Once ovulation occurs and the egg is released, it is “picked up” by the fallopian tube where it is fertilized. The fallopian tubes must be open and free of obstruction to allow the eggs/embryo to freely pass. Conditions such as endometriosis, scarring from previous surgery or infections, congenital abnormalities, or prior tubal ligation for sterilization can cause tubal obstruction. The HSG fertility test documents that the fallopian tubes are open and unobstructed.
In many cases of tubal obstruction, in vitro fertilization is the first line treatment. This is because IVF bypasses the fallopian tubes, with the eggs being retrieved directly from the ovaries and combined with sperm in the laboratory. The choice of surgery vs. IVF depends upon many factors, including the location and severity of the blockage. Many clinical studies demonstrate that the cumulative success rates are higher after IVF than after tubal reversal surgery.
It is sometimes possible to reverse tied tubes using a surgical procedure that reconnects the fallopian tubes under an operative microscope. A successful outcome depends on multiple variables, including the woman’s age, the length of fallopian tube to be restored, and the exact fragment of fallopian tube originally “tied” or destroyed. This delicate surgery should be performed by a highly trained and skilled fertility specialist.
Even though the per-cycle IVF success rates are greater than tubal surgery, some patients choose surgery. These are usually younger women who have many years to attempt natural intercourse, thus increasing the cumulative pregnancy rates. There is no limit to the number of natural cycles that may occur, whereas IVF cycles may be limited by cost. See our page on the costs of infertility treatment. Older women may not have time to attempt numerous natural cycles because their fertility declines rapidly with age