In tubal factor infertility, the function of one or both fallopian tubes is impaired. A fallopian tube may be blocked as a result of a prior pelvic infection, scarring from previous abdominal surgery, or because of conditions such as endometriosis. Sometimes, the cause is unknown. Fallopian tube damage can inhibit the sperm and egg from appropriately meeting and fertilizing, and can decrease the chances that a fertilized embryo travels into the uterus and implants correctly. For this reason, ectopic pregnancies (pregnancies that occur outside of the uterine cavity, most commonly in the fallopian tube), are more common in women with tubal factor infertility.
Fallopian tube health can be assessed by performing a hysterosalpingogram (HSG). During the hysterosalpingogram, a small amount of dye is injected into the uterus through the cervix during a speculum exam, and an x-ray picture is taken. In cases where the fallopian tubes are normal and open, the dye can be traced from the uterus and through the fallopian tubes, until it can be seen spilling into the abdominal cavity. The test can also detect whether the fallopian tubes appear to be abnormal or non-functional. A fallopian tube that is both blocked and dilated is called a hydrosalpinx.
During laparoscopic surgery, the fallopian tubes can also be evaluated. A small amount of dye is flushed through the uterus, and can be seen emerging from the end of the fallopian tubes if they are open.
In cases where only one fallopian tube is damaged, the patient may still become pregnant naturally. If there are minor pelvic adhesions distorting the fallopian tubes, then sometimes surgery will correct the issue. However, if tubal disease is significant, in vitro fertilization (IVF) can be used to bypass the fallopian tubes entirely with good success rates. Women with a hydrosalpinx, however, have been shown to have lower rates of success with IVF, due to the fluid that collects in the fallopian tube. Sometimes, a hydrosalpinx will be removed prior to undergoing IVF so that this tubal fluid does not negatively affect the uterine environment.