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Once ovulation occurs and the egg(s) is released, it is "picked up" by the fallopian tube, and migrates to the opposite end of the tube at the junction of the uterus. Fertilization usually occurs in the fallopian tube.
The fallopian tubes must be open and free of obstruction to allow the eggs to freely pass. Conditions such as endometriosis, scarring from previous surgery or infections, congenital abnormalities, or prior tubal ligation (for sterilization) can cause tubal obstruction. When this occurs the eggs cannot reach the site of fertilization. 
In many cases of tubal obstruction, in vitro fertilization is the treatment of first choice. This is because IVF bypasses the fallopian tubes with the eggs being retrieved directly from the ovaries and combined with the sperm in the laboratory. Fortunatly, our Dallas, Texas IVF clinic is one of the most successful in the country.
Many women with declining ovarian reserve will be candidates for our donor egg program. The choice of surgery vs. IVF depends upon many factors including the location and severity of the blockage. Many clinical studies demonstrate that the cumulative success rates are higher after IVF than after tubal reversal surgery.
It is sometimes possible to reverse the tubal sterilization procedure, in a surgical procedure that reconnects the delicate fallopian tubes under an operative microscope. Successful outcome depends on multiple variables including the woman’s age, length of fallopian tube restored, and the exact fragment of fallopian tube originally “tied” or destroyed. This delicate surgery should be performed by a highly trained and skilled fertility specialist.
Even though the per cycle IVF success rates are greater than tubal surgery, some patients choose surgery. These are usually younger women who have many years to attempt natural intercourse thus increasing the cumulative pregnancy rates. There is no limit to the number of natural cycles whereas IVF cycles may be limited by cost. See our page on infertility treatment cost. Older women may not have time to attempt numerous natural cycles because their fertility may decline rapidly with age.
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