One Tube Wonder: What’s Next When One Tube’s Blocked?

Can you still get pregnant if one fallopian tube is blocked?
In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down what it really means when one of your fallopian tubes isn’t working. From proximal vs. distal blockages to the surprising truth about which ovary ovulates—and how often—it all matters more than you think.

You’ll learn:

• Whether natural pregnancy is still realistic
• The real odds of ovulating on the same side every month
• When IUI works—and when it doesn’t
• Why distal tubal blockages are a red flag
• And how IVF bypasses it all (unless there’s a hydrosalpinx)

Whether you’re trying naturally, considering IUI, or thinking about IVF, this episode will give you the clarity and confidence to take the next step in your fertility journey.

 🎙️ Listen now to find out: Is one tube enough?

#TacoBoutFertilityTuesday #FertilityPodcast #OneTubeWonder #BlockedFallopianTube #TryingToConceive #IVFJourney #IUI #IVFvsIUI #TTCCommunity #OvulationFacts #ReproductiveHealth #Hydrosalpinx #FertilityTips #FertilityDoctor #InfertilityAwareness #FertilityEducation

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Transcript

0:00

Today we talk about what happens when one of your fallopian tubes is blocked. I'DOCTOR Mark Amols, and this is Taco about Fertility Tuesday. So let's start with the basics. Youve got two fallopian tubes. Each one'job is to catch an egg, let the sperm in, and transport the embryo to the uterus. Think of them like airport runways. If one shut down, the other is better to be clear for landing. Right? So if one tube is blocked, it sounds like it's a 5050 kind of deal, right? Well, one works, one doesn't. But it's not always that simple that you could have. See, if you had one tube removed surgically, let's just say, for fun, and let's just say you had one ovary, it happen to be on the same side as a tube that's still there, then your chance of getting pregnant every month would be exactly the same as anyone else. But if you have one tube that's blocked, and we don't know why, and it's not something we can really know why, then your chances of getting pregnant go down considerably. The question is why? Well, before we get into the why, let's talk a little bit about blockages. Because they're not all created equal. First, there is what's called up proximal blockage. That means near the opening of the uterus. Sometimes when you have a proximal blockage, it may actually be due to muscle spasm or mucus, and that's preventing the dye from going through. And that's not a really big deal. But the problem is you don't know which it is because there's no way to know. Now, you can take a small wire and place it through there to see if it can open it up. Sometimes you can just push a little harder on the dye and see if you can push through it and push the mucus plug out. But when you have a proximal blockage, the question is, is it truly blocked or could it just be a muscle spasm? Now, a distal block is a little bit different. That's near the ovary. That could be very concerning because that can come with scarring, adhesions, and even worse, a thing called the hydrosalines. I did a podcast episode on hydrosalines and talks about how those can be harmful. Anytime I see a distal blockage, I'm definitely thinking there's something else going on there. I'm thinking something like maybe an infection happened in the past or there's some type of scarring there from a prior Surgery, that's when I start going through the history to figure out why. Then there's a, what we call a mid tubal blockage. That's where halfway up the tube, it's blocked. That's absolutely a true blockage, because there's no way it can spasm m mid tube. But one of the things that all three of these have in common is this idea of can a tube just block by itself, just having one twoube blocked? Well, yeah, it could happen. But we also have to think about the environment. Both tubes are in the same pelvis and both tubes have the same entryway through the vagina, into the cervix, into the uterus and then to both tubes. And the reason why this is important is because whatever caused the blockage, if it is due to a pathological reason, means that that infection, that cause probably was exposed to the other tube. And that makes sense, right? It's not like on one side of your pelvis you're going to have an infection without the infection being on the other side of the pelvis. That would be very unlikely. It can happen, but it's not always going to happen that way. And so you have to think maybe the other tube is exposed on the same thing. If you had an infection, whether it's chlamydia, gonorrhea, mycoplasm, ureoplasm, and it somehow caused your tube to be blocked, well, that came through the vagina and that means it went into uterus, which means both tubes were exposed. See, the thing is, when you think of a tube being blocked, we think scarring. But we have to keep in mind that even the tube being affected, such as when we talk about ectopic pregnancies, where the lining of the flopian tube is damaged, that could be enough to prevent you from getting pregnant. And so one of the questions we have to ask ourselves is when one tube is blocked, can we just move forward blindly and think that everything is fine, or do we need to think that there might be a bigger problem here? And part of that is clinical decision making. If someone's been trying for 10 years and I can't find anything else and one tube is blocked, yeah, I'm assumeding it's a tubal disease. And I'm going to tell them, don't waste your time to an IUIs, but whether, if it's only been a year that you've been trying, well, technically reasonable, that maybe just didn't get pregnant during that time because if your ovary ovulated on the side that was blocked, Obviously you're not going to get pregnant there. But what's surprising is you can technically pick up the follicle on the other ovary. Now, it's not as good of a chance, but it can t happen. But this may be a mythbuster for you. A lot of people think the ovaries take turns. It's like some type of polite tennis match. Left the then right, then left, then right. But in reality, you can ovulate from the same side, two, three, even 10 months in a row. M and that wouldn't be statistically impossible. Matter of fact, if you look at the odds of ovulating from the same ovary, what you'll find is it's about 1 in 4 chance to do it three months in a row. In one year, it's about 1 in 2000 chance. Now, once you start getting up higher, like three years, it's about 134 billion. And just for fun, what's the chances if you essentially went your whole life in ovula on the same side, and basically the, math kind of gave up the number I've never heard of. It basically came back to show it was like 1.3 with like 100 zeros. Basically, you're more likely to get hit by an asteroid twice. So the point is, yes, you can all feel in the same side, even if your tube is blocked. But usually after a few months, you will ovulate then on the other side. So the question really comes up is if you have a block tube and the other one is open, can you still get pregnant? Absolutely. Now, obviously, it depends if the ovary is ovulating that month on that side. And there are things you can do that sometimes improve that. You can take a med like Letozole or Clomid and make you ovulate on both sides. That way you're able to make sure you get eggs on both sides and it's closer to the tube that is working. And like I said, if you technically ovulate on the side that's blocked, you technically can still get pregnant, but it's not as good and the odds are lower. And so you would rather ovulate on the side. That's good. So are IUIs then worth it? Well, the answer is, if technically it's a proximal block tube, it's very possible it could be spasm. And your chances of getting pregnant are just as good as someone with two working tubes. But when this distal or mid tubal blockage IUI success drops Significantly, sometimes in half. The question is why? Because distal blockage means inflammation, adhesions, that something else was going on. I'm not saying you can't get pregnant. What I'm saying is you're gambling. Now, you can do a laparoscopy. Someone can go in there and look at your tubes and see if maybe it's not as bad as you think. But the end of the day, the chances are going to be lower if you have a blocked distal tube versus if you take someone who has a blocked proximal tube, which could just be spasm. So, as I mentioned earlier, if you've been trying for 10 years and there's nothing else wrong, I'd say jump straight to ivf. But at its very beginning, you have a proximal blockage. There's nothing else wrong. It's not unreasonable to try howuises, and you probably will get pregnant. Now, if you have a proximal blockage, but you have a history of, let's say, a couple episodes of gonorrhea or chlamydia. Well, now I'm starting to think maybe that blockage is real. And then I always wonder, is the other twoub working? In the end, it's still reasonable to try IUIs. No one's going to harm themselves from trying them. But for some people, especially if you're paying this out of pocket, you may not want to waste money there. If your chances are lowering, you might want to jump to something that can bypass the tubes. But insurance covers it. Why not try the IUIs first? It's not a big deal. The question is, does IVF solve it? And the answer is yes. IVF is the great equalizer. Block tubes doesn't care. And that's because we're bypassing the floating tubes. We're taking the eggs straight out of the ovary, we fertilize them, and then we put the embryo into the uterus without using the fallopian tubes. So you would think that's the answer to everything. Well, unfortunately, there's a catch. If your fallopian tube is filled with fluid such as a hydrosalpinks, then the toxic backwash can lower your obvious success rate. Matter fact, reduce it by half. So that is the one time IVF cannot fulfill and you have to go and remove that floin tube, or at least clip it so that toxins cannot go into the uterus. However, if there's no hydrosopings, then your IV'success should be just as good as someone with two open tubes, because you are bypassing the fallopian tubes. Now, I didn't mention it, but if you have both tubes blocked, I think it's pretty obvious you need to do ivf. Not technically. You could do a surgery and see if maybe they can be unblocked. And yes, proximal blockages and distal blockages can theoretically be unblocked in certain situations. Mid tubal cannot. The only way you can fix a mid tubal blockage is you would have to actually cut the tube and re. Anastomosis. Mean bringing them together and time them together to get them to work again. That's basically like doing a tubal anastomosis when someone gets their tubes untied. Technically, but this's the only option. To do IOI or IVF when you have one block tube. No, but you should ask why. And if there's something else behind it. Infections, endometriosis, prior surgeries, you probably have an answer. But what if you don't? Well, then you can do a laparoscopy, and that way you can go looking at the tubes and see if there's something else going on. If everything looks clean, then you can say, listen, I want to try doing IUIs first. And that's very reasonable. But if you don't do a laparoscopy, don't assume just because you have one good tube that is perfect because that tube is in the same neighborhood as the other tube, and that neighborhood has a bad crime rate, then there's a good chance the other two might have that risk, too. So let's wrap this all up. If you got one block tube and it's proximal, well, then you can try IUI totally fair. Now, like I said, it's been 10 years. there's nothing else wrong. You might want to look into it further. If you've got one block tube and it's a distal blockage or a mid tubal blockage, discuss surgery or moving straight to ivf. The chances are it's not muscle spasm, because that can happen there, and there's actually some disease state that caused it. When it comes to a hydrosaline, again, a distal blockage, well, at that point, you got to remove that tube before doing the embryo transfer. You can technically do IVF and create the embryos, but before doing the transfer, you need to make sure that you fix the hydrosopings by removing the tube or clipping it. Now, what about just natural pregnancy? Whether if you have, a block proximal T. Well, yeah, you could possibly get pregnant, but it's just going to take a little longer because as we talked about, you could theoretically ovulate on the same side for several months. But as we talked about, it's impossible to pretty much ovulate your whole life on one side. Now, if you listened to my podcast before about being over 40, then you know probably not to waste any time with IUI and jump straight to IVF because one you have the tube questionable part and number two, because being over age 40 we know that wasting time doing IUOS at that point is going to hurt you more than help you. The point is one block tube is at the end of the world. But it's clue. The key is knowing what kind of block you have and also knowing what type of patient you are, what's your history. That way the next step will make sense. This is why you involve a reproductive doctor who can help you make these choices. Sometimes you push forward, sometimes you pivot, and sometimes you get a little help from science and your favorite fertility podcast. Thanks again for joining me on Talk About Fertility Tuesday. And remember, whether you got one tube, two tubes, or no clue, we're here to help you make sense of it all. If you love us and like this episode, give us a five star review on your favorite medium and tell your friends about us. But most of all, stay informed and keep taco abouting it. Okay, that was corny. I look forward to talkgging in next week on Talk About Fertility Tuesday.