Fallopian tubal disease is a common cause of infertility, affecting almost 30% of couples presenting to the reproductive care specialist. Approximately 10-25% of women with tubal disease have proximal fallopian tube blockage. The initial screening test for determining fallopian tube patency is the hysterosalpingogram (HSG). Although the specificity of HSG is high, there is a significant false positive rate, with many patients who truly have patent tubes, being misdiagnosed with tubal disease. This is especially true in patients diagnosed with proximal tubal disease, as there are other common treatable entities (tubal spasm, mucous plugs, mild adhesions, or cellular debris) that can masquerade as tubal blockage. If proximal tubal obstruction is secondary to a mucous plug/accumulated cellular debris, this often can be successfully reversed with endotubal therapy.