Tubal blockage is caused by infection, endometriosis or previous pelvic or gynecologic surgery. The most common infection that causes tubal blockage is pelvic inflammatory disease (PID). Often a woman may not realize she had an infection or know that it would lead to infertility. Pelvic inflammatory disease usually starts as a bacterial infection of the cervix and the bacteria migrate through the uterus to the tubes where they cause scarring. Occasionally the scarring leads to the accumulation of tubal fluid called a Hydrosalpinx. A Hydrosalpinx should be removed prior to fertility treatments because it decreases the effectiveness of fertility treatments. Other pelvic or abdominal infections such as a ruptured appendicitis or inflammatory conditions can lead to scarring and blockage of the tubes. Women who have both tubes blocked or are missing both tubes due to prior surgery can get pregnant with In Vitro Fertilization.