Dear Eggsperts–Just recently (and I mean REAL recent- like just last week) I was diagnosed with a blocked Fallopian tube. In that moment, I was too overwhelmed to even think about questions. As a nurse, after I left my mind started going 90 to nothing. I was curious if you could answer some questions for me. My blockage is Unilateral.
1. If I ovulate on my blocked side (the left side), what happens to the egg since it has no place to go?
2. I also have a diagnosis of PCOS, it is possible that I’m ovulating and the egg is stuck in the tube and causing me to have irregular cycles?
3. Can a miscarriage without infection cause the blockage? (I know several things can cause blockage: endometriosis and ruptured appendix are two of which I am aware of and unfortunately have dealt with both)
Thank you so much for your time!
Sincerely–Tubal Tina
Dear Tina–It sounds like you have had to deal with a lot of things that, unfortunately, could impact your potential fertility. Honestly, any one of these individually can make it harder to get pregnant. Though, sadly, the combination makes it even tougher. We hope we can give you some guidance to help you with your journey, and decision-making for that matter, as you work with your doctor to make the best decision about your next steps.
To begin, let’s talk about what some findings of a Hysterosalpingogram (HSG) may mean and then we can answer your questions.
The HSG tells us if the tube is open, but it doesn’t tell us if the tube is “working.” The tube has to be able to move the sperm and egg and embryo (if fertilization happens) in the right directions for fertilization and ultimately embryo implantation in the uterus.
In general, most things that will cause tubal blockage are considered “global” meaning that if it impacted one tube, it may have impacted the other tube. Even if the other tube is open, it may not be working properly. As with most things, there are a few exceptions:
- Depending on where the tube is blocked, it may mean different things. Here are the location terms we use in the clinic to describe where the tube is blocked:
- Proximal–The tube is blocked at the opening to the uterus.
- If both tubes are blocked, this could be muscle contraction of the uterus during the test and additional testing may be needed to confirm if the tubes are really blocked, or if they may be open. Your doctor could attempt to surgically fix some blockages at this level. Not all are repairable, however.
- Having one tube blocked at the level of the uterus could be because of a single abnormality of the uterus (i.e. fibroids, polyps, scarring, etc) that too may be able to be fixed with surgery. Additional testing may be needed, as well, in this case.
- Mid-tube–This is almost always a true blockage that can’t be corrected.
- Distal–Tube is blocked at the end of the tube.
- This can be due to inflammation and scarring due to infection, endometriosis, previous surgery, and unknown causes. Because these things usually occur throughout the pelvis, blockage of one, usually means the other is also injured. There are some exceptions:
- If you have had a ruptured, hemorrhagic ovarian cyst or surgery on an ovary, blockage of the tube on the side of that ovary may not have affected the other tube.
- Inflammation of the appendix (appendicitis) may have caused a “local” effect and caused inflammation and blockage of the right fallopian tube, but the left is unaffected.
- This can be due to inflammation and scarring due to infection, endometriosis, previous surgery, and unknown causes. Because these things usually occur throughout the pelvis, blockage of one, usually means the other is also injured. There are some exceptions:
- Proximal–The tube is blocked at the opening to the uterus.
- Other factors to be aware of:
- If it looks like the blockage is scarring outside the tube that prevents the dye from flowing freely in the pelvis, this too can potentially be corrected with surgery.
- If the tube is dilated, this is called a hydrosalpinx. Leaving a dilated tube in place has been shown to lower pregnancy rates, even with IVF, due to the toxic nature of the fluid build-up that. Most reproductive endocrinologists will recommend removing the tube.
Food for thought: If one tube is blocked and the other is open, you can still conceive, but pregnancy rates will be lower.
I like to use the analogy of an itchy ear and a broken arm. If my left ear itches, but my right arm is broken, I can still scratch my left ear with my right arm, but it’s harder to reach. If you ovulate on the left, the right tube might be able to pick up the egg, but it won’t do it efficiently, especially if the damaged left tube is in the way of the right tube reaching the egg.
In general, like flipping a coin, half of ovulations will happen from the left and half from the right (but it may not always alternate each month.) If the left tube is blocked, you are more likely to conceive when you ovulate on the right. You may only know this by ultrasound.
Realizing that the decision to have surgery this is a hard one, many doctors recommend in vitro fertilization (IVF). Here are a few things we think you should know about surgery considerations when attempting to correct any of the above as found on the HSG.
- Data is limited with regard to how successful tubal surgery is. Also, “success” is measured as having conceived within 36 months following surgery. (As in, did the patient get pregnant within 36 months after surgery?). That’s 3 years!!! With IVF, you could have been pregnant, delivered and be raising a toddler in that amount of time.
- Depending on how severe, and the location***(footnote) of the tubal damage, success rates are variable, but never very high.
- Recurrence of obstruction is common after surgery. Even if the tubes can be opened, we can’t ensure they function properly.
- If the tube is damaged, there is an increased risk of tubal pregnancy. Surgical repair of a damaged tube may increase the chance of pregnancy, but with an even more increased chance of tubal pregnancy.
OK, with that information, let’s answer your specific questions:
1. If I ovulate on my blocked side (the left side), what happens to the egg since it has no place to go?
When you ovulate, an egg is released from the ovary. It actually goes into the pelvis and the tube picks it up.
- If the left tube does not pick up the ovary, it may fall lower into the pelvis and the right tube may pick it up, but this doesn’t always happen.
- If the egg is not picked up by a tube, it eventually dissolves in the body.If an egg is not fertilized and implanted into the uterus, your period happens about 2 weeks after the egg is released from the ovary.
2. I also have a diagnosis of PCOS, it is possible that I’m ovulating and the egg is stuck in the tube and causing me to have irregular cycles?
With Polycystic Ovarian Syndrome (PCOS), this means you don’t ovulate regularly. This means you don’t actually release an egg from the ovary every month and this is why you have irregular cycles. Since the egg isn’t being released, it isn’t being stuck in the tube. PCOS and tubal blockage are actually 2 different conditions that both impact fertility.
3. Can a miscarriage without infection cause the blockage? (I know several things can cause blockage: endometriosis and ruptured appendix are two of which I am aware of and unfortunately have dealt with both)
This is a “maybe” answer. If there was any scarring in the uterus as a result of the miscarriage (and there are a few reasons this can happen, even without infection), you could have blockage at the level of the uterus. It is unlikely that a miscarriage without an infection would cause tubal blockage in the middle or distal part of the tube.
We hope we met your Eggspectations—An Eggspert
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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.
- ***Footnote
- Proximal obstruction—tubal cannulation can be considered.
- Distal obstruction:If it looks like scar tissue outside the tube, surgery may be able to remove the scarring, but there isn’t a guarantee it won’t return. Just like a plastic surgeon may be able to make a skin scar look better, a small scar will still be there.
- If it looks like mild obstruction, but no dilation of the tube, surgery may be able to open the tube, but we can’t tell if the tube will work properly and we can’t guarantee it won’t scar back down.
- If there is dilation of the tube, or if certain features of the HSG suggest tubal injury at the distal and proximal portions of the tube, surgery is rarely successful.