The fallopian tubes are the path on which egg and sperm find each other. If they are blocked, a natural pregnancy often fails to happen – entirely without noticeable symptoms. Here you can find out how tubal patency is tested and which paths are open to you if the tubes are blocked.
Priv.-Doz. DDr. Michael Feichtinger explains why open fallopian tubes are so important for a natural pregnancy, how a blockage occurs – and why many women are unaware of it. You will find an overview of all the common reasons for an unfulfilled wish for a child on our causes page.
After ovulation, the fallopian tube catches the egg – this is where fertilisation takes place, and from here the fertilised egg travels on into the uterus to implant. A blockage of the fallopian tubes means that this connection between ovary and uterus is permanently interrupted: no sperm cells can reach the egg, and fertilised eggs cannot reach the uterus.
There are several reasons why fallopian tubes can be blocked. Often, unnoticed infections in the past (e.g. from chlamydia) are the cause, but endometriosis, adhesions after abdominal surgery and congenital malformations can also lead to a tubal blockage.
The insidious part: a woman cannot tell whether her fallopian tubes are open or not, as a blockage causes neither pain nor any other symptoms. Blocked fallopian tubes are also not visible on a normal gynaecological ultrasound – a targeted examination is needed.
Testing tubal patency is one of the standard building blocks of a fertility work-up – together with the hormone status, determination of the ovarian reserve (AMH) and the partner's semen analysis. The check is particularly worthwhile if pregnancy fails to occur despite a regular cycle and good timing, if pelvic inflammation or a chlamydia infection is known, after abdominal surgery, in cases of endometriosis – or after a previous ectopic pregnancy.
As a general guideline: if you are under 35 and have been trying to get pregnant for a year without success – from 35, after just six months – the right time for a complete work-up has come.
Three established procedures are available – from the gentle ultrasound examination to surgical assessment. We discuss individually which method is right for you.
In hysterosalpingo-contrast sonography (HyCoSy, also HYCOSY), a fluid that is visible on ultrasound is flushed through the fallopian tubes via a thin catheter. If it flows through unhindered, the tubes are open. The examination involves no X-ray radiation, takes only a few minutes and is completely painless for most women – you see the result immediately on the ultrasound image.
Hysterosalpingography (HSG) is the classic X-ray procedure: an X-ray contrast medium is introduced into the uterus, and X-ray images then show whether the contrast medium flows through the fallopian tubes. The HSG also depicts the uterine cavity, but works with X-ray radiation – in modern fertility work-ups, the ultrasound-based HyCoSy is therefore often preferred.
In a laparoscopy, a camera is introduced into the abdomen through small incisions under anaesthesia, while a dye is flushed through the fallopian tubes (chromopertubation). The advantage: adhesions or endometriosis lesions can be treated directly in the same operation. As a surgical procedure, however, laparoscopy is usually reserved for situations in which there are concrete grounds for suspicion.
You are welcome to have your tubal patency tested by HyCoSy at our institute – we need up-to-date vaginal infection swabs for this. The examination is usually carried out in the first half of the cycle, i.e. after the end of your period and before ovulation.
A pleasant side effect: thanks to a certain "flushing effect" of rinsing the fallopian tubes, fertility is actually slightly increased in the first months after the examination. The HyCoSy is also a building block of our Ferticheck Female, with which we can comprehensively assess your fertility.
The diagnosis "blocked fallopian tubes" is not the end of your wish for a child – it only shows that the natural path is blocked. In some cases, surgical treatment of adhesions can be considered; whether this makes sense depends on the findings, your age and your overall situation.
In most cases, the most efficient path is assisted reproduction: in IVF, eggs are retrieved directly from the ovary, fertilised in the laboratory and the embryo is then transferred into the uterus. The fallopian tubes are bypassed completely – historically, a tubal blockage was in fact the very starting point for which IVF was developed.
Good to know: tubal sterility – i.e. fallopian tubes that are blocked on both sides, removed or non-functional (tubal ligation not included) – is a medically established indication of the Austrian IVF Fund. If the requirements are met, the fund covers a substantial part of the treatment costs; the diagnosis must be documented by a specialist using imaging procedures or a surgical report. You will find all the details on our page Costs & IVF Fund.
You will find an overview of all the common reasons for an unfulfilled wish for a child – from female fertility and the hormone status to male infertility – on our causes page.
Unfortunately, you cannot tell: blocked fallopian tubes cause neither pain nor other symptoms and are not visible on a normal gynaecological ultrasound either. A blockage often only comes to light when pregnancy fails to occur despite a regular cycle. Only a targeted examination such as the HyCoSy brings clarity.
Most gently with the HyCoSy: a fluid that is visible on ultrasound is flushed through the fallopian tubes via a thin catheter – entirely without X-ray radiation. Alternatives are the HSG (X-ray procedure) and laparoscopy as a surgical assessment. You can have a HyCoSy done directly at our institute by appointment.
The HyCoSy is completely painless for most women – some feel a brief, period-like pulling sensation. The examination takes only a few minutes, and you see the result immediately on the ultrasound image.
Both procedures test whether a contrast medium flows unhindered through the fallopian tubes. The HyCoSy uses ultrasound and involves no X-ray radiation, while the classic HSG (hysterosalpingography) works with X-ray images and X-ray contrast medium. In modern fertility work-ups, the HyCoSy is therefore often preferred.
Usually in the first half of the cycle – i.e. after the end of your period and before ovulation. This ensures that there is no early pregnancy. For the examination at our institute, we also need up-to-date vaginal infection swabs.
Yes, that is possible in principle – one open fallopian tube can catch the egg and enable fertilisation. How good the chances are depends on your overall situation and is assessed together with the other findings, such as the hormone status and semen analysis.
Then the natural path is blocked – but not the path to your longed-for child. In IVF, the fallopian tubes are bypassed completely: the eggs are retrieved directly, fertilised in the laboratory and the embryo is transferred into the uterus. Tubal sterility is also a recognised indication of the Austrian IVF Fund, which can cover a substantial part of the costs.
In some cases, adhesions can be released in the course of a laparoscopy – whether this is promising depends on the extent and location of the blockage. If having a child is the priority, IVF is often the more direct path. We discuss openly what makes sense in your situation at a first consultation.
A short, gentle examination is enough to gain clarity about your fallopian tubes – we are at your side along the way.
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