The fallopian tubes are two narrow tubes, each about 10 cm long, running from either side of the uterus and ending in finger-like fringes (fimbriae). When an ovary releases an egg, the fimbriae pick it up and draw it into the tube. The wider outer part of the tube (the ampulla) is where sperm meet and fertilize the egg; the embryo is then carried towards the uterus by rhythmic muscle contractions and by tiny hair-like cilia lining the tube. Tubal problems prevent the egg from being picked up or sperm from reaching it, and increase the risk of ectopic pregnancy. Tubal factors account for about a quarter to a third of female infertility.
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Infection and adhesions of the tubes and pelvis
The tubes can become infected by organisms spreading up from the vagina, cervix or uterus, most often sexually transmitted infections such as chlamydia and gonorrhoea, or after childbirth, miscarriage or procedures. Infection can also reach them from elsewhere in the pelvis, for example tuberculosis or a burst appendix.
Infection can destroy the delicate lining of the tubes, which nourishes the embryo and helps move it to the uterus. It can also cause adhesions between the tubes, uterus, ovaries and pelvic walls, which restrict the tubes’ movement or kink and block them. Sometimes the end of the tube becomes completely blocked and fills with fluid, causing it to swell (hydrosalpinx).
Adhesions can also follow surgery, such as treatment of an ectopic pregnancy, removal of fibroids, or operations on nearby pelvic organs. Endometriosis is another important cause, because bleeding from endometriosis tissue each month is trapped in the pelvis.
Impaired tubal function
Even when the tubes are open, damage to the fimbriae can stop them picking up the egg, and damage to the cilia inside can stop the embryo from being moved to the uterus. Both can result from infection or endometriosis.
Tumours of the tube or ovary
Tumours of the fallopian tubes or ovaries can also interfere with how the tubes work.
Hysterosalpingography (HSG): the tubal dye test
The doctor injects a special X-ray dye through the cervix. In a normal test, the dye fills the uterine cavity, passes through both tubes and spills freely into the pelvis. HyCoSy, a similar test using ultrasound instead of X-rays, is an alternative.
What HSG shows
HSG shows the shape of the uterine cavity, revealing polyps, fibroids, adhesions and congenital anomalies, and shows whether the tubes are open or blocked or swollen (hydrosalpinx). It can also suggest pelvic adhesions if the dye collects in pockets instead of spreading freely. In some women, flushing the tubes with oil-based dye during HSG modestly increases the chance of pregnancy in the following months.
How it is done
The test is done shortly after the period ends and before ovulation, once pregnancy, active infection and allergy to iodine contrast have been excluded; antibiotics are sometimes given. With the woman lying on the X-ray table, a thin catheter is passed through the cervix and the dye injected while images are taken. It takes only a few minutes.
Side effects
Cramping pain for a short time is common; taking a painkiller beforehand helps. Pelvic infection and allergic reactions to the dye are rare.
Treatment of tubal problems
Infection
Prompt treatment of genital infections with the appropriate antibiotics, ideally including the partner, prevents chronic pelvic inflammation, tubal blockage and damage to the fimbriae.
Adhesions
Adhesions around the tubes and ovaries can be divided by laparoscopy.
Tubal surgery or IVF?
For most women with significantly damaged or blocked tubes, IVF now offers better pregnancy rates than tubal repair, without the increased risk of ectopic pregnancy that follows surgery. Surgery may still be worthwhile in selected cases:
- Blockage close to the uterus: can sometimes be opened with a fine catheter passed through the cervix under X-ray or hysteroscopic guidance (tubal cannulation).
- Mild damage at the outer end: the opening can be re-formed (salpingostomy) or adhesions around the fimbriae freed.
- Reversal of tubal ligation: the blocked section is removed and the remaining ends rejoined microsurgically. Results are best in younger women with clips or rings rather than extensive removal of tube, and with enough tube remaining.
- Hydrosalpinx before IVF: a swollen, fluid-filled tube lowers IVF success, because the fluid flows back into the uterus. Removing the tube (salpingectomy) or blocking it close to the uterus before IVF roughly doubles the chance of pregnancy.
International Guidelines
In line with global standards, Dr. Sabry follows the latest recommendations from the American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE), and Royal College of Obstetricians and Gynaecologists (RCOG). Thus, patients receive care that is safe, ethical, and evidence-based.
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Why Choose Dr. Ashraf Sabry?
Dr. Ashraf Sabry, consultant in obstetrics, gynecology, fertility, and aesthetic gynecology, is recognized among the best OBGYN and fertility specialists in Cairo. With over 20 years of experience, he combines science and compassion to provide world-class care. Book your appointment through the contact page, WhatsApp, or call +201022224442.