Essential for fertilization, the fallopian tubes can sometimes deteriorate or even become blocked, making conception difficult. How to explain blocked fallopian tubes? What treatments to remedy this so-called tubal infertility? Decryption.

The fallopian tubes are an essential organ of the female reproductive system. Measuring about ten centimeters each, these two ducts formed by smooth muscles and covered by the peritoneum connect the ovaries to the uterus. During ovulation, the oocyte expelled by the ovary is captured in the pinna, the terminal part of the proboscis, and moved to the bulb, the central part of the duct. This is where fertilization by a sperm can take place. Then, for 3 to 4 days, the embryo develops in the tube, the time necessary for its transport to the uterine cavity.

Fragile, the fallopian tubes are particularly sensitive to infections and certain pathologies that can lead to the appearance of lesions or adhesions and can thus cause their degradation or obstruction. These obstructions (unilateral if they are only on one side or bilateral if they affect both tubes) are characterized by their location and extent.

• the obstruction is said to be proximal if it is located near the internal opening of the proboscis,
• distal obstruction describes an attack close to the external opening of the proboscis,
• if the obstruction allows a small passage, we speak of phimosis ; if it is total, d’hydrosalpinx.

In all cases, blocked tubes make conception difficult, if not impossible if both tubes are affected. This is called tubal infertility.

The most common causes of this type of female infertility are:

• iatrogenic scars of the genital tract the cause of which is linked to a history of neighboring surgery: traumatic childbirth, curettage, digestive surgery, etc.,
• gynecological infections and especially sexually transmitted infections (chlamydia, gonococci, certain mycoses) causing severe pelvic inflammation such as salpingitis. These inflammations are the cause of 9 out of 10 tubal infertilities. Moreover, when they are iterative or chronic, these infections can lead to deterioration of the tubal mucosa and dilation of the tubes.
• infections that are not localized in the female reproductive system (tuberculosis, appendicitis, etc.)
• non-infectious causes (endometriosis, agenesis, certain types of fibroids, stigmata of ectopic pregnancy, torsion of the ovary).

In the event of suspicion of a degradation or an obstruction of the tubes, two examinations are generally recommended in first intention:

• Hysterosalpingography allows, after the injection of a product of contrast, the study of the uterine cavity and the tubes by radiography. It can be supplemented by a blue test, performed under laparoscopy, which consists of injecting a blue product to assess the permeability of the proboscis,
• The laparoscopy, usually associated with hysterosalpingography, not only helps refine the diagnosis, but also corrects some tubal abnormalities.

This first follow-up could be supplemented by a hysterosonosalpingography (to assess tubal permeability by ultrasound) or a salpingoscopy (direct observation of the tubal bulb by endoscope). However, these two examinations are not recommended in the clinical practice recommendations for the management of infertile couples from the National College of French Obstetrician Gynecologists (CNGOF).

Depending on the origin of the tubal infertility and the state of damage to the tubes, different treatment options may be recommended:

• adhesiolysis is preferred to remedy mild tubo-ovarian adhesions. Performed by laparoscopy, it helps lift adhesions and restore mobility to the tube relative to the ovary.
• In the event of distal tubal obstruction, several laparoscopic reconstructive surgery may be recommended after evaluation of the tubal mucosa (tubal score) and the couple’s infertility assessment. If the prognosis is good, a fimbrioplasty (opening of the outer end of the tube) or a (neo) salpingostomy (surgical reconstruction of the pinna of the tube) can be performed. If the prognosis is not good, reconstructive surgery is not indicated. However, a salpingectomy may be considered in case of hydrosalpinx.
• In case of proximal tubal obstruction, tubal cannulation (or catheterization) is indicated. It allows, by inserting a catheter, to unblock the tube and restore its patency. If this intervention gives good results, it is not recommended in the event of pathology of the mucosa or if the couple must resort to medically assisted procreation for other reasons.
• In case of endometriosis, laparoscopic treatment may also be recommended depending on the severity of the disorder.

Finally, when surgery is not indicated and the tubal pathology is definitive, in vitro fertilization can be offered to the couple to satisfy their parental project.