Before You Try Any Remedy, Ask One Question About Your Blocked Tubes

A woman has been trying to conceive for months with no result. She sees her doctor, who orders the usual investigations: hormone panel, cultures, HSG. Everything is normal except her fallopian tubes, which are blocked.

The doctor mentions surgery and IVF. She has already made up her mind against both. So she searches: articles, YouTube, Facebook groups where members post their HSG results and trade interpretations. Someone says, "Woman X had the same problem, did this, and her tubes opened." So she tries the same thing.

This is not a criticism of women who look for support online. But there is a missing first step.

The first step: ask about severity

The moment your doctor says your tubes are blocked, ask how severe is the blockage?

Only your doctor, looking at your HSG, ultrasound or laparoscopy findings, can tell you where yours falls. Ask for the actual reports, not just the conclusion.

So what exactly is "severity"?

Severity is not just whether your tube is blocked. It's how much damage the blockage has done and how much of the tube's function is left.

A healthy tube does three jobs: it catches the egg, moves the egg and embryo along with muscle movement and tiny hair-like cilia, and provides the environment where fertilization happens. A tube can be blocked and still have most of that machinery intact, or look open on a scan and have very little left. Severity describes where yours sits between those two.

For tubal blockage in general, it depends on:

• Where: near the uterus (proximal) or at the outer end by the ovary (distal)
• How complete: partial or complete
• The tube itself: healthy lining and flexible wall, or scarred and rigid
• Scarring around it: adhesions binding the tube to the ovary and pelvis
• How many tubes: one or both
• Other conditions: endometriosis, infection, fibroids

For hydrosalpinx, where the tube is sealed at its outer end and fills with fluid, it also includes:

• Degree of dilation: mild, moderate or severe
• Shape: normal-looking, slightly swollen, or sausage-shaped
• Fluid: how much, and whether it's visible on ultrasound
• Signs of infection or inflammation (salpingitis)

Surgeons grade these findings formally, for example with the American Fertility Society classification (American Fertility Society, 1988). Your report may not show a grade, but the findings behind one are usually there.

What this means for you

• Your outlook. The less damage, the more room the tube has to recover. Mild cases have the most room and severe ones the least.
• Time and effort. A mild case may need less of both than a moderate one, and a severe case is the least predictable.
• Your decisions. It helps you decide how long to try a natural approach, when to re-test, and whether to prepare for surgery or IVF alongside it.
• Your risks. A damaged tube raises the chance of ectopic pregnancy, and visible fluid can affect IVF success.
• It's not a verdict. Severity describes the tube's condition at the time it is assessed. It says nothing about your worth or your chances of ever becoming a mother, and the underlying condition may change over time.

Severity is also about the tube, not how you feel. Some women with severe hydrosalpinx have no symptoms, and some with mild cases have a lot of discomfort. Only imaging and your doctor's findings show it.

Mild, moderate and severe hydrosalpinx

In general terms, a mild hydrosalpinx may involve slight dilation with relatively little obvious structural damage. A moderate case may show more obvious swelling and changes to the tube's wall or lining. A severe case may involve marked swelling or a sausage-shaped tube, more extensive structural damage and significant surrounding scarring. Long-standing disease can leave one or both tubes structurally damaged.

In my experience, women with mild and moderate hydrosalpinx who commit to a natural approach on their own, or work with herbal specialists and naturopathic doctors, have been much more likely to see their tubes open and go on to conceive than women with severe cases. Moderate cases usually take more time, effort and resources. Severe cases are the hardest and least predictable, because the tube may already be structurally damaged. This comes from what I've seen in practice, not from clinical trials, and I'd rather say so plainly than dress it up as more.

Severity matters in conventional medicine too. In the original Boer-Meisel study of women treated for hydrosalpinx, the estimated probability of intrauterine pregnancy was about 77% in the good-prognosis group, 21% in the intermediate group and 3% in the poor-prognosis group (Boer-Meisel et al., 1986). A later evaluation of the Boer-Meisel prognostic system reported pregnancy rates of about 70% in the good-prognosis group and 6.6% in the poor-prognosis group (Desai & Hazra, 1992). The tube's condition shapes outcomes whatever route you take.

Why two women can do the same thing and get different results

Severity is a big part of it. A woman with a mild case has more to work with than one with a badly damaged tube. It isn't the only factor:

• Other conditions. Endometriosis, pelvic infection, adhesions and some uterine conditions can also affect fertility and treatment decisions. A woman with only a tubal problem may have a different outlook from one dealing with several fertility-related conditions.
• Not every blockage is permanent. HSG can show a blockage near the uterus that is really spasm or a mucus plug.
• Age and time. Egg quality declines with age, so age can make a significant difference even when two women have similar tubal findings.

Image: illustrates the hidden case difference between women A and woman B

Comparing your case with "Woman A" means little unless you know how her case compared to yours.

If you're considering IVF, know this

Hydrosalpinx affects IVF outcomes. A pooled analysis of 14 studies covering 5,592 women found pregnancy rates of 19.7% with hydrosalpinx versus 31.2% for other tubal infertility (Camus et al., 1999). A Scandinavian randomized trial found that salpingectomy before IVF benefited women whose hydrosalpinges were large enough to see on ultrasound (Strandell et al., 1999). A later Cochrane review also found that treating tubal disease before IVF can improve clinical pregnancy outcomes in appropriate patients (Melo et al., 2020). Current guidance considers factors such as the extent of tubal disease, age, ovarian reserve and other infertility factors when deciding on treatment options (Practice Committee of the American Society for Reproductive Medicine, 2021).

If IVF may ever be part of your plan, having fluid assessed now can help you understand what may need to be addressed before treatment. Tubal disease also raises the risk of ectopic pregnancy (Practice Committee of the American Society for Reproductive Medicine, 2021).

Unilateral and Bilateral Hydrosalpinx

When talking about severity, unilateral and bilateral hydrosalpinx are not the same situation. Even if the hydrosalpinx is mild or moderate, having one affected tube is different from having both tubes affected. This can also mean that recovery and the overall fertility picture may not be the same for two women with apparently similar levels of tubal damage.

Unilateral hydrosalpinx means that the hydrosalpinx affects one fallopian tube, while the other tube is not affected by hydrosalpinx.

Bilateral hydrosalpinx means that both fallopian tubes are affected by hydrosalpinx.

So a woman with mild unilateral hydrosalpinx and a woman with mild bilateral hydrosalpinx should not automatically expect the same outcome or the same journey. The same applies to moderate cases. The condition of the other tube matters.

This is another reason not to judge your situation simply by comparing it with another woman's story. Two women can both be told they have "mild hydrosalpinx" but still have very different situations depending on whether one or both tubes are affected, how much each tube is dilated, the extent of scarring, and what other fertility factors are present.

Questions to take to your doctor

1. Is one tube affected or both?
2. Is it mildly, moderately or severely dilated?
3. Is fluid visible on ultrasound?
4. Is the wall thin or thick, and are the inner folds preserved?
5. Are there adhesions, signs of infection, or structural damage?
6. Do I also have endometriosis, fibroids or cysts?
7. Given my age, how much time do I have?

Knowing your answers helps you decide how aggressively to pursue a natural route, how long to give it, and when to bring in other options. Whatever you choose, set a timeline and re-test so you know whether it's working. Fever accompanied by significant pelvic pain should be assessed promptly rather than treated as something to simply wait out.

Thanks.

Efe Abu

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References

American Fertility Society (1988). The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertility and Sterility, 49(6), 944–955.

Boer-Meisel, M.E., te Velde, E.R., Habbema, J.D. and Kardaun, J.W. (1986). Predicting the pregnancy outcome in patients treated for hydrosalpinx: a prospective study. Fertility and Sterility, 45(1), 23–29.

Camus, E., Poncelet, C., Goffinet, F., et al. (1999). Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Human Reproduction, 14(5), 1243–1249. doi:10.1093/humrep/14.5.1243

Desai, P. and Hazra, M. (1992, August). Evaluation of the efficacy of Boer-Meisel's prognostication system in predicting the pregnancy outcome in patients treated for hydrosalpinx. Journal of Obstetrics and Gynaecology of India, 447–450.

Melo, P., Georgiou, E.X., Johnson, N., van Voorst, S.F., Strandell, A., Mol, B.W.J., Becker, C. and Granne, I.E. (2020). Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database of Systematic Reviews, 2020(10), CD002125. doi:10.1002/14651858.CD002125.pub4.

Practice Committee of the American Society for Reproductive Medicine (2021). Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertility and Sterility, 115(5), 1143–1150. doi:10.1016/j.fertnstert.2021.01.051.

Strandell, A., Lindhard, A., Waldenström, U., Thorburn, J., Janson, P.O. and Hamberger, L. (1999). Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Human Reproduction, 14(11), 2762–2769. doi:10.1093/humrep/14.11.2762.

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All content on this site is provided for informational purposes only and is not a substitute for professional medical advice or consultation with your doctor.