Surgical therapy for coexistent proximal and distal obstruction has consisted of combined proximal (reimplantation of reanastomosis) and distal (salpingostomy) repairs. Data suggest that successful relief of proximal obstruction by fluoroscopically guided tubal canalization (FTC) may be achieved in 60% to 95% of cases. We studied the use of FTC as a preoperative adjunct in 14 patients with coexistent proximal tubal obstruction (PTO) and distal tubal obstruction, progressing to surgical repair of distal disease if proximal patency was achieved. Unilateral (9/14) or bilateral (5/14) PTO was demonstrated on at least one hysterosalpingogram (HSG) and during chromotubation performed as part of the diagnostic laparoscopy. FTC was successful in four patients (28%). HSG revealed proximal reocclusion in two patients. Two patients had persistent proximal patency and underwent distal salpingostomies and adhesiolysis for mild hydrosalpinges and pelvic adhesive disease. No pregnancies have been achieved after 12 and 18 months follow-up. The lower patency rate and higher recurrence rates of PTO when compared to data of prior studies suggest that in vitro fertilization, though more costly, ultimately may represent the most expedient and effective method of management of coexistent proximal and distal tubal disease.