Endometriosis and Blocked Fallopian Tubes: Causes, Treatments

If you’ve been told you have endometriosis and a blocked fallopian tube (or two), it can feel like your body just launched a surprise “escape room”
challengeexcept you didn’t sign up, and the clues are written in medical jargon.
The good news: there are multiple ways to diagnose what’s going on, reduce symptoms, andif pregnancy is a goalimprove your chances with the right plan.

This guide breaks down how endometriosis can contribute to blocked fallopian tubes, what testing actually shows (and what it doesn’t),
and the real-world treatment paths doctors commonly use. You’ll also find practical examples, decision points, and a patient-experience section at the end
to make all of this feel less like a textbook and more like something you can use.

First, a Quick “Tube Map”: What the Fallopian Tubes Do (and What “Blocked” Means)

Fallopian tubes are narrow passageways that help move an egg from an ovary toward the uterus. Fertilization typically happens in the tube,
and then the embryo travels into the uterus. When a tube is blocked, that pathway is partly or fully obstructedso sperm may not reach the egg,
the egg may not be picked up properly, or a fertilized egg may struggle to move into the uterus.

Common ways a tube gets blocked

• Scar tissue (adhesions) around the tube or ovary that kinks or “tethers” normal movement
• Damage inside the tube (like scarring of the lining) that affects transport
• Hydrosalpinx (a fluid-filled, swollen tube) often linked to prior inflammation
• Post-surgical scarring after pelvic procedures
• Prior infection (like pelvic inflammatory disease), which can also overlap with endometriosis

Important detail: sometimes the tube isn’t “plugged” like a clogged straw. It can be more like a garden hose that’s bent, squeezed,
or stuck to the groundwater might pass sometimes, but function still isn’t great.

How Endometriosis Can Lead to Blocked Fallopian Tubes

Endometriosis happens when tissue similar to the uterine lining grows outside the uterus. That tissue can trigger inflammation, irritation,
and scarring over time. When it involves the pelvic areaespecially near the ovaries and tubesit can change anatomy and interfere with tubal function.

1) Inflammation that invites scar tissue and adhesions

Inflammation is the “spark.” Adhesions are the “glue.” Endometriosis can cause the body to form bands of scar tissue that make pelvic organs stick
to each other. Adhesions can wrap around a tube, pull it out of alignment, or trap an ovary so the egg can’t be picked up efficiently.

2) Distorted pelvic anatomy (the tube and ovary lose their teamwork)

A healthy tube doesn’t just sit there; it has to move and coordinate with the ovary. With moderate to severe endometriosis, adhesions can disrupt that
relationshipso even if a tube looks “open,” it may not work well.

3) Ovarian endometriomas and nearby scarring

Endometriomas (“chocolate cysts”) are ovarian cysts associated with endometriosis. They can come with surrounding inflammation and scarring that affects
nearby tubes. Treatment can help, but surgery itself may also carry a risk of additional adhesionsso the approach is individualized.

4) Endometriosis on or near the tube

Endometriosis lesions can involve areas close to the fallopian tube, contributing to adhesions and impaired function. Even without a dramatic blockage,
subtle changes can affect egg pickup and transport.

5) Hydrosalpinx (a special “tube problem” that changes fertility planning)

Hydrosalpinx is when the tube becomes swollen and fluid-filled, usually after inflammation. The fluid can be hostile to embryos and is often treated differently,
especially if IVF is planned. In many fertility practices, addressing a hydrosalpinx before IVF is considered a major step to improve outcomes.

Signs and Symptoms: When Endometriosis and Tubal Blockage Show Up

Endometriosis symptoms vary widelysome people have severe pain, others have almost none. Sometimes infertility is the first sign that something is off.
That unpredictability is annoying, but it’s also a clue: symptoms alone don’t tell the whole story.

Common symptoms of endometriosis

• Pelvic pain (often worse around periods)
• Heavy or prolonged periods, or spotting between periods
• Pain during sex
• Pain with bowel movements or urination (especially around menstruation)
• Fatigue and bloating (“endo belly”)
• Trouble getting pregnant

A blocked tube by itself doesn’t always cause symptoms. Many people only discover tubal factor infertility after testing.
If there’s hydrosalpinx, some people have pelvic discomfort or unusual discharge, but many don’t.

Diagnosis: How Doctors Check for Blocked Tubes and Endometriosis

Diagnosis is usually a combination of symptoms, history, imaging, and targeted fertility testing. The best test depends on your goals
(pain relief, pregnancy, both) and the urgency of a fertility timeline.

Hysterosalpingography (HSG): the classic “are the tubes open?” test

An HSG is an X-ray procedure where contrast dye is placed through the cervix into the uterus to see if it flows through the tubes.
It can show whether a tube is open, partly blocked, or fully blocked. It also provides information about the shape of the uterine cavity.

• Pros: widely available, relatively quick, useful first-line test for tubal patency
• Limitations: it may not fully explain why a tube is blocked or how well it functions
• Real-world note: sometimes spasm can mimic blockage, and your clinician may interpret results in context

Ultrasound and MRI: helpful, but not a full “tube verdict”

Pelvic ultrasound can detect ovarian cysts (including endometriomas) and sometimes hydrosalpinx. MRI may help map deep disease in some cases.
But imaging can miss endometriosis lesions and can’t always show functional tubal issues.

Laparoscopy (often with chromopertubation): the “look and test” approach

Laparoscopy is minimally invasive surgery that allows direct visualization and possible treatment of endometriosis. During laparoscopy,
some surgeons perform chromopertubationdye is introduced through the uterus while the surgeon watches whether it spills from the tube ends,
providing a direct assessment of tubal patency.

Example: what testing can look like

Scenario A: An HSG shows the right tube is open and the left tube doesn’t spill. Ultrasound suggests a possible endometrioma on the left ovary.
A fertility specialist might recommend laparoscopy if pain is significant or if clarifying anatomy could change the plan.

Scenario B: HSG suggests both tubes are blocked and ultrasound shows hydrosalpinx. In this case, the conversation often shifts toward IVF planning
and whether tube surgery (like salpingectomy or proximal occlusion) is recommended first.

Treatment Goals: Pain Relief vs Fertility (and How Plans Change)

Treatment for endometriosis and blocked tubes is not one-size-fits-all. The big fork in the road is whether pregnancy is a current goal.
Many medications that help endometriosis pain work by suppressing ovulationgreat for symptoms, not helpful if you’re actively trying to conceive.

If your priority is symptom control (not trying to conceive right now)

• NSAIDs (like ibuprofen/naproxen) can help pain for some people
• Hormonal therapy (combined hormonal contraceptives, progestin-only options) can reduce bleeding and pain
• GnRH analogs/antagonists may be used in selected cases under medical supervision
• Pelvic floor physical therapy may help if muscle spasm and chronic pelvic pain overlap
• Surgery may be considered if symptoms are severe or persistent

If your priority is pregnancy (now or soon)

Fertility-focused treatment depends on age, ovarian reserve, severity of endometriosis, semen analysis, and the location/type of tubal blockage.
Many clinicians try to avoid long stretches of ovulation-suppressing therapy when time matters.

Surgical Options: Treating Endometriosis and Addressing Tubal Disease

Surgery can serve two purposes: (1) reduce pain by treating endometriosis lesions and adhesions, and (2) improve fertility by restoring anatomy
or addressing tubal disease that interferes with conception.

Laparoscopic treatment of endometriosis

Surgeons may excise (cut out) or ablate (destroy) lesions and remove adhesions (adhesiolysis). For fertility, the goal is often to restore normal
pelvic anatomy so the ovary and tube can work together again.

A key reality: adhesions can recur. That’s not a failureit’s part of why timing and follow-up plans matter, especially when fertility is the goal.

Tubal surgery (reparative options)

If the tube is blocked, surgeons may consider procedures aimed at restoring patency or function (depending on the blockage site and severity).
Options can include repairing distal tubal disease (near the fimbriae) or addressing scar tissue that prevents normal movement.
Not all blockages are good candidates for repair.

Hydrosalpinx before IVF: why “fixing the tube” sometimes means removing or occluding it

If a hydrosalpinx is present, many fertility guidelines support treating it before IVF because the fluid can reduce implantation rates.
Common strategies include salpingectomy (removing the affected tube) or proximal tubal occlusion
(blocking it near the uterus) to prevent the fluid from reaching the uterine cavity.

Fertility Treatment Paths: From Trying Naturally to IVF

1) If one tube is open (or partly functional)

If at least one tube is patent and other factors look favorable, a clinician may recommend a period of trying naturally (timed intercourse),
sometimes with ovulation tracking or medications, depending on the overall picture.
In some situations, intrauterine insemination (IUI) may be discussedespecially if mild male factor issues exist.

2) If both tubes are blocked (or function is severely impaired)

When both tubes are blocked, IVF is often the most direct path to pregnancy because it bypasses the tubes.
The question becomes whether surgery is still useful before IVFfor example, treating hydrosalpinx or reducing severe disease that affects outcomes.

3) If endometriosis is moderate to severe

In moderate to severe endometriosis, pelvic anatomy can be significantly distorted. Some people benefit from surgery first,
while others may be advised to proceed directly to IVF depending on age and fertility timeline.
A reproductive endocrinologist often helps weigh the trade-offs.

Decision factors clinicians commonly use

• Age and time-to-pregnancy urgency (fertility generally declines with age)
• Ovarian reserve testing (blood tests and ultrasound follicles)
• Location of the tubal blockage (proximal vs distal; hydrosalpinx vs mild narrowing)
• Severity of endometriosis and presence of endometriomas
• Male factor fertility (semen analysis)
• Prior surgeries and risk of adhesion recurrence

What You Can Do Now: Practical Steps That Actually Help

Track patterns (without letting the spreadsheet become your personality)

A short symptom diarypain timing, bleeding, bowel/bladder symptoms, and cycle lengthcan help your clinician spot endometriosis patterns
and plan testing efficiently.

Know when to ask for a fertility-focused evaluation

If pregnancy is a goal and it’s taking longer than expectedor you already know you have endometriosisasking about tubal evaluation (often starting with HSG)
can be a reasonable step. If a tube issue is found, earlier guidance can save months of guesswork.

Ask smart questions at appointments

• Is my blockage likely inside the tube, or from adhesions around it?
• Do you suspect hydrosalpinx? If yes, how does that change the plan?
• If surgery is recommended, what is the goal: pain relief, fertility improvement, or both?
• What is the “Plan B” if pregnancy doesn’t happen after surgery?
• Would IVF be more effective than tubal repair in my situation?

Bottom Line

Endometriosis can contribute to blocked fallopian tubes through inflammation, adhesions, and changes in pelvic anatomy. The right treatment depends on your goals:
symptom control, pregnancy, or both. For diagnosis, tests like HSG evaluate tubal patency, while laparoscopy can confirm and treat endometriosis.
For fertility, options range from trying naturally (when at least one tube works) to IVF (especially with bilateral blockage).
If hydrosalpinx is present, addressing it before IVF is often recommended to improve success rates.

Most importantly: you don’t need a “perfect” plan on day one. You need a clear next step, a timeline, and a clinician who can connect the dots
between pain, anatomy, and fertility goals.

Experiences People Commonly Report (and What They Often Wish They’d Known Earlier)

The medical facts matter, but so does the lived realitybecause endometriosis plus tubal issues can affect daily life, relationships, confidence,
and how you move through the healthcare system. The experiences below are common themes patients report (not one person’s story),
shared to help you feel less alone and more prepared for what the process can look like.

1) “I thought my pain was normal… until the fertility tests.”

Many people describe years of painful periods, bloating, or pelvic discomfort that they were told was “just cramps.”
Some only learn endometriosis might be involved after trying to get pregnant and getting an HSG result that shows a blocked tube.
That moment can feel validating (“So I wasn’t being dramatic!”) and frustrating (“Why didn’t anyone connect this sooner?”).
If you’re in that spot, it can help to bring a simple timeline to your appointment: when symptoms started, what makes them worse,
and what you’ve tried.

2) The HSG experience is usually “doable,” but emotions can hit harder than the cramps

People often say the HSG itself was uncomfortable but briefmore like intense period cramps than lasting pain.
The bigger challenge is sometimes the result. Hearing “blocked” can trigger immediate catastrophizing:
“Does this mean I’ll never get pregnant?” In many cases, it means the pathway needs help, not that the destination is impossible.
Some feel relief if one tube is open; others feel overwhelmed if both look blocked or if hydrosalpinx is mentioned.
A practical tip patients often share: schedule something gentle afterward (a calm meal, a walk, a favorite show),
because your brain may be louder than your body that day.

3) Surgery decisions can feel like a high-stakes choose-your-own-adventure

When laparoscopy is discussed, patients frequently describe two competing feelings: hope (“Maybe this fixes it!”) and fear (“What if it makes it worse?”).
The truth is nuanced. Surgery can improve anatomy and reduce pain, but adhesions can recur, and the best choice depends on your fertility timeline.
Many people say the most helpful conversations were the ones that included a clear decision framework:
What problem are we trying to solve? (Pain? Tube blockage? Hydrosalpinx? Endometrioma?)
What does success look like? (Less pain? A chance to conceive naturally? Better IVF odds?)

4) Hydrosalpinx can change the plan overnightand that’s not your fault

Patients often describe hydrosalpinx as the “plot twist.” They expected fertility meds or maybe minor surgery, and suddenly they’re hearing about
salpingectomy or tubal occlusion before IVF. This can feel scary because it sounds permanent.
But many also report that once a specialist explained the logicpreventing harmful fluid from reaching the uterus and improving IVF successit felt less like
“losing a tube” and more like “removing a roadblock.” People commonly wish someone had explained earlier that fertility treatment is sometimes about
improving the environment for pregnancy, not preserving every piece of anatomy at all costs.

5) The emotional load is real: grief, anger, and “I’m tired of being the project manager of my uterus”

Endometriosis and infertility workups often come with appointment fatigue, insurance frustration, and the mental weight of tracking cycles,
symptoms, and next steps. Patients frequently describe feeling like they’ve been assigned a second unpaid job:
coordinator of labs, scans, referrals, and “Can you fax that again?” It’s common to grieve the loss of an “easy” path to pregnancy
or to feel angry that pain wasn’t taken seriously sooner.
Many find it helps to:

• Bring a support person to appointments (or have someone on speakerphone)
• Write questions down beforehand (because anxiety is a memory eraser)
• Ask for the plan in a timeline format (“What happens next if this doesn’t work?”)
• Seek counseling or support groups, especially during IVF decisions

6) Relationships can get strainedcommunication helps more than “being tough”

People often report that endometriosis pain affects intimacy and that fertility stress affects communication.
Some couples feel closer; others feel like every month becomes a performance review.
A common helpful shift is moving from “What’s wrong with me?” to “What is this condition asking us to manage together?”
That can reduce blame and make room for practical teamwork: rides to procedures, sharing costs planning, and agreeing on boundaries around family questions.

7) After treatment, many people say the biggest win is clarity

Whether someone ends up trying naturally, doing surgery, pursuing IVF, or focusing on symptom control,
a common theme is that having a clear diagnosis and plan reduces the mental chaos.
Even when the plan is challenging, clarity can feel like getting the lights turned on in a room you’ve been stumbling through for years.

Gentle reminder: this article is educational and can’t replace medical care. If you have severe pain, heavy bleeding, fever,
sudden worsening symptoms, or urgent fertility concerns, talk with a qualified clinician promptly.