If the patient has a tubal angiogram showing bilateral blockage of the umbilical ends of the fallopian tubes, however, there is a requirement for natural conception, a combined hysterolaparoscopy is recommended in this case. First, a laparoscopy is performed to separate the adhesions at the umbilical end, and second, a paracentesis is performed. After the surgery, a laparoscopy will be done. Under the laparoscope, a Melanoplasty can be done and the patient can be observed if the tubal surgery was done successfully. If it is done successfully, you can start to prepare for pregnancy after 1 month after the operation, and it is better to conceive naturally within 6 months. If you are not able to conceive naturally within 6 months, the possibility of having another blockage of the umbilical end of the fallopian tube will be very high. In this case, it is not recommended to conceive naturally and assisted reproductive technology is recommended.