This problem affects 10-15% of all couples, with less than half of the cases attributed to female infertility factors. These are most commonly associated with tubal factors (e.g., blocked fallopian tube – sactosalpinx), anovulation (cause in the ovary or hypothalamus/pituitary, PCOS syndrome), structural uterine disorders (septa, septum, fibroids, adenomyosis, etc.), or other factors (e.g., immunological factors, endometriosis).

In ruling out tubal factors, in addition to ultrasound examination with contrast, diagnostic laparoscopy is most helpful. During this procedure, we flush the fallopian tubes with blue dye to check their patency and the presence of any adhesions around the fallopian tubes and ovaries.

Treatment

If the fallopian tubes are closed and not patent to contrast during flushing, we can open them microsurgically through laparoscopy (neotubostomy).

When a uterine septum is suspected, which we diagnose through transvaginal ultrasound examination, we perform an outpatient hysteroscopy to cut the septum with scissors, thereby increasing the interior space of the uterus. During hysteroscopy, fluid also flushes both fallopian tubes, which can additionally contribute to spontaneous conception.