Treatment of tubal blockage

Surgery may be considered when tubal factors are the source of infertility. Unfortunately, results are disappointing as often, the ciliary action of the tubes is not recovered even when tubal patency is restored. The best results occur in the reversal of sterilisation; 60-80% of patients subsequently achieve pregnancy.

Operative techniques include:

• salpingolysis - dividing of peritubal adhesions around the ampullary ends. It is most effective when the fimbriae are undamaged. Thirty percent of patients may achieve a pregnancy although at increased risk of ectopic pregnancy.
  
  
• salpingostomy - indicated for fimbrial occlusion. Success rates are low as the fimbriae are often damaged and there is a tendency for the new opening to close.
  
  
• tubal anastamosis and reimplantantion - indicated when the isthmic part of the tube is occluded. The blocked segment is excised and the cut ends anastamosed. If the blockage is localised, 70% of patients may achieve pregnancy.

Reference

1. NICE. Fertility problems: assessment and treatment. Clinical guideline CG156. Published February 2013, last updated September 2017