Tubes pick up the egg at ovulation, permit sperm to reach the egg after intercourse or insemination and transport the dividing fertilized embryo into the uterus to permit normal implantation within the uterine cavity. HSG (hysterosalpingogram) is the initial step in evaluation tubal status, but further evaluation may require laparoscopy which a minor outpatient surgery.
Tubes are exquisitely susceptible to damage by sexually transmitted bacteria such as Chlamydia trachomatis and Neisseria gonorrhea. Pelvic infections (PID) are notoriously “silent” so only about 50% of women with damaged tubes are aware of having had an episode of PID in the past. Pelvic infections are most common in women in their teens and 20’s but their consequences last for years.
Pelvic infections can result in distal closure of the tube near the ovaries with dilation of the tube by accumulated secretions (What is a Hydrosalpinx?). Whereas in the past tubal surgery was frequently performed, its results have been generally disappointing with re-occlusion of tubes, ectopic pregnancies and low live birth rates. IVF represents a much more successful approach to distal tubal occlusion, but for best results the occluded tube(s) should be removed before IVF is initiated. If only one of the tubes forms a hydrosalpinx, Dr. Chetkowski and others have reported high pregnancy rates with removal of the diseased tube without requiring IVF (Hydrosalpinx, Tubal Infertility, IVF and Surgery).
Occlusion of the tubes proximally near insertion into the uterus is much less ominous than distal occlusion and requires no intervention before IVF. This portion of the tube is very narrow and can easily become closed by a mucus plug, debris or even transient tubal spasm. Select patients with proximal tubal occlusion may benefit from opening them up by cannulation which is usually performed by an interventional radiologist with x-ray guidance.