The main function of the fallopian tubes is to transport the egg and the fertilized egg, just like the magpie bridge where the cowherd and the weaver meet. If the fallopian tube is obstructed, the egg and sperm cannot meet and fertilize, thus preventing pregnancy; if the adhesions around the fallopian tube are not in good shape, the tube’s function of collecting and transporting eggs will be affected, which will reduce the chance of pregnancy; if the fallopian tube is fluid-filled, the tube on the fluid-filled side will lose its function and the fluid will enter the uterine cavity to flush and poison the embryo. Let’s discuss how to prepare for pregnancy separately according to the different conditions of the fallopian tubes, assuming that the female ovulation is normal and the male semen routine is normal at this time. The first case is a complete obstruction of the fallopian tubes bilaterally. In this case, there are two treatment options. One is laparoscopic tuboplasty and sparing surgery, the results of which vary depending on the patient’s physical condition and the site of tubal obstruction. For example, interstitial obstruction has a lower success rate than pot-belly obstruction, and scarred patients have a lower success rate. The results of the surgery also need to be judged by active post-operative attempts to conceive for six months to a year. Another option is in vitro fertilization treatment. IVF involves removing the woman’s eggs and the man’s sperm, fertilizing them in an in vitro culture, forming embryos and then transferring them to the woman’s uterus without the need for the fallopian tubes to function. Therefore, bilateral tubal obstruction is an absolute indication for IVF treatment. It was because of bilateral tubal obstruction that Leslie Brown underwent an attempt at IVF treatment, which was finally successful, and so in 1978 the world’s first IVF baby, Louise Brown, was born! The second condition is bilateral peri-fallopian adhesions or one tubal obstruction and one peri-fallopian adhesion. Peri-tubal adhesions are what we often refer to as tubal patency. The fallopian tubes are patent but poorly aligned, which can manifest as tortuosity, uplift, and limited contrast diffusion. In this case, we should give the fallopian tubes a certain chance, for example, we can monitor ovulation for several cycles and try to conceive when we are sure that there is ovulation and normal sperm. If the tubes are still not functioning, laparoscopic surgery or IVF treatment should be considered. The third condition is unilateral or bilateral hydrosalpinx. Depending on the woman’s wishes, if she is determined to have children on her own, she may consider surgical ostomy to remove the hydrocele before actively trying to conceive. It is important to note that hydrocele can recur and may require a second surgery. On the other hand, a long-standing fluid-filled fallopian tube may have lost its transport function and will no longer be able to transport eggs and fertilized eggs even if the fluid is released after surgery. Patients requesting IVF treatment may opt for direct removal of the fluid-filled fallopian tube or a proximal ligation with distal ostomy, with the aim of preventing the fluid from entering the uterine cavity and affecting the endometrium and embryo. As you can see, whether you are getting pregnant on your own or undergoing IVF treatment, you need to address the fluid in the fallopian tubes first. The success rate of laparoscopic surgery needs to be combined with the site and degree of tubal obstruction, previous surgical history, patient’s physical condition, and the presence of tuberculosis history. For example, tubal obstruction or adhesions due to abdominal tuberculosis or chronic pelvic inflammatory disease are not recommended for surgical treatment because it is difficult to separate the adhesions. The success rate of IVF, on the other hand, is mainly related to ovarian function, male partner’s semen routine and endometrium. These are ideal solutions for tubal problems. However, in reality, the choice between surgery or IVF treatment is a more tangled matter, which requires a combination of the female partner’s age, ovulation, male partner’s sperm quality, and the degree of tubal obstruction or adhesions. For example, if the female partner has ovulation problems or the male partner has poor sperm quality, it will cost more money or time for ovulation promotion and trying to conceive if she chooses to undergo laparoscopic surgery. For older women who cannot wait too long for their ovarian function to decline dramatically with age, it is recommended to consider IVF treatment directly. Of course, it is most important for women to make their own decisions based on their own wishes. Treatment of obstructed or adherent fallopian tubes with topical or oral medications is basically ineffective. Women with tubal problems are at a much higher risk of ectopic pregnancy than normal women. Whether it is a natural pregnancy or an embryo transfer, you must be careful of ectopic pregnancy after pregnancy and have a gynecological ultrasound as soon as possible in early pregnancy to clarify intrauterine pregnancy or ectopic pregnancy, and seek emergency medical attention if abdominal pain and vaginal bleeding occur before the ultrasound.