A few days ago, a friend referred a couple to my clinic for treatment. Both of them are white-collar workers. When they got married, they didn’t plan to have a baby because their careers were just starting, and they had abortions three times. Now they have a stable career and want to have a baby of their own, but they have been trying for three years but have not been able to conceive. After careful questioning, I learned that the male partner’s semen tests were normal, the female partner’s menstruation was regular, ultrasound and hormone levels were not abnormal, and they had been tested for ovulation at the hospital and had deliberately had intercourse during ovulation, but there were no results. I then considered that the reason for this couple’s non-pregnancy might be a tubal problem. Tubal infertility is one of the most common causes of female infertility, with 40% of women in the infertility population having tubal lesions. The fallopian tubes play an important role in female reproductive function and are located at the “fortress” where the sperm passes and the sperm-egg union and the fertilized egg runs, with a special status of “one for all, one for all”. It is involved in the transport of sperm, the uptake of eggs, the place where sperm and eggs unite, and finally the transport of the fertilized egg formed by the union of sperm and egg to the uterus. The luminal environment of the fallopian tube is the microscopic environment that determines whether the sperm and egg can successfully unite to complete fertilization. Therefore, the fallopian tube is not just a “tube” but a “bridge to life”. The common causes of tubal adhesions and blockages are tubal inflammation, peri-tubal adhesions, post-operative ectopic pregnancy, tubal ligation and tubal dysplasia. How to determine if the fallopian tubes are open? Since tubal examination is invasive, to avoid unnecessary damage, it is recommended to perform tubal examination after knowing the male partner’s semen and the female partner’s ovulation status. The test should be performed 3 to 7 days after menstruation and no intercourse during the month. There are many options to check the patency of the fallopian tubes. Usually your doctor will ask you to have a hysterosalpingogram (X-ray), or a hysterosalpingogram, which is a proven method to understand the morphology of the fallopian tubes and to find the site of obstruction. In addition, for patients with combined ovarian cysts requiring surgery, laparoscopic ovarian cyst debridement with tubal lavage is recommended. It lies in the ability to visually diagnose the presence of abnormalities in the fallopian tubes and also to observe the entire pelvic cavity. If intraoperative Mylan tubal lavage reveals incompetence, depending on the circumstances, immediate surgery can be performed at that time. How to treat infertility caused by tubal factors? There are two main types of treatment for tubal infertility: laparoscopic tuboplasty and in vitro fertilization-embryo transfer (IVF), a procedure in which the female partner uses medication to promote ovulation, then removes the eggs from the female ovaries and the male partner removes the sperm, and the eggs and sperm are cultured together in the laboratory to fertilize them into fertilized eggs and develop into embryos. The embryo is then transferred to the uterine cavity for implantation and development. Which patients are suitable for the procedure? Which patients are suitable for IVF? The management of tubal damage and post-operative pregnancy rates vary from site to site. For example, IVF is recommended for obstruction of the proximal fallopian tube. For distal tubal lesions (umbilical), non-atretic lesions such as cystoplasty and peripheral adhesions can be treated with adhesiolysis, which has a high postoperative pregnancy rate and is arguably the most beneficial tubal procedure; however, for completely atretic distal lesions such as hydrocele, especially thick-walled hydrocele, the postoperative pregnancy rate is only 0%-1% and surgical treatment is no longer recommended. It is not either one or the other, but the ultimate goal of the doctors is to choose the better method or a combination of both to improve the fertility rate. One of our patients, Ms. Chen, 33 years old, had a successful tubal surgery two years ago due to incomplete atresia of the right (distal) fallopian tube, but she had not conceived after 1.5 years of adequate post-operative attempts. Therefore, the doctor suggested IVF technique. After ovulation promotion and other treatments, she is now pregnant with two children at 3 months of gestational age. Therefore, patients who are young and whose angiogram suggests incomplete atresia of the umbilical end of the fallopian tube can be considered for surgery, and if the surgery is successful, the couple can try to conceive together after the surgery, and if they still have not conceived after more than 1 year of postoperative attempts, IVF is recommended. If the patient is older than 35 years old and the angiogram shows bilateral proximal incompetence of the fallopian tubes or complete incompetence of the umbilical ends, IVF treatment is recommended. Ms. Wang finally underwent tubal imaging and was found to have bilateral proximal blockage of the fallopian tubes. She took our advice and underwent IVF and has now delivered a healthy baby at full term.