Tubal Occlusion in Patients With Fibroids: A Retrospective Cohort Study

INTRODUCTION: Although fibroids are known to affect reproductive health, their relationship to tubal occlusion remains unclear. While fibroids may compress or obstruct the fallopian tubes, data on the true incidence and predictive factors for tubal occlusion in this population are limited. OBJECTIVE: To evaluate the incidence of tubal occlusion in patients with fibroids and assess the effect of fibroid and patient characteristics on tubal occlusion. METHODS: Retrospective chart review of patients with documented presence of fibroids who underwent chromopertubation in a single health system from 2015 to 2025. Patients with a history of tubal surgery or incomplete records were excluded. Primary outcome was incidence of tubal occlusion in patients with fibroids. Secondary outcomes were the effect of fibroid characteristics, concurrent endometriosis, and infertility on tubal occlusion rate. A sub-analysis of tubal occlusion in patients who underwent myomectomy, both before and after the procedure, was performed. RESULTS: N=130. The incidence of occlusion of at least one tube was 67% (87/130) and that of bilateral tubal occlusion was 43% (56/130). Although not statistically significant, the mean largest fibroid size was 4.1 cm for those with tubal occlusion vs 2.8 cm for those without (p=0.207). ROC analysis showed weak discriminatory ability to predict a fibroid size threshold associated with tubal occlusion (AUC 0.568, 95% CI 0.464–0.68). There was no significant difference in number of fibroids, or largest uterine dimension between patients who did and did not have tubal occlusion (p=0.835, p=0.440, respectively). Incidences of endometriosis and infertility were 35% (47/130) and 37% (48/130), respectively. Presence of endometriosis or previous diagnosis of infertility separately was not associated with a significant difference in incidence of tubal occlusion (p=0.341, p=0.122), nor was concurrent diagnosis of both endometriosis and infertility (23 patients, 18%, p=0.871). Among patients who underwent myomectomy, no significant difference was found in incidence of tubal occlusion before (30/60) vs after (31/60) myomectomy (p=0.232, p=0.375 for the left and right tube, respectively). CONCLUSIONS: In this study, tubal occlusion was observed in the majority of patients with fibroids, but not associated with fibroid number or size, myomectomy, endometriosis, or infertility. These findings suggest a multifactorial pathophysiology that is not fully understood. Given the high prevalence, routine assessment of tubal patency in patients with fibroids may be warranted, and further prospective studies are needed to clarify the true incidence and contributing factors.