Fallopian Tube Procedures for Infertility

Surgery Overview

A fallopian tube blockage often prevents successful passage of the egg to the sperm, or the fertilized egg to the uterus. Surgery can be used to try to correct this common cause of infertility. What type of surgery you have depends on where and how much the fallopian tube is blocked.

Some tubal procedures can be done using microsurgical techniques. These may be done during open surgery on the belly or using laparoscopy through a small incision. The surgeon must have special training and expertise in these techniques. Here are the most common tubal procedures.

Tubal reanastomosis is often used to reverse a tubal ligation or to repair a part of the fallopian tube damaged by disease. The blocked or diseased part of the tube is removed. Then the two healthy ends of the tube are joined. This procedure can be done through an incision in the belly (laparotomy), but some specialists can do this procedure using laparoscopy.

Salpingectomy is the removal of part of a fallopian tube. It's done to improve in vitro fertilization (IVF) success when a tube has a buildup of fluid (hydrosalpinx). Hydrosalpinx makes it less likely that an IVF procedure will succeed. Salpingectomy is preferred over salpingostomy for treating a hydrosalpinx before IVF.

Salpingostomy is also done when the end of the fallopian tube is blocked by a buildup of fluid. This procedure creates a new opening in the part of the tube closest to the ovary. But it's common for scar tissue to regrow after a salpingostomy. This can reblock the tube.

Fimbrioplasty may be done when the part of the tube closest to the ovary is partially blocked or has scar tissue. These problems can prevent normal egg pickup. This procedure rebuilds the fringed ends of the fallopian tube.

For a tubal blockage next to the uterus, a nonsurgical procedure called selective tubal cannulation is the first treatment of choice. Using fluoroscopy or hysteroscopy to guide the tools, a doctor inserts a catheter, or cannula, through the cervix and the uterus and into the fallopian tube.

What To Expect

After open abdominal surgery, you most likely will have a 2- to 3-day hospital stay. You probably can return to work in 4 to 6 weeks. How long it takes depends on the extent of surgery, the kind of work you do, and your overall health.

After laparoscopic surgery, you'll have a brief hospital stay. Your return to daily activities can take a few days to a couple of weeks, depending on the type of procedure.

Why It Is Done

Fallopian tube surgery may be done if:

• Hysterosalpingography shows blocked fallopian tubes.
• A blocked fallopian tube has a buildup of fluid (hydrosalpinx).
• You want to have a tubal ligation reversed.

How Well It Works

Fallopian tube procedures can improve the chance of getting pregnant for some people.

The chance of getting pregnant after clearing or fixing a blocked tube depends on many things. These may include where the blockage is and how much of the tube is blocked. When a tube is mostly blocked, tubal surgery may be done along with in vitro fertilization (IVF) to increase the chance of getting pregnant. The amount of tube that is left after a surgery can also affect success. If a large part of the tube must be removed, the chance of getting pregnant after surgery is reduced.

The success of a sterilization reversal is influenced by the tubal ligation method used, by how recently the tubal ligation was done, and by the person's age.

Other things that affect the chance of pregnancy after these procedures include the surgeon's skill level and experience, as well as other possible infertility problems.

Risks

Risks of fallopian tube surgery include:

• Pelvic infection.
• Scar tissue (adhesions) forming on the reproductive organs, causing them to bind to the abdominal wall or to other organs.
• Increased risk of tubal (ectopic) pregnancy after surgery.