Blocked Fallopian Tube & Clomid Treatment: What You Need to Know

Question
Hi there.  My name is Lisa, I have been trying to conceive for 1.5 years now with my second husband.  I have a 6 year old with first husband.

Since I got married we have been trying with no luck.  We got my results back the other day after the dye test to show that one tube was blocked half way down.  My other tube is well and open.

The gyni suggested putting me on clomid to try and encourage eggs in my good side as well as my bad side, have you heard of this before and if so what is the success rate?

Also my husband has a lower than average count which is very erratic but gynie didnt seemed to concerned about his count as they were mobile and he said many men have fathered on his count before.

Please advise on what our chances are?  Also he has put me on a ivf waiting list.

Thanks very much.

Lisa.

Answer
Hello Lisa,

Based on your description, you have two problems:  tubal factor and male factor.  Infertility, is additive, meaning that the more problems you have, the more unlikely it is to become pregnant i.e. your chances are more decreased.

You gynecologist is not correct, and I'm afraid that he/she is leading you in the wrong direction.  The main reason for recommending Clomid is because it is a default treatment.  Many doctors treat with Clomid, eventhough that is not the optimal treatment for the patient, mainly because they cannot offer more.

First of all, the fact that you have one blocked tube is concerning.  This is an indication that some event occurred in the past that led to the tubal blockage.  That event is usually some form of tubal infection, whereby a bacteria entered the tubes via the vagina, caused an inflammation in the tube and caused scar tissue formation.  The problem is that these infections don't usually limit themselves to one tube.  They usually enter both.  In your case the damage was more severe on one side than the other so that one side is blocked.  That does not mean that the other side is normal.  Remember, fluid can pass through even the smallest opening.  When I have this type of situation, I usually counseled that it is likely that the open tube is still damaged and non-functional.  With that in mind, the only treatment option is IVF.

Second, the male factor (semen analysis) is very important and has to be interpreted correctly.  If the count is less than 20 million, that is abnormal.  A count between 10 million and 20 million can be a candidate for IUI (intrauterine insemination), but that also depends on the percent motility.  If you multiply the count x the motility, you get a number called the "total motile count" which needs to be above 20 million.  That is the number of sperm that are actually available to get up to the tube to fertilize the egg.  Less than 10 million count also indicates that there is a functional problem with the sperm i.e. that the sperm may not have the ability to fertilize the egg.  In this case, the recommendation is to inject the sperm directly into the egg, which requires IVF.

Taken together, IVF is probably the optimal treatment for you, but you should have a consult with a fertility specialist to make sure.

I hope this answers your questions,

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.