QuestionHello. I'm seeing an RE to conceive another baby. We needed help conceiving three times in the past (2 IUIs and one IVF...all succesful) for unexplained infertility. This time, I'm currently in my first cycle and today is day 7. I've been taking 225 U of Gonal-F since Day 3, and have been responding well (two 14 mm follicles and one 11mm on the left side, and one or two 10s on the right side; and my E2 is 425 today). Today, I had a saline ultrasound (I don't know exactly what the procedure is called). It's a routine procedure in my RE's office before starting treatment. Since my RE knows me from past pregnancies, she allowed me to do this required saline ultrasound test during this first medicated cycle with Gonal-F. I also had this procedure done two years ago before an IVF cycle and after I had a right-sided tube lapartomy for an ectopic pregnancy. My right tube was spared. On the previous saline ultrasound (after the right tube/side lapartomy), the right tube was patent. In fact, both tubes were clearly patent on the previous saline ultrasound. I've had no surgeries since and have given birth (vaginally) to twins (from an IVF cycle) since then. Today, when I had the saline ultrasound, they said my right tube (the tube that was operated on two years ago) was patent. However, today on the left side (my "normal side", I thought), they were having trouble seeing "spillage". At one point during the procedure, they thought that they saw a hydrocele??? in my fallopian tube, but they later determined that it was just part of my bowel. AFter injecting two syringes full of saline through the catheter and a lot of pressing and prodding with the probe, finally at the end of the procedure they thought that they could see just "a little free fluid" on the left side near the ovary. I'm not confident with IUI attempts now even after my RE walked out of the procedure saying that we'll proceed with this cycle, and that we should be "okay." My question is: Why didn't we see spillage as clearly on the left side? Could my tube that was never operated on all in the sudden be blocked? The left side was the side that has never been touched, and it was patent just two years ago on the saline ultrasound. I haven't had any pelvic infections or surgeries. Today, I think I recall during the procedure that the RE said that it might have just been harder to see the spillage because my ovaries are currently being stimulated??? Is that true or am I just dreaming this? Is there any other explanation why they wouldn't see spillage on the left side (like pelvic position, position of the catheter, etc?) or should I assume that my left tube is now suddenly imparied for some reason? In that case, with a history of right tube ectopic repair and now a possible left tube impairment, I would think our chances of a succesful IUI is very low, correct? Thank you so much in advance for your explanation.
P.S. Assuming there is an explanation as to why we didn't see spillage on the left side, what are the chances of my small 10 mm follicles on the right side "catching up" and having a fighting chance to become mature and possibly fertilized? I think that I recall from previous cycles that after several days of taking Gonal-F that the small 10mm follicles never caught up to a decent size by the time I was ordered to give the Ovidrel trigger.
AnswerHello,
I cannot contradict your RE's advice or opinion, but suffice it to say that this situation, in it's entirety, is very curious. I have not heard of anyone doing a saline hysterosonography in the midst of an ovulation induction cycle. I also don't understand why you would be undergoing an IUI cycle, when you required an IVF cycle to get pregnant before? With a history of ectopic pregnancy, you are at increased risk of another ectopic!
I also don't understand why one tube would be patent over the other in a fashion that is opposite of a previous finding. Did the doctors call the wrong sides? Sometimes, because we are facing the patient, we make the mistake of calling that side based on the side we are facing i.e. the opposite of your side. Could that be what happened here?
In order for pregnancy to ensue, it does not necessarily matter what side has the patent tube, as long as the egg can travel through the pelvis without difficulty. Having had previous surgery, this could be a problem because you could have formed scar tissue in the pelvis that would obstruct the egg from reaching the tube.
These are clearly questions that you need to put to your RE doc, and make sure she gives you a reasonable answer. After all, you are paying a lot for this procedure and you want the best chances for it to work.
In terms of your follicles, if the stimulation is not sufficient, not all the follicles will grow into ovulatory-sized follicles (>16 mms). But, that is the goal with IUI. We only want three ovulatory follicles with an IUI cycle.
Sincerely,
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.
