Fallopian tubes can block when adhesions (internal scars) form after the body undergoes a healing event due to surgery, infection, endometriosis or repeat trauma. Women who have undergone surgery or had an infection, such as PID (pelvic inflammatory disease) or chlamydia, are at an increased risk of developing adhesions that can block their fallopian tubes.
Endometriosis, which is frequently accompanied by adhesions, is another major cause of tubal occlusion (blockage). Repeat traumatic events resulting from physical or sexual abuse, accidents and falls, or athletic injuries can also cause blockage at one or both tubes. Other causes include vaginal and yeast infection, and sexually transmitted diseases.
If only one tube is blocked, the patient may still have the opportunity for a natural pregnancy, but the chances are diminished by 50%. If both of the fallopian tubes are blocked, a woman’s only option becomes in vitro fertilization (IVF). Because most women prefer to have a natural conception, they consider treatments to open the tubes.
There are currently two scientifically researched methods to open blocked fallopian tubes: surgery and the Clear Passage Approach®. This page compares these two approaches for treating blocked fallopian tubes.
Description of common procedures. Depending on the location of the blockage, your doctor may suggest that s/he attempt to open your blocked tube(s) surgically. Success rates vary by location of the blockage. Unfortunately, even when the surgery goes well, the body responds by laying down adhesions – which are a major reason that tubes get blocked in the first place.
Proximal blockage: If the tube is blocked at the beginning (by the uterus), the doctor may be able to perform minimally invasive techniques such as a transcervical balloon tuboplasty. In this procedure, a tiny balloon catheter is inserted into the tube in order to open it.
These are generally the simplest, least invasive, and most successful surgical procedures doctors can perform on blocked tubes. In the largest study available for these procedures (151 women), the procedure opened tubes in 90% of the women and 35% had post-surgical pregnancies. However, only 19% of the opened tubes remained open six months after surgery; 81% closed again, presumably due to post-surgical adhesions. (Gleicher et al., 1993)
Mid-tubal or distal blockage: When a fallopian tube is blocked further beyond the uterus than the entry, the challenge to surgically open the tube becomes significantly greater. Unable to be reached via a simple “cleaning out” of the tube accessed through the uterus, physicians are forced to perform a more invasive procedure to open the tube.
The challenge is to cut into and repair a tiny structure designed to carry a single cell – the woman’s egg or the man’s sperm. While an accomplished surgeon can often perform the surgery, the tube must then recover by laying down scar tissue to help mend the surgical repair.
One of the few studies we could find on opening distal occlusion by surgery cited a 40% rate for opening distally blocked tubes, but only a 9.8% intrauterine pregnancy rate after the surgery. Thus, many physicians recommend avoiding this surgery and going directly to in vitro fertilization (IVF). Some doctors recommend removing the tube before IVF. In this case, IVF becomes the only option for a woman to become pregnant.
Hydrosalpinx: In some cases, a fallopian tube will be swollen, filled with a liquid that may be toxic to an implanted embryo. This condition is called hydrosalpinx. In most of these cases, the tube is partly or totally blocked at the distal end, near the ovary. The fimbriae (the delicate finger-like structures designed to retrieve the egg from the ovary) are often adhered together or ‘clubbed.’ Many doctors feel that this tube will never work again, so they suggest removing it and going directly to IVF.
Laparoscopic surgery. Most tubal surgeries begin as laparoscopies. In this surgery, the physician puts the patient under general anesthesia, then cuts several holes (ports) in the lower abdomen and pelvis. One port is used to fill the cavity with a gas to help separate the organs so the surgeon can create a space in which to insert their surgical instruments and access the reproductive organs. Using the other ports, the doctor will insert a light, generally a camera, and the surgical instrument(s) with which they can cut or burn adhesions that they see, open and repair the blocked tube. You can observe a laparoscopy to clear fallopian tubes by clicking here.
If adhesions are extensive, the physician may perform or convert to an open surgery called a laparotomy. In that surgery, the body is cut open with a scalpel and the sides generally separated with a metal retractor. Next, the physician enters with a scalpel, laser or other surgical instrument to cut or burn any adhesions s/he may find, then attempt to open and repair the blocked tube(s). S/he will repair or cauterize any bleeding that occurs, and will generally check the area for other problems before exiting the body and sending the patient to a room where staff can monitor their recovery.
Direct visualization. The surgeon can directly see the tube, open and repair it, and insert a dye to check that the tube has been opened.
Observe nearby areas. In addition to treating the tube, the physician can work to decrease adhesions, and can visualize and assess the condition of nearby structures, noting any additional areas that may be of a concern.
Operative report. The doctor will dictate a report that describes what s/he observes and the procedures s/he performs during the surgery.
Data on success rates is available. As noted above and in the medical literature, published data showing expected success rates for opening the tube, post-surgical pregnancy rates, and long term re-occlusion rates is readily available.
Anesthesia complications. Recent studies note concerns about neurotoxic effects on the brain and other body tissues for patients who undergo one or
more sessions of general anesthesia. (Perousanksy & Hemmings, 2009)
Inadvertent enterotomy. When a patient has significant adhesions, it can be difficult for the doctor to see the structures beneath them. Thus, a surgeon can unintentionally cut into a nearby healthy organ or other structure – called an inadvertent enterotomy (IE). An IE can cause serious problems or death. In a study from the Journal of the Society of Laparoscopic Surgeons, authors note that:
- “IE in laparoscopic abdominal surgery is underreported.”
- “Death from IE is not uncommon.”
- “IE was the most common laparoscopic complication at our hospital.” (Binenbaum & Goldfarb, 2006)
Hospitalization during recovery. Most patients must undergo a hospital stay after laparoscopy or laparotomy. Patients are monitored to ensure their recovery and that there are no immediate post-surgical complications or infections.
New adhesions generally form after surgery. A multi-decade study shows that 55% to 100% of women develop adhesions after pelvic surgery. (Liakakos et al., 2001) Thus, new pelvic adhesions form in over half of surgical cases.
Description of the procedure. The Clear Passage Approach is a manual physical therapy; it uses no drugs or surgery. It has been cited in numerous studies and peer-reviewed medical journals for its ability to decrease adhesions. The studies show effectiveness with certain conditions using large groups of participants and via ‘before and after’ reports submitted by independent diagnostic physicians. For its ability to decrease adhesions, a major cause of tubal occlusion.
In a large published study (235 women), the therapy opened blocked tubes in 61% of women with total bilateral occlusion (both tubes totally blocked before therapy). Rates were 69% in women who had not previously undergone tubal surgery, but only 35% in those who had, presumably due to to the unavoidable damage caused to the fallopian tube. (Rice et al,, 2015a)
Post-therapy pregnancy rates were 57% — compared to the 35% pregnancy rate after surgery in the study noted above. No long term follow-up of occlusion was performed, but several of the participants had additional pregnancies/births with no further therapy.
The therapy is ‘all natural’ in that it is 100 percent ‘hands-on.’ Patients describe it as feeling like a very deep massage. The therapy can sometimes be much lighter, depending on the area and depth being treated. Physical therapists use their hands to deform and detach the tiny strands that comprise adhesions – similar to pulling out the strands of a nylon rope or pulling out the run in a sweater. They describe it as “pulling out salt-water taffy, in very slow motion.”
The therapy is site-specific; the therapists are experts at palpating and manipulating the soft tissues of the body – where adhesions generally form. They use data from the patient’s history, direct feedback from the patient during therapy, and a thorough training and understanding of methods developed over 30 years to deform and detach the molecular/chemical bonds that are at the core of adhesions. The usual protocol, which is cited in the studies, consists of 20 hours of therapy, spaced over five or more days. You can view a short video of a Clear Passage therapy session by clicking on the image below.
No hospitalization. Therapy is performed in a private treatment room, one-on-one with a highly skilled therapist certified in the work. Patients are invited to bring a partner or family member along for company, if they like.
Tubes are not removed; they remain in the body. When the reproductive structures remain intact, intrauterine pregnancy can occur – either naturally or via IVF.
Data on success rates is available. As noted above, published data showing expected success rates for opening tubes and post-therapy pregnancy rates are available.
No anesthesia. The patient is awake and communicative during the procedure. Patient involvement is encouraged, with the patient invited to give feedback throughout the course of therapy.
Decreased risk. Risk is minimal. There is no cutting or burning, no risk from anesthesia, and no risk of inadvertently cutting through a nearby organ or other structure.
No foreign bodies are introduced. No staples, stitches, films or meshes are inserted into the body. No cameras, gas, lights or surgical instruments enter the body.
Side effects are mild and transient. The most common side effects reported with therapy are temporary tenderness, fatigue, aching, hip or back pain. When they occur, these symptoms pass within a few days.
Improvements in other areas of the body. Because therapy focuses on detaching adhesions throughout the body, patients regularly report significant increases in flexibility and range of motion after therapy. Many report decreased pain and/or increased function in areas near the site where they are being treated. Some report this in areas they had forgotten or had not realized they were having a problem with, until therapy relieved the pain or tightness.
Therapists cannot see the tubes during therapy. Because we do not open the body, we cannot see the tubes. We deduce the presence of adhesions and tubal occlusion by conducting a thorough review of your history, diagnostic tests and any symptoms you have experienced. To gain further insights, we may require diagnostic tests or documentation from your physician.
During therapy, we palpate the areas of your body related to your history of healing events, goals and symptoms (if any). We also note any other areas where we note tightness or increased temperature. Because our therapists have been doing this work for an average of over 25 years each, they are experts at palpating the body.
Costs of therapy are generally a fraction of the cost of surgery; as with surgery, insurance reimbursement may vary based upon your insurer and your plan. Clear Passage is an out-of-network provider for your insurer.
Travel and time are a consideration. Therapy generally takes five days (e.g., Monday – Friday); it is only provided by certified therapists in several cities in the U.S. and U.K. The 5-day program is designed for out-of-town and out-of-country patients.
Both surgery and therapy require that patients be screened for appropriateness and contraindications before treatment.
Screening before surgery. Before surgery, physicians consult patients to review the goals, risks and potential rewards they can expect from the procedure. They may order diagnostic tests to help rule out contraindications such as active infection and to help identify problem areas of the body for that should be assessed during surgery.
Screening before therapy. Before therapy, Clear Passage directors consult applicants to review goals, risks and potential benefits they can expect. As well as viewing any available radiographic films of the tubes, we conduct a thorough review of the applicant’s history of healing events (prior surgery, trauma, infection, endometriosis, etc.) to determine if and where adhesions have likely formed and how they might be causing problems.
We screen applicants for two reasons:
- to determine the likelihood that we can help an applicant reach her goal, and
- to rule out contraindications that could decrease effectiveness of therapy or cause problems.
To these ends, we may require additional tests or correspondence with your physician before we will accept you for therapy.