Question:

I am 39 years old, and was just diagnosed with blocked fallopian tubes. Is my only option to have children through IVF due to my age? Can I have the tubes unblocked and then have artificial insemination since that's cheaper?

Answer:

A blockage of the fallopian tubes is one of the most common causes of infertility. It accounts for about one third of cases in women. However, determining the best way to treat it is a complex problem without a single, clear answer.

The blockage may have come from scar tissue caused by a pelvic infection, endometriosis, or pelvic surgery.

A blockage can occur at various locations:

• At the end of the tube, near where it's connected to the uterus (proximal)

• At the end of the tube, near the ovary (distal)

• The entire tube (in severe cases)

The advantage of surgically unblocking the tubes is that if successful, the couple can proceed with all future attempts at pregnancy without medical intervention.

If in vitro fertilization (IVF) is used, medical procedures are required every cycle to retrieve the egg and implant the embryo.

Both procedures allow infertile couples the chance to conceive. However, no studies adequately compare the treatments because there are so many factors to consider. For example, the location of the blockage, the severity of blockage, the presence of other factors affecting the couple's fertility, the technique used for surgery, and maternal age.

You should consult a fertility expert to assess your situation. In general, most infertility experts recommend surgery to unblock tubes over IVF in younger women who have tubal blockage at the distal end of the tube and in whom tubal damage is less severe.

— Joan Bengtson, M.D.
Assistant professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
Department of Obstetrics, Gynecology and Reproduction, Brigham and Women's Hospital