QuestionHello. I'm with a new RE that specializes in laparoscopy for infertility. He did an HSG and I have one fully blocked and one partially blocked tube. I'm going in this week to discuss my options. I'm 34 and I have two children and have had two miscarriages. I have issues with thyroid and I'm homozogous with MTHFR. I had a laparoscopy last october and they removed a good amount of scar tissue and adhesions and found a small amount of endometriosis in the cel de sac. I'm in really good hands with my new RE. My question is this. What kind of options do you think he'll suggest to me? The nurse said it's not the worst news in the world. Do you think it's helpful that the one tube is only partially blocked in the middle?
Danielle
AnswerHello Danielle,
If you are going to see an RE, he should be able to give you all your options including the option of IVF. If your doctor does not do IVF, I wonder if he is in fact an RE?
This is what I would tell my patient who had your story. The fact that one tube is blocked means that some event occurred that caused it to be blocked. That event is usually an inflammation or infection that is like wild-fire that rose through the uterus and entered the tubes. Because both tubes are connected to the uterus, it most likely affected both tubes but one tube was affected more than the other. Because of this, one tube is scarred completely and blocked, but that does not mean that the other tube is not damaged within. In fact, it is mostly damaged at the micro level but was not damaged enough to block off the tube. That means that it still will not function. Even if the tube were surgically fixed at the fimbria (end of the tube, because the internal structure is damaged, this cannot be repaired and the tube will not function correctly. In fact, you would be at higher risk for a tubal pregnancy called an ectopic. For this reason, I will usually counsel my patients to assume that the tubes are not viable and the treatment has to be something that does not require the tubes. The only treatment that fits this is called in vitro fertilization (IVF) where the eggs are removed directly from the ovaries and the tubes are not required.
So with that being said, if your doctor is an RE and can do IVF, he will give you two options. One option would be to do laparoscopy and open the tube that is blocked at the end (if that is where it is partially blocked) or the other option is to proceed with IVF. If you choose IVF, then the tubes need to be evaluated to see if they form a "hydrosalpinx", which is a dilated tube with fluid within. This fluid is usually inflammatory fluid and can reduce the chance of the embryo implanting with IVF so the tube needs to either be separated from the uterus at the point where it exits the uterus (ligation) or the tubes need to be removed (salpingectomy). This can be done laparoscopically. So if you were my patient, and a hydrosalpinx were visible n ultrasound, then I would counsel to undergo laparoscopy to ligate the tubes at the cornua before proceeding with IVF.
I hope this answers your question.
Good Luck,
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
