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Once the eggs are released (ovulated) from the ovarian follicles they must be picked up by the fimbriated end of the fallopian tubes. The fimbria are fingerlike projections that assist in collection of the egg. As the egg starts to travel down the fallopian tube, fertilization occurs. The embryo remains in the tube for several days prior to reaching the uterus. Any condition that inhibits this passage, such as a blockage or other tubal damage, can lead to infertility. 
The patency (“openness”) of the tubes is evaluated using a hysterosalpingogram (HSG). This test is discussed in the “Fertility Tests” section. Essentially, damage to the tubes is observed by x-ray examination after introduction of dye into the uterus, which flows back through uterine cavity and retrograde into the fallopian tubes.
Tubal blockage, or damage, can be caused by endometriosis which can attach to, and even penetrate, the fallopian tubes. Severe pelvic infections (pelvic inflammatory disease or PID) can cause serious tubal damage as can scar tissue from previous surgeries. Rarely, a woman will be born without one, or both, of her tubes. Salpingitis Isthmica Nodosa (SIN) can also be a cause of proximal blockage of the fallopian tubes. Many women are now seeking to have previous tubal sterilization procedures reversed.
In most cases, in vitro fertilization (IVF) is now the ‘treatment of first choice” for tubal disease. Using IVF, the eggs are retrieved directly from the ovaries and combined with sperm in the lab, thus eliminating the need for fallopian tube transport.
It is sometimes possible to surgically reverse a tubal sterilization procedure. Even so, women must be strongly cautioned that tubal ligation is considered a permanent means of birth control. Whether or not the tubes can be reconnected depends upon several factors, including where they were tied, how much tube remains, how they were tied (electrocautery, etc.) and other factors. The risk of ectopic pregnancy is 10% or greater if pregnancy occurs after tubal repair. The risk of ectopic pregnancy after IVF is usually less than 2%.
In general, numerous studies demonstrate that pregnancy success per cycle is higher using IVF than surgery. In some women, especially younger women, there may be a reasonable argument for surgery. The number of times a younger couple can have intercourse to attempt pregnancy is virtually unlimited. For example, if they are having regular intercourse, they are attempting a “natural cycle pregnancy” each month. IVF cycles are relatively expensive and the total number is often limited by cost. Some couples may only be able to attempt one of two IVF cycles with the pregnancy rate varying according to many patient specific variables. Their overall cumulative chance for pregnancy may be similar after surgery and 2-3 years of intercourse compared to one IVF cycle. This is highly dependent upon several “couple specific” variables.
Women in their mid to late thirties should seek care from a reproductive endocrinologist/ fertility specialist early in their care as fertility can decline very rapidly in this age group. The pregnancy success rates for these couples are usually significantly higher when IVF is employed.
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