Questionhi, i am 32 female.i had a miscarriage in june 2010. USG showed endometrial polys and multiple fibroids of various sizes. After six months of my m/c i went for abdominal myomectomy and three intramural fibroids along with the polyps were removed. then after four months me and my husband tried for a baby but no success. Doctor told to go for HSG. during HSG test the fluid was not going inside the uterine cavity. showing a large filling defect suspecting of submucous fibroid and both fallopian tubes blocked at corunal and bcoz my doctor could not see indside of my uterus. she planned for hysteroscopic myomectomy and laparoscopic to see the fallopian tube blockage. but during hystescopy again she could not see inside of the uterus bcoz of the difficulty in dilation of the cervix. during the laparoscopy it is seen adhesion of the uterus to the anterior wall of the pelvic and left fallopian tube attach with the posterior wall of the uterus.
my question is why the dialation of the cervix is so diffucult and could the adhesion be a reason for which i m not able to get pregnant.
AnswerHello Angelina from India,
I cannot answer the question as to why the cervical dilation was difficult. That should not have been the case. Even the smallest and tightest cervices can be dilated. Dilating the cervix can also be assisted with pretreatment using a medication called Misoprostol the night before the procedure. But the main reason I cannot answer this question is because I don't know the experience, expertise and competency of your doctor. Maybe she is just not good enough?
In terms of the adhesions, I am not surprised that you developed adhesions after a myomectomy. It is well known that this can occur and is an expected complication of the procedure. These adhesions can block movement of the egg to the tubes and therefore lead to infertility. For that reason, in the U.S. we do not recommend myomectomy for infertility patients unless the fibroids are causing severe life threatening problems. In addition submucous fibroids DON'T grow all of a sudden. They should have been seen previously if you indeed have them. Now submucous fibroids can definitely impair fertility, through interfering with implantation, and these are the only types of fibroids that need to be removed prior to treatment. Other fibroids do not need to be removed.
At this point, if the adhesions are found to be extensive, you may need to proceed with IVF (In Vitro Fertilization) in order to achieve pregnancy. Especially if the tubes are now blocked. In addition, if the endometrial cavity is scarred because of entrance into the cavity at the time of myomectomy (another complication risk), then your cavity may be permanently deformed such that you could not become pregnant or carry a pregnancy. You'll need to have some testing, hysteroscopy, to verify that before making that conclusion. I mention it only because it may be a possibility to explain why your doctor could not get into the cavity and why there is a defect noted from the HSG.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
