<p>Hi! Usually In Vitro Fertilization (IVF or test tube baby) is the most effective and safe option for people with blocked tubes. The American Society for Reproductive Medicine recommends all women experiencing infertility (no conception after 6 months of intercourse) and over age 40 consider going straight to IVF. IVF offers the additional advantage of being able to reduce the risks of age related miscarriages and birth defects with the addition of PGS, or preimplantation genetic screening of embryos for aneuploidy (abnormal numbers of chromosomes found is conditions like Downs syndrome). Start with seeing a board certified reproductive endocrinologist for a full evaluation. Best of luck! Dr Serena H Chen</p>