QuestionDear doctor,
I am 34 years old and have one child (3 years old) and two miscarriages. First miscarriage (embryo stopped growing 6.5 weeks) at Jan08, second Nov08 (9.5 weeks).
Just before i became pregnant with the most recent one, i found out i had bilateral hydrosalpiges that showed up on transvaginal ultrasound.
We were considering having surgery to remove the fallopian tubes (on the advice of an IVF specilaist) then start IVF when suddenly we found out we were pregnant. Unfortunately at 9.5 weeks i had a miscarriage. (Nov08).
We are awaiting results of tissue testing to determine if chromosomal abnormality. We are also booked in for a repeat ultrasound.
1.Does having bilateral hydrosalpiges cause you to miscarry at 10 weeks pregnant. If so by how much (i.e what %)? Gyn says they do not make you miscarry but morel likely to not allow implantation.
2. Would the preferred option be to clip them, or just remove them and commence IVF eventhough I have gotten pregnant naturally? Or would the best option be give it one more go naturally?
3.Any other advice would be appreciated.
Country: Australia
AnswerHello Mumsou,
You present a very interesting scenario because women with hydrosalpinges usually cannot get pregnant. The reason is, is because the cause of the hydrosalpinx is a tubal infection that caused damage to the tubes. Not only did it cause the tube to be obstructed, but the even usually leads to damage of the inner lining of the tube that is important for egg and sperm transport. Therefore the recommendation is to proceed with IVF. Your case negates that thinking.
Hydrosalpinges can lead to non-implantation, and by the same mechanism, miscarriage. It is thought that the hydrosalpinx has inflammatory fluid within that migrates back into the uterus. Several studies have found decreased pregnancy rates in IVF when hydrosalpinges are present. That is why it is recommended to clip the tubes or remove them prior to IVF. This inflammatory fluid causes a mild inflammation of the uterine lining causing the lack of implantation. If implantation were to occur, I would expect that the same inflammation could lead to the death of the embryo from a mild amnionitis. That, however, is theoretical.
Because you have shown that you are the exception to the rule, you have two options: you can have a laparoscopy and have the tubes opened (salpingoplasty) or you can have the tubes clipped/removed. If the tubes are opened, you have the opportunity to become pregnant naturally, like you just showed that you could. It would allow the fluid to escape into the abdomen, thereby reducing the chances of backflow into the uterus. However, if there is tubal damage within, you are at increased risk of a tubal pregnancy called an ectopic pregnancy. That can be life threatening if it ruptures and you hemorrhage. The second option, which then requires IVF is certainly the safer option, but the more expensive option. You need to discuss these two options with your docs.
If I were counseling you, I would almost be inclined to recommend the former (tubal repair), as long as you were completely aware of the risk of ectopic and willing to take that chance. I would then watch you very closely if you were to become pregnant to rule out the ectopic.
I hope that 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.
