The fallopian tubes are a fragile and necessary piece of a woman’s reproductive system. They must be clear and undamaged to allow the sperm to fertilize an egg and the resulting embryo to be transported to the uterus.
According to the American Society for Reproductive Medicine (ASRM), 35 percent of infertility cases are caused by problems with the fallopian tubes. Tubal damage is particularly suspect in women with regular, ovulatory menstrual cycles and a husband with normal sperm.
Tubal damage or obstruction is often caused by a pelvic infection such as gonorrhea or chlamydia, endometriosis, pelvic inflammatory disease or other abdominal infections including appendicitis or intestinal infections. Damage is also caused by prior surgery, including for ectopic pregnancy.
The fallopian tubes and uterus are soft tissues, so they cannot be seen on a standard X-ray and can only be seen on ultrasound when they are severely damaged or full of fluid.
A hysterosalpingogram (HSG) is the most common way to evaluate the fallopian tubes. A small amount of X-ray contrast dye is injected into the uterine cavity to outline the cavity of the uterus and tubes. An expert can tell from the resulting image if there is an abnormality within the uterus and if the fallopian tubes look normal.
While an HSG is an excellent technique to diagnose problems with the uterus or fallopian tubes, it does not reveal anything about the ovaries – which are also soft tissue – or how they are working in relation to the fallopian tubes.
If the HSG reveals the fallopian tubes are blocked, then a laparoscopy may be performed to assess the severity of the damage. In some cases, surgery may be able to correct the blockage, scarring or other tubal damage.
However, if the damage is too severe, pregnancy will likely only be achieved through reproductive technologies such as in vitro fertilization (IVF). In some cases, removal of the damaged tubes may be recommended before pursuing IVF treatment.