Xiao Liu was diagnosed with tubal obstruction as the cause of her infertility. When she heard that her colleague Xiao Wang had a successful pregnancy 4 months after laparoscopy in the hospital, she also came to the fertility clinic. But the doctor told her that she could only get pregnant through IVF in this condition. Xiao Liu was a bit confused: the same tubal infertility, why is the treatment different? As we mentioned last time, infertility due to tubal factors accounts for about 30%-40% of female infertility causes. These include tubal incompetence, tubal blockage, partial or distal tubal adhesions, hydrocele, uplift and peri-tubal inflammation. In terms of lesions, they can be divided into two major categories: external tubal lesions and intra-tubal lesions. External tubal lesions are mainly caused by pelvic adhesions or peritubal inflammation, resulting in restriction of tubal movement and loss of egg collection function, which can be treated by laparoscopic release of adhesions or distal tubal ostomy. Xiao Wang was the one who had a hysterosalpingogram (HSG) under X-ray, which showed adhesional obstruction of the distal fallopian tube and had a high chance of natural pregnancy within 1 year after laparoscopic surgery. Intraluminal lesions are mainly due to mycoplasma, chlamydia, gonococcal upstream infections, or previous tubal tuberculosis, resulting in damage to the cilia and mucous membrane in the tubal lumen, and loss of the ability to transport sperm and embryos even if the tubes are patent. These lesions cannot be resolved by surgery. Xiao Liu once had tuberculosis at the age of 15. Despite standard treatment, HSG showed severe lesions in the fallopian tubes, and only IVF could help conceive. In addition, hydrosalpinx, as a specific manifestation of tubal inflammation, can be secondary to distal obstruction or severe lesions in the lumen. Since the toxic factors in hydrocele can kill sperm and embryos, it should be treated aggressively when detected. If the lesion is mild, a laparoscopic tubal ostomy can be used to drain it and there is a possibility of natural pregnancy after the procedure. However, if the lesion is severe and recurrent, the fallopian tubes need to be removed and IVF can be used to help conceive.