The management of tubal disease depends on the initial pathological process and the severity of damage. In vitro fertilisation (IVF) remains the main treatment strategy for women with severely damaged fallopian tubes. The main causes of tubal factor infertility include previous tubal infection, previous surgery, endometriosis and congenital abnormalities. Infection, endometriosis and surgery affect tubal function via different mechanisms but all lead to inflammation. Classification of tubal disease is essential for use in clinical trials but also as a potential prognostic indicator to assist patients and clinicians in decisions regarding further management. The tubal disease is classified into grade I - minor, grade II - intermediate or moderate and grade III - severe. Once tubal disease has been identified, management options include expectant management, tubal cannulation, surgery and IVF. Several prognostic factors need to be considered when counselling women regarding their individual further management options.