Can Fallopian Tubes Be Repaired?

As readers of this blog are aware…my family is not really sure that I am a “real” doctor since I am not a general surgeon. As IVF success rates have climbed, the number of reproductive surgeries perfomed has plummeted. When I was a Duke medical student I still remember the REs scheduled 5-10 laparoscopies every day that they were in the operating room! My how times have changed. The problem with most surgeries aimed to improve fertility is that they often don’t help very much. In addition, since infertility is a couple’s disease and half the problems are with the men, fixing tubes or zapping endometriosis doesn’t help much if his “swimmers” are more like “floaters.”

So here is today’s Question of the Day from 100 Questions and Answers about Infertility.


27. Can fallopian tubes be repaired?

Prior to the advent of IVF, surgical repair of damaged fallopian tubes was considered standard medical care. Unfortunately, most patients did not become pregnant following this procedure, and 10% to 20% experienced tubal (ectopic) pregnancies. Today, IVF has replaced reparative tubal surgery for most patients with damaged fallopian tubes for two reasons: (1) IVF is a nonsurgical treatment and (2) it results in excellent pregnancy rates, especially for patients with tubal disease.

Some patients ask, “Why is it so difficult to repair damaged tubes?” Unfortunately, the problems that cause tubal disease, such as pelvic infections, usually damage the tubal fimbria—that is, the delicate finger-like projections at the end of the tube that are responsible for capturing the egg when it is released from the ovary. Pelvic infections may also damage the tubal muscle and inner mucosa, leaving behind a scarred, nonfunctional organ that is not amenable to surgical repair. In general, most patients with tubal disease are best treated using IVF. Tubal reparative surgery is usually not effective and, in fact, it may increase the woman’s risk for having an ectopic or tubal pregnancy. If a couple is not interested in IVF or if they are not deemed to be good candidates for IVF, then tubal surgery may be the only option available to them in terms of fertility treatment.