or close it makes it hard for us to know whether they are blocked or just remain closed. However, standard diagnostic procedures for assessing blocks in tubes include:

Diagnosing blocked fallopian tubes considering the medical history

If there is a history of infertility, history of a previous ectopic pregnancy, or abdominal surgery and pelvic inflammatory disease, then your doctor will suggest obstructed fallopian tubes.

  • HSG: This special radiologic procedure is used to investigate the shape of your uterus and the shape and size of your fallopian tubes. Partial or complete blockage of fallopian tubes is seen using HSG [5]. It is also called uterosalpingography. Here, a dye is injected into your cervix through a tiny tube. The flow of the dye is tracked by taking x rays of the pelvis.

Your tubes are normal if the dye freely flows through the uterine cavity and into both of the fallopian tubes. A blockage may be present if the dye runs through the uterus but does not flow through fallopian tubes. Sometimes, your doctor may perform this HSG test for the second time, as 15% of women get a false-positive result.

Diagnosing Blocked Fallopian Tubes by Imaging Tests

The diagnosis of the blocked fallopian tubes can be done using a series of imaging tests. They are:

  • Ultrasound: This is also called Sonohysterogram. It is similar to HSG but makes use of sound waves to get the picture of your fallopian tubes.
  • Hysteroscopy: Diagnostic hysteroscopy allows your doctor to check the uterus, ovaries, and fallopian tubes. Hysteroscope is a thin tool to view the inside of the uterus and has a light and a camera. It is inserted via the vagina through the cervix into the uterus and enables us to see blocks in fallopian tubes.
  • Laparoscopic surgery: This is also known as key-hole surgery and is considered the most accurate test to detect blocks of fallopian tubes. Here in Laparoscopic surgery, a blue dye called methylene blue is passed through the cervix. The dye flow that comes out of the tubal ends is watched directly and tubal patency or blockage is confirmed.
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Treatment for blocked fallopian tubes

Treatment for the tubal disease will depend on the type of damage or blockage. Surgery is needed to remove the blockage in some patients and it is not beneficial always. If your damaged or blocked fallopian tubes cannot be treated, still you can get pregnant through IVF.

Pharmacotherapy for blocked fallopian tubes

The usage of medicines is less effective in treating already existent fallopian tubes obstruction. In patients having pelvic inflammatory disease, antibiotics help to prevent the formation of blocks.

Surgical treatment of blocked fallopian tubes

Fallopian tube obstruction is treated traditionally using Tuboplasty. Tuboplasty includes performing a few surgical procedures [6] to restore the patency and functioning of your fallopian tubes so that you can achieve pregnancy. Different types of Tuboplasty that are done by Laparoscopy or microsurgical techniques or laparotomy are as follows:

  • Tubal reanastomosis: This procedure is done by an abdominal incision or laparotomy, while a specialist can do it using Laparoscopy. Through this procedure, tubal ligation is reversed or repairing the portion of damaged fallopian tube by disease is done. The blocked part is removed and then unaffected healthy ends are again joined together.
  • Salpingectomy: When your tubes become filled with fluid-like hydrosalpinx, then this procedure is performed to remove the part of the tube. The affected part of the fallopian tube is removed to enhance the success of IVF. This procedure is more preferred than Salpingostomy in resolving hydrosalpinx condition before you go for conception through IVF.
  • Salpingostomy: This is preferred when one end of the tube is blocked by fluid that is accumulated due to hydrosalpinx. Your doctor will create a new opening in the part of the tube that is closest to the ovary so that eggs can travel from ovaries to the fallopian tubes through this new opening. It is common for the scar tissue to start growing on the newly created tubal opening, causing a new blockage.
  • Fimbrioplasty: This is a procedure where your doctor will rebuild the fimbriae when picking up an egg becomes difficult due to the scar tissue or block that is formed at the distal end of the tube. This is preferred over Salpingostomy as here the risk of formation of scar tissue is less.
  • Selective tubal cannulation: It is a non-surgical treatment of blocks in fallopian tubes that are present closest to the uterus. A catheter is inserted through the vagina and uterus to reach the blockages. Your doctor will be able to get the exact location of blocks by using x-rays or ultrasound. Then a small balloon is inflated or a thin wire is used to push the blocks out of the tubes.

Risks of blocked fallopian tube surgery

As with any other surgery, fallopian tubes blockage removal surgery has few risks like bleeding, infection, scar tissue formation, damage to adjacent organs, and increased chances of ectopic pregnancy. If you had tubal surgeries, then there is a higher chance of having an ectopic pregnancy. So it is highly recommended for you to visit your doctor once you find that you are pregnant following your tubal surgery.

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Fertility following blocked fallopian tubes treatment

Following your tubal blockage treatment, your ability to get pregnant depends on your age, length of your tubes, amount of scarring on tubes, and severity of other associated fertility conditions. Among successfully treated women, 10 to 80% are able to achieve pregnancy in the future.

Even if there is no guaranteed pregnancy following blockage treatment, there are some factors that make pregnancy more likely to happen, and these factors are-blocks that are present near to your uterus and length of fallopian tubes with at least 7.5cm after tubal surgery.

The age of the woman plays a key role in her fertility. If you are above 35 years, then your fertility rate is decreased and there is a need for you to consider undergoing IUI or IVF following fallopian tube blockage surgery. Surrogacy is also an option for women with blocked tubes.

IUI for Blocked Fallopian Tubes

If one of your fallopian tubes is clear and opened, then you can consider having pregnancy through IUI, a common form of artificial insemination. It is an in-office procedure where sperm is collected, washed, concentrated and then placed directly into your uterus with the help of a small catheter attached to a syringe.

Tubal Infertility and In vitro-fertilization (IVF)

If both the tubes are completely blocked or damaged or if the surgical repair of blocks in your tubes fails or if scar tissue forms blocking tubes again after surgery or if you no longer have your fallopian tubes for some reason, still you can get pregnant through IVF.

IVF is the process that omits the function of fallopian tubes and involves retrieving eggs directly from the ovaries and combining them with the partner’s sperm or donor’s sperm in the lab dish. The fertilized egg or embryo thus formed is then placed back into your uterus to get implanted on your uterine lining and grow further into a baby. In IVF, you can get pregnant by using either your own eggs or donor eggs.

The best thing about IVF treatment is that it completely avoids blocks in fallopian tubes and so the presence of blocks is not at all a problem. This is the reason IVF is preferred as the first treatment option for a woman having tubal infertility.

Tubal Infertility and Surrogacy

When IVF or IUI are not recommended for you for some medical reasons or if you don’t want to undergo IVF or IUI, then you can think of Surrogacy. Here, the surrogate mother will agree to bear your child in her womb and return the baby to you after delivery. It is often a legal agreement.

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Ayurvedic treatment for tubal blockage

An Ayurvedic key factor in treating fallopian tube blocks is Uttar Basti, a procedure where the uterus is enveloped with medicated oil. This uterine soaking in medicated oil is done for 3 whole days and 3 additional days. This treatment helps to settle down the adhesions and inflammation and thus opens the tubes.

A study conducted to evaluate the effect of Kumari Taila Uttar Basti procedure showed that it is a highly effective treatment to clear blocks without any complications. Among 62.50% of unilateral and 37.50% of bilateral tubal blockage patients, when Uttar Basti was given at 5ml for two consecutive cycles, it was found that tubal blockage was removed in 80% of patients and 40% of patients conceived in two months.[7]

Panchakarma treatment like Vamana and virechana is done for patients according to their condition using Ayurvedic medicines.

Ayurvedic Medicine For Blocked Fallopian Tubes

Ayurvedic is widely used medicine and trusted since ages as it is 100% natural without any side effects. The blockages of fallopian tubes are treated effectively by Ayurveda. Following are well-renowned herbs used:

  • Kalmegh: The other name for this herb is Echinacea Pallida and is effective in treating blocks in tubes. This is a perennial herb and is rich in antimicrobial and anti-inflammatory properties and contains alkylamides, polysaccharides, and caffeic acids. If you have an autoimmune disease, this herb is not good for you. It should be taken after the Ayurvedic doctor’s consultation.
  • Usnea: This is another effective herb for blocks in tubes and it is a lichen (a combination of algae and fungi). It has a chemical that kills major germs and is found all over the world.
  • Goldenseal or Peet Kandh: This herb has anti-inflammatory effects and also tones the inner mucous membrane of fallopian tubes and thus protects them. It is widely used in unblocking treatment. It is not to be used in pregnancy.

Other Herbs Used in Treating Blocked Fallopian Tubes

  • Lodhra: This is commonly used medicine in Ayurveda. It boosts your fertility and helps to unblock fallopian tubes
  • Dong Quai: This is Chinese herbal medicine and used to unblock fallopian tubes and also treats other reproductive issues. A meta-analysis of 2015 suggests that with Chinese herbal medicine, the pregnancy rate is doubled.
  • Ginseng: This is traditional Chinese medicine. This herb inhibits inflammation and increases antioxidant nature in the cells.
  • Mugwort: This is also a fertility-boosting herb and is used for unblocking fallopian tubes. It is followed in Europe, Asia, and often in Chinese medicine, where Mugwort is burnt over an acupressure point.
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Homeopathic treatment for blocked fallopian tubes

Homeopathic medicine helps to treat the block of tubes by dissolving scar tissue and adhesions and by absorbing excess fluid and mucus that is formed inside of the tubes due to infections and inflammation.

Only partially blocked tubes are treated and cannot treat completely blocked tubes, and results will vary from case to case. Homeopathic medicines that are used for blocks are Apis Mellificia, Lachesis, Pulsatilla, Medorrhinum, and Sepia. It is advised to strictly avoid self-medication and a homeopathic doctor should be consulted.

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India foods for blocked fallopian tubes

If you are diagnosed with blocks in your tubes, we list here a few home remedies that can give you relief. They can help to prevent the formation of blocks.

  • Vitamin C foods: blockages of fallopian tubes due to infections can be healed by taking enough amounts of vitamin C rich foods, as it promotes your immunity and helps in iron absorption from your foods. Oranges, lemons, strawberries, bell peppers or capsicum, and kiwi are rich in vitamin C.
  • The goodness of Garlic: Garlic is enriched with natural antibacterial properties that help to fight the microbes and boost your immune system. It prevents blood clot formation, improves circulation of blood, reduces scar formation in the mucus membrane of fallopian tubes thus keeping them clear and open.
  • Ginger: A common Indian dish ingredient having multiple benefits is Ginger. A study done in 2014 showed that gingerol, which is an active ingredient in ginger, has both anti-inflammatory and antioxidant natures. They reduce inflammation and aid in good circulation thus preventing blocks of tubes.
  • Turmeric: Curcumin in turmeric is shown to reduce inflammation. You can consume turmeric in milk or add to your regular food. More than 8 grams of turmeric per day show adverse effects, so be sure to take it correctly.
  • Castrol oil massage: Castrol oil is a well-known remedy for infertility and blocks in tubes, as massage with this oil on the lower abdomen helps to stimulate the lymphatic system of the uterus and aid in increased blood flow.
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Lifestyle changes that help to prevent blocks in fallopian tubes

If you are trying to get pregnant and if you have blocked fallopian tubes, then you can consider a few lifestyle changes that can help naturally to unblock them. You should try the following natural changes in your daily living before thinking of surgically unblocking your tubes.

  • Stop taking alcohol and quit smoking: There are several studies showing that infertility is caused by consuming alcohol and tobacco use. So, better avoid them to improve your fertility levels and overall quality of life.
  • Reduce stress with meditation: We all know that stress is the major cause of many health problems including infertility. Regular meditation is an effective technique to help in de-stressing your mind and regulates hormonal balance.
  • Yoga practicing: Yoga includes gentle stretching poses that help to massage inner reproductive organs and focus on healing health alignments. Practice yoga poses that work on the abdomen and low back like “Viparita Karani” and “Setu Bandhasana” to help unblock your tubes.
  • Acupressure: The technique of applying pressure on different pressure points in our body can promote healing by increasing blood flow and reducing inflammation.
  • Fertility cleansing program: This complete body cleansing therapy is done for 28 days to remove toxins from organs like kidneys and liver that are causing infertility. It involves taking a healthy diet with herbs and improves better nutrient absorption.
  • Systemic enzyme therapy: By making use of systemic enzymes (enzymes that are naturally present in our body), this therapy helps to clear and break excess scar tissue, cleanse your blood, increase circulation of reproductive organs and boost your immunity. The fibrin present in the scar tissue of your fallopian tubes is believed to be dissolved by this therapy.
  • Toxin flush by Activated charcoal: Using activated charcoal to absorb the toxins and cleanse your body is a popular method that is followed.
  • Fertility massages: Some healthcare providers suggest fertility massages with warm oils on your abdomen can unblock fallopian tubes.

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references

List of ReferencesHide

1 .

teachmeanatomy.info.“The Fallopian (Uterine tubes) Tubes”.Teach Me Anatomy; 12 May 2019

2 .

Briceag I, Costache A, et al.“Fallopian tubes--literature review of anatomy and etiology in female infertility”. J Med Life. 2015;8(2):129-131, PMID:25866566.

3 .

Khalaf Yacoub.“Tubal subfertility”. ABC of subfertility,BMJ; 2003 Sep 13;327(7415):610-613, PMID:12969933.

4 .

reproductivefacts.org.“Hydrosalpinx”. ReproductiveFacts.org from the American Society for Reproductive Medicine; 2014.

5 .

Acog.org. “Hysterosalpingography”.ACOG The American College of Obstetrician and Gynecologist; August 2011.

6 .

Uofmhealth.org. “Fallopian tubes procedures for Infertility”.Michigan Medicine, University of Michigan; May 29, 2019.

7 .

Upadhyay Kamayani Shukla, Karunagoda Kaumadi, et al.“Effect of Kumari Taila Uttar Basti on fallopian tube blockage”.Ayu. 2010; PMID:22048533.

Last updated on: : 12 Aug 2020

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