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Tubal Disease
Tubal disease can be caused by previous surgery, pelvic inflammatory disease, endometriosis, or it can be congenital. Also many women seek to have a previous tubal sterilization procedure reversed. Depending upon where the tube is damaged (blocked) IVF is often the treatment of choice. 
Sometimes tubal reversal is possible depending upon where the tubes were tied. In general, IVF produces higher per cycle success rates. If surgery is attempted, the tubal reversal should be performed by a skilled microsurgeon. The Fallopian tubes are delicate and must be handled with the greatest care. Women 35 or older are usually advised to seek IVF as the first line treatment.
The eggs are ovulated into the fallopian tube where they meet with the sperm at the end of the tube where fertilization occurs. The pre-embryo is then carried to the uterus. Blockage of the tube prevents these events. Scarring from previous surgery can also cause tubal blockage. In general, the per cycle success rates with in vitro fertilization are higher than those after tubal surgery.
The first step is the hysterosalpingogram test which allows us to assess whether or not, and where, the tubes are blocked. The next step is a examine the tubes laparoscopically and the reversal may be performed at this time. Each case is individually evaluated and we always recommend the procedure(s) most likely to result in pregnancy in the most cost effective manner.
Uterine Disease
Uterine factor disease can cause infertility and is usually a result of pelvic inflammatory disease, endometriosis, fibroids, previous surgery, or it can be congenital. In cases of severe uterine damage, surrogacy (another female who can carry the pregnancy) is the only treatment. Fortunately, uterine factor infertility is relatively uncommon.
Treatment options are available based upon each couple's diagnosis. Surgery to remove fibroids or endometriosis is sometimes effective and some structural defects can be corrected. Medications such as Lupron are often effective in reducing the amount of endometriosis.
Infertility Causes
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