One of the common questions patients search online is: “Can I get pregnant with blocked fallopian tubes?” The answer depends on whether one tube or both tubes are blocked, where the blockage is present, and whether the tube is truly blocked or only appears blocked on a test.

The fallopian tubes are important because they are the place where the egg and sperm usually meet. After ovulation, the egg is picked up by the fimbrial end of the tube. Fertilisation happens inside the tube, and then the embryo travels into the uterus. If both fallopian tubes are completely blocked and non-functional, natural pregnancy is usually not possible, and IVF may be required.

Can HSG or Sono Show a False Blockage?

Many women are told they have blocked tubes after an HSG test or sonosalpingography. These tests are useful first-line tests, but they are not always final. Sometimes, the tube appears blocked because of tubal spasm, especially near the uterine end of the tube. Pain, anxiety or temporary muscular contraction can prevent dye from passing, making the tube look blocked.

Therefore, a diagnosis of tubal blockage on HSG or sono should be interpreted carefully. In many cases, the true condition of the tubes is known only during laparoscopy with chromopertubation, where dye is passed through the uterus while the surgeon directly sees whether it comes out through the tubes.

You may also watch Dr. Kaberi Banerjee’s patient education video on fallopian tube blockage here: Fallopian Tube Blockage: Symptoms, Causes, Diagnosis and Treatment.

Three Possible Findings at Laparoscopy

There are usually three broad scenarios.

The first possibility is that the tube was never truly blocked. It may have looked blocked on HSG because of spasm, but under anaesthesia during laparoscopy, dye passes normally. In such cases, the couple may be advised to try naturally, consider ovulation induction, or IUI depending on age, sperm count and duration of infertility.

The second possibility is severe tubal disease. There may be a frozen pelvis, dense adhesions, severe endometriosis, hydrosalpinx, or badly damaged tubes. In such cases, opening the tubes may not give good results and may increase the risk of ectopic pregnancy. IVF is usually the better option because it bypasses the fallopian tubes.

The third possibility lies in between. There may be correctable adhesions, fimbrial blockage, or a proximal/cornual block near the uterus. In selected cases, the surgeon may try to free adhesions, open the fimbrial end, or pass a cannula through the hysteroscope to open the corneal end of the tube. Whether this is possible can often be decided only during laparoscopy.

When Should IVF Be Chosen Instead of Tubal Surgery?

Tubal surgery is not always the best use of time. If the woman is above 35, AMH is low, infertility is long-standing, both tubes are badly damaged, hydrosalpinx is present, or the husband’s sperm count is very poor, IVF may be a more practical and successful option.

CT scan and MRI usually cannot tell us whether the tube can function normally. They may show large masses or severe disease, but they cannot replace laparoscopy for assessing tubal patency, adhesions and fimbrial function.

The right treatment for blocked fallopian tubes should be individualised. Some women may conceive naturally after confirmation that the tubes are patent. Some may benefit from tubal correction. Others may need IVF. The decision depends on age, ovarian reserve, sperm quality, duration of infertility and the actual condition of the tubes.

References

1. Practice Committee of the American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril. 2021.
2. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265.
3. Opsahl MS, Miller B, Klein TA. The predictive value of hysterosalpingography for tubal and peritoneal infertility factors. Fertil Steril. 1993;60(3):444-448.
4. Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64(3):486-491.
5. Roy KK, Hegde P, Banerjee K, et al. Fimbrio-ovarian relationship in unexplained infertility. Gynecol Obstet Invest. 2005;60(3):128-132.
6. Banerjee K. Fallopian Tube Blockage: Symptoms, Causes, Diagnosis and Treatment. Dr Kaberi Banerjee YouTube patient education video. 2021.