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Severe one-sided pelvic pain with a missed period is an emergency. Go to hospital now. This may be an ectopic pregnancy, which is life-threatening. Damaged tubes considerably increase that risk.

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Blocked fallopian tubes

The tubes carry the egg from the ovary and are where fertilisation happens. When they are blocked or damaged, sperm and egg cannot meet — and IVF exists precisely to bypass them.

Two things matter disproportionately for our patients. Genital tuberculosis is a leading cause of tubal damage across South Asia and much of the Middle East and Africa. And a fluid-filled damaged tube substantially reduces IVF success unless it is dealt with first.

Clinically reviewed by Dr. Annie Varughese, Consultant in Reproductive Medicine Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Major cause in our markets
Genital tuberculosis
Frequently silent until infertility appears
Hydrosalpinx
Must be treated first
It roughly halves IVF success if left
Main treatment
IVF
It bypasses the tubes entirely
Higher risk of
Ectopic pregnancy
Damaged tubes raise it considerably
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What tubal infertility is

The fallopian tubes are not simple pipes. Their inner lining is covered with fine hairs that sweep the egg towards the uterus, and fertilisation normally happens within the tube. Damage can block them completely or leave them open but non-functional, and a tube that looks patent on a dye test may still not work.

Pelvic infection is the commonest cause worldwide — chlamydia and gonorrhoea in particular, frequently without any symptoms at the time. Previous pelvic surgery, appendicitis with peritonitis, endometriosis and previous ectopic pregnancy all contribute.

Genital tuberculosis deserves particular emphasis because it is common across South Asia, the Middle East and Africa and rare in Europe, which means it is under-considered by protocols written elsewhere. It damages the tubes and often the endometrium too, silently, and may present only as infertility years later. It requires anti-tuberculous treatment, and where the endometrium is severely damaged the outlook for implantation is genuinely poor — which must be discussed honestly.

A hydrosalpinx is a tube blocked at its outer end and distended with fluid. That fluid can leak back into the uterus and is toxic to embryos. Its presence reduces IVF success substantially, and removing or clipping the tube before treatment restores the success rate.

Symptoms

Symptoms and warning signs

Common features
  • Often no symptoms at all — found only during infertility investigation
  • Difficulty conceiving
  • Pelvic pain, sometimes cyclical
  • A history of pelvic infection or sexually transmitted infection
  • Previous ectopic pregnancy
  • Painful periods or pain during intercourse
  • In genital tuberculosis, sometimes very light or absent periods
Warning signs of an emergency
  • Severe one-sided pelvic pain with a missed period
  • Fainting or collapse with pelvic pain
  • Fever with pelvic pain and discharge
  • Heavy vaginal bleeding with pain
  • Shoulder tip pain with abdominal pain
  • Positive pregnancy test with severe pain

A hydrosalpinx must be dealt with before IVF, not after

A tube blocked at its far end fills with fluid, and that fluid can drain back into the uterine cavity where it is toxic to embryos and interferes with implantation. The evidence is clear that IVF success is substantially reduced — roughly halved in some series — when a hydrosalpinx is left in place, and that removing or clipping the tube beforehand restores it. This is a straightforward laparoscopic procedure. If a hydrosalpinx has been seen on your ultrasound or dye test and IVF has been proposed without addressing it, that is a question to raise before you pay for a cycle.

Diagnosis

How it is diagnosed

A dye test shows whether the tubes are open; laparoscopy shows their condition.

Initial tests

  • Hysterosalpingogram — an X-ray with dye showing whether the tubes are open and the shape of the uterine cavity
  • Hysterosalpingo-contrast sonography — an ultrasound-based alternative avoiding X-rays
  • Pelvic ultrasound — may show a hydrosalpinx as a fluid-filled tubular structure
  • Chlamydia testing — past infection is the commonest identifiable cause

The deciding tests

  • Laparoscopy with dye test — the reference standard, showing adhesions, endometriosis and the actual condition of the tubes
  • Endometrial biopsy with TB PCR and culture — where genital tuberculosis is suspected, which in our patient group is often
  • Hysteroscopy — assesses the uterine cavity, frequently affected in genital tuberculosis
  • Chest X-ray and tuberculin testing — supporting evidence for tuberculosis elsewhere

Ask specifically about tuberculosis if you are from an endemic region

Genital tuberculosis is a leading cause of tubal infertility across our markets and is frequently not tested for, because protocols written in Europe do not prioritise it. If you have blocked tubes, very light or absent periods, or a thin endometrium, ask specifically for endometrial sampling with TB PCR and culture. Send the hysterosalpingogram report and images, any laparoscopy findings, your pelvic ultrasound and any tuberculosis testing already done.

Options

Treatment options

IVF bypasses the tubes entirely, which is why it is usually the answer.

First, if relevant

Treating genital tuberculosis

A full course of anti-tuberculous therapy over six months or more, before any fertility treatment. Treating active infection is essential, though it does not reverse tubal damage already done. Where the endometrium is severely scarred, the outlook for implantation is poor and this needs saying honestly rather than discovering after several failed cycles.

Usually appropriate whenConfirmed or strongly suspected genital tuberculosis. This comes before anything else.
Before IVF

Removing or clipping a hydrosalpinx

Laparoscopic removal of the damaged tube, or clipping it to stop fluid draining into the uterus. It is a straightforward procedure and it substantially improves IVF success. It does not reduce ovarian function when done properly, and the tube in question was not going to work anyway.

Usually appropriate whenA hydrosalpinx visible on ultrasound or dye test, before starting IVF.
Main treatment

IVF

Eggs are collected directly from the ovaries and fertilised in the laboratory, so the tubes are bypassed completely. This is why IVF was originally developed, and tubal factor infertility remains the indication where it works most predictably.

Usually appropriate whenBlocked or damaged tubes, once any hydrosalpinx and any tuberculosis have been dealt with.
Selected cases

Tubal surgery

Reconstructive surgery to open a blocked tube or divide adhesions has a limited role now. It may be worth considering in a young woman with a single, mild, distal blockage and no other factors, particularly where IVF is unaffordable. Success is modest and the risk of ectopic pregnancy afterwards is raised.

Usually appropriate whenYoung women with limited, mild damage, or where IVF is not accessible.
The decision

How the choice is made

Has tuberculosis been excluded

In our patient group this is not a theoretical question. Endometrial TB PCR and culture where there is any suspicion.

Is there a hydrosalpinx

If so, deal with it before IVF rather than after a failed cycle.

Extent of damage and your age

Mild damage in a young woman may justify surgery. Extensive damage means IVF, and delaying it costs egg quality.

If you are from a region where tuberculosis is endemic and have blocked tubes with light periods, we will want that excluded before any IVF cycle is planned.

Urgency

How urgent is your case

Usually safe to plan travel
  • Tubal blockage confirmed, no acute symptoms
  • Hydrosalpinx identified, planning surgery first
  • Tuberculosis treated and completed
  • Investigations complete, planning IVF
Needs local assessment before travel
  • Severe one-sided pain with a missed period
  • Fever with pelvic pain and discharge
  • Positive pregnancy test with severe pain
  • Heavy bleeding with pain
  • Active untreated pelvic infection

We will tell you which column you are in

Ectopic pregnancy is a genuine risk with damaged tubes and is life-threatening. Any severe one-sided pain with a positive or possible pregnancy needs immediate local assessment.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Hysterosalpingogram report and images
  • Pelvic ultrasound report
  • Laparoscopy findings if performed
  • Any tuberculosis testing — endometrial PCR, culture, chest X-ray

Also helpful

  • History of pelvic infection or sexually transmitted infection
  • Details of any previous ectopic pregnancy or pelvic surgery
  • Your cycle pattern, particularly if periods are very light
  • Your partner's semen analysis
Send my reports for review See published cost ranges
Questions

Questions patients ask

Sometimes, but the results are modest and the role of tubal surgery has narrowed considerably. Reconstructive surgery may be worth considering in a young woman with limited distal damage and no other factors. For most women IVF is more effective, because it bypasses the tubes entirely rather than trying to repair them.

A tube blocked at its outer end and distended with fluid. That fluid can drain back into the uterus where it is toxic to embryos, and its presence substantially reduces IVF success. Removing or clipping the tube laparoscopically before IVF restores the success rate, and this should be done before a cycle rather than after one fails.

It is a leading cause of tubal infertility across South Asia, the Middle East and Africa, and it is frequently missed because protocols written in Europe do not look for it. It is often silent, presenting only as infertility years later. If you have blocked tubes and light or absent periods, ask specifically for endometrial sampling with TB PCR and culture.

Yes, considerably, if the tubes are damaged but not completely blocked. Even after IVF the risk is somewhat raised. This is why any severe one-sided pelvic pain with a missed period or positive test must be treated as an emergency, and why early scanning is arranged once pregnancy is confirmed.

Not when performed properly. The tube is removed close to itself rather than disturbing the ovarian blood supply, and studies show ovarian reserve is preserved. Clipping the tube instead of removing it is an alternative where surgery would be difficult. The tube being removed was not going to function anyway.

A hysterosalpingogram tells you whether the tubes are open and shows the uterine cavity, and for many women that is sufficient to plan treatment. Laparoscopy shows the actual condition of the tubes and pelvis, and detects endometriosis and adhesions the dye test misses. It is worth considering where the picture is unclear or where surgery might be indicated.

RelatedOn this site
Fertility and IVF in IndiaRead → EndometriosisRead → Unexplained infertilityRead → Brain and spinal tuberculosisRead → IVF cost in IndiaRead →
Contact

Send us your reports

Send the hysterosalpingogram report and any laparoscopy findings. If you are from a region where tuberculosis is common and your periods are light, tell us — we will want that excluded.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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