Tubal Problems
Friday, December 01, 2006
Carl M. Herbert, MD
The tube has three sections, the cornu, the isthmus, and the ampulla and fimbria. The cornu, which is the connection to the uterus, is a narrow valve that opens and closes in response to uterine contractions. It measures about half an inch in length, and is lined by glands that make fluids.
The isthmus, the narrowest connecting part of the tube is an intricate and tiny tube lined with cilia, the tiny hair-like projections off of cells that move in waves to pull sperm and embryos along the tube. The walls of the isthmus are thrown up into multiple complex folds. The isthmus is hardly a simple conduit, but rather a complex and active moving pathway.
The ampulla, the funnel-shaped end of the tube, is connected to the fimbria, feathery fingers that reach out to the ovary and pick up the newly released egg. These three portions of the tube work together to carry sperm out to the end of the tube, pick up the egg, and provide a site for fertilization. They then carry the fertilized embryo to its resting spot in the uterus.
The pathway to the egg is an arduous one; only a small proportion of the ejaculated sperm find the egg. At ejaculation, sperm are deposited in the vagina and then swim through the cervix and uterus and into the fallopian tubes. Some reports indicate that sperm can be found in the fallopian tubes within five minutes of ejaculation 51; they are quite speedy. The sperm travel with the motion of their own tails and with assistance from muscular contractions in the uterus and tubes, and with the motion of cilia, tiny hair-like cells that line the inside of the tube. The sperm travel to the end of the tube, where they meet and fertilize the egg. The fertilized egg, or embryo, then moves back down through the tube to the uterus, taking several days to make the journey.
With such a delicate and sophisticated pathway, it is common for problems to develop in the tubal system. Here are a few of these:
Cornual Occlusion: The connection between the uterus and fallopian tube is a fragile area that can become blocked. This is referred to as cornual occlusion or proximal tubal occlusion. Most blockages are actually contractions of the uterine muscle and are not true blockages. The diagnostic test to detect this can irritate the uterus and cause the uterine musculature to contract. This is a temporary condition that has no effect on fertility. Other blockages reflect true problems in this portion of the tube, which can result from infection or inflammation, fibroids or polyps, or use of an IUD. A common example is a condition known as Salpingitis Isthmica Nodosum (SIN), in which the tube becomes inflamed and nodules develop in the glands that line this portion of the tube.
Isthmic Occlusion: This condition occurs only rarely naturally. The isthmus is the smallest and narrowest portion of the tube, but has a thick muscular wall that is not easily damaged. Tuberculosis and other infections and tubal polyps are possible, but rare causes of isthmic occlusion. Most cases are intentional 51; this is the location where a tubal ligation is performed for sterilization.
Hydrosalpinx and Fimbrial Phimosis: The hydrosalpinx refers to a tube that is filled with water ("hydro" = water, "salpinx" = tube). With infection by bacteria, such as gonorrhea or chlamydia, the end of the tube can become inflamed. If the end of the tube becomes blocked, fluids can no longer drain from the tube, and build up under considerable pressure. These fluid filled tubes can become quite large, requiring surgical removal. A hydrosalpinx is unable to pick up eggs, resulting in infertility, and is subject to infection. Milder degrees of injury to the tube can result in loss of or damage to the feathery appendages of the tube, the fimbria. This is known as fimbrial phimosis. This can vary from quite subtle degrees of blockage to nearly complete obstruction of the tubes.
The tubes are quite delicate in their structure and function, and any of this delicate structure can be injured. The ciliary cells that help sperm and embryos move through the tubes can be lost. Studies often show patches of missing cells, probably victims of injury from bacterial infections. This can happen throughout the tubes. The folds that occur in several segments of the tubes can also be injured, resulting in blind cul-de-sacs through which sperm and embryos cannot pass.
Diagnosing these problems usually requires a medical study. The exact tests are determined in association with a fertility specialist, a physician who is board certified in reproductive endocrinology and infertility.
Examples of tests used for diagnosing tubal problems are:
Ultrasound: Most patients will start with an ultrasound, in which uterine and ovarian relationships can be studied. A normal fallopian tube is almost always invisible on ultrasound. A hydrosalpinx may appear as a large fluid filled cyst between the ovary and uterus.
Hysterosalpingogram (HSG): The HSG is a dye study of the uterus. At pelvic exam, a catheter is placed in the cervix and dye flushed into the uterus and tubes with gentle pressure. An X-Ray picture is taken of the uterus and tubes. It may reveal cornual occlusion, or a hydrosalpinx, the most common abnormalities, or more subtle problems like tubal polyps and fimbrial phimosis. Commonly one of the tubes fills and spills dye more easily than the other, a phenomenon known as preferential spill. The HSG can cause cramping, which is usually mild, but can be quite strong in women with a sensitive uterus. Ibuprofen taken 2 hours before the procedure can help reduce the cramps. The procedure carries a small risk of infection, but this is usually only seen when tubal injury is present.
Treating these problems is highly individualized and depends on the patient's age, medical problems, and patient wishes. The available procedures are:
Laparoscopy: Laparoscopy is the classic procedure to evaluate and treat tubal disease. Under anesthesia, an incision is placed in the belly button, and a small television camera is placed through the incision. The doctor can look at the pelvic organs, and introduce some treatment equipment through small ¼ inch incisions. Problems can be treated with scissors, cautery, or a laser.
Tubal cannulation: Devised for the treatment of cornual occlusion, a tiny wire is placed through the cervix and uterus and into the tube. The wire gently opens the tube and may relieve an obstruction in this area. Tubal cannulation can be performed in the X-Ray department under fluoroscopy or via a hysteroscope. A physician who is experienced in the techniques is essential.
Evaluation of these problems can be complex, and devising a treatment plan requires a close relationship with a physician with experience in these areas. A few common scenarios follow:
Hydrosalpinx: A hydrosalpinx carries risk of infection and very low pregnancy rates even after treatment. Hydrosalpinx can be treated laparoscopically, a procedure known as neosalpingostomy. In neosalpingostomy, an incision is made in the end of the hydrosalpinx and the edges of the incision are folded or flowered back, leaving an open tube. The best outcomes occur in young women with a small hydrosalpinx. Unfortunately, the tube often closes back up, and pregnancy rates are relatively low. Even when the fallopian tubes are bypassed, via techniques such as in vitro fertilization, a hydrosalpinx can have adverse effects on pregnancy rates. Basically a small hydrosalpinx in a young woman might be repaired, with the understanding that further surgery might be necessary if the repair is unsuccessful; a larger hydrosalpinx should be removed.
Bipolar Disease: Bipolar disease refers to the situation in which there exists injury to both the cornual and the ampullary or fimbrial portion of the tube. It is very difficult to get a satisfactory repair when problems are present at both ends of the fallopian tubes. Most patients with bipolar disease should proceed to in vitro fertilization.
Tubal adhesions: Some patients with an otherwise normal evaluation, including a normal Hysterosalpingogram, can have subtle adhesions over the fallopian tube and ovaries. These adhesions appear like cobwebs over the surface of these organs, and can prevent eggs successful ovulation, prevent the tubes from picking up eggs, and limit the mobility of the tubes. Patients at special risk for these problems include those who have used IUDs, had abdominal problems, such as appendicitis or an ovarian cyst removal. Limited adhesions benefit from laparoscopy. The adhesions can be removed with scissors, cautery, or a laser. Age is a significant factor in who will respond to these procedures 51; younger women benefit more than older women.
42 Comments:
At Fri Mar 30, 10:21:00 AM 2007,
Nicole said…
Any thoughts on the following:
Hydrosalpinx from birth defects along with an accessorary tube coming off of other tube. Hydrosalpinx was removed but the remaining tube was not showing any fimbria but was clear. No other complications.
I was told all of these issues were birth defects. Do I have any chance of pregnancy or is IVF my only hope?
At Fri Mar 30, 12:15:00 PM 2007,
Dr. Carl Herbert said…
A congenital hydrosalpinx is quite unusual but possible. The etiology of the hydrosalpnx might have some bearing on the quality of the repaired tube as an infectious etiology will definitely damage the very delicate cilia which line the inside of the tube and help move the egg/embryo on its journey to the uterus. A congenital defect may allow those cilia to remain intact and after a surgical procedure to open the distal end of the tube, there might be some hope for a successful pregnancy without IVF. Your hydrosalpinx was removed and therefore, there is not a hope for that tube. You might ask your doctor what the pathology of the tube demonstarted at the pathological examination which would have occurred after the surgery. It might be interesting to know what the cilia and tubal endothelium (lining) looked like.
The other tube demonstrated either an accessory tube or perhaps what is more common, an accessory tubal ostium. This is a small extra opening attached to the more distal part of the main fallopian tube but usually has little hope of being functional. Because the main tube did not appear to have any fimbria, it is quite unlikely (although never impossible) for the egg to get into the tube to provide an opportunity for conception. Again, the reason for the lack of fimbria may be some sort of congenital defect but may also represent a patent(open) hydrosalpinx possibly secondary to an infectious cause and therefore the inside of the tube may be damaged as well. In this case, there is a high risk for a tubal pregnancy if you are able to conceive.
All said, your best approach for getting pregnant is definitely IVF. Fortunately the complete hydrosalpinx has been removed which would have been recommended before attempting an IVF procedure. The other tube is open, so it should not have an adverse affect on IVF success. Remember, it is still POSSIBLE, although unlikely, to develope a tubal pregnancy during an IVF procedure. On occasion, the embryos transferred back into the uterus will migrate back into a fallopian tube and can become trapped there, especially if the tubal lining is damaged or abnormal for any reason. This is not a reason to avoid IVF just a reminder to remain alert until the first pregnancy ultrasound confirms an intrauterine location for your pregnacy. I do recommend you seek IVF treatment and certainly hope you will be successful.
Dr. Carl Herbert
At Mon Apr 09, 03:42:00 AM 2007,
Anonymous said…
Nancy
Doctor said that my tube are patent after an hysterosalpingogram which was done after 6 months of my miscarriage when I had to perform a curtage.
Now 5 years elaspse and still no sign of pregnancy, I feel sometime that after an intercourse sperm spil out from the uterus easily... I have been recomended to perform a Laparoscopy. I am very confused of how the laparoscpy will suceed help me in developing a pregnacy....
At Mon Apr 09, 07:22:00 PM 2007,
Dr. Carl Herbert said…
Dear Nancy,
A laparoscopy will allow visualization of the entire pelvis area as well as making sure your tubes have remained open over the last 5 years. It is possible to have open tubes on HSG but significant adhesions (scar tissue) around the tubes. These adhesions are not visible on HSG but can decrease the ability of the tube to pick up an egg. You also might have endometriosis or other abnormalities which can only be diagnosed by seeing them. Fortunately, many of these conditions which decrease pregnancy rates can be successfully treated during the laparoscopy procedure. I recommend a laparoscopy mostly in young women (younger than 35 years) who have no explination for their infertility or who have a history or symptoms of a condition which can be diagnosed and treated with laparocopy. With older women and sometimes those with recurrent miscarriages, the cause of infertility is much less likely to be found at laparoscopy so the recommendation for this surgical procedure is made less frequently.
Dr. Carl Herbert
At Tue Apr 10, 10:48:00 PM 2007,
Anonymous said…
i have 2 kids that are 17 and 18 but want to have a baby and they said i have a cyst if it is removed do i have a chance at having a baby i'm 34 no miscarriages ever and had a doctor look at my tubes and said they were blocked can they be unblocked at my age and i have very painful periods and sex sometimes.
please help
At Tue Apr 17, 11:06:00 AM 2007,
Carl M. Herbert, MD said…
Dear Anonymous,
You have presented several issues which I'll try to address. First you were fertile several years ago as you have 2 children. However, it has ben 17 years since your last pregnancy, so things may have changed in the interim. Your doctors have told you you have a cyst. This is a very non-specific discription because you can have many different types of cysts in many different locations. The most common location described for a woman would be on or near her ovaries. Every time a woman grows a follicle to ovulate an egg, she makes a cyst. This is a normal physiologic cyst that is of no significance. However, a woman might have endometriosis in her ovary which is the classic "chocolate cyst" and it can be associated with endometriosis in the pelvis. This condition can decrease fertility and is also associated with painful periods and pain with intercourse. Because your doctor has said your tubes are blocked, the cyst may represent fluid in your tube or a "hydrosalpinx". Obviously, you will need more evaluation and information about this cyst to decide if it needs treatment and how best to do the treatment if it is needed.
Blocked tubes will make you infertile. Occasionally the blockage represents a condition that can be treated surgically to open the tubes and make them functional for creating a pregnancy. However, often the damage to the tubes is severe enough that treatment is not an option. In those cases, in vitro fertilization will allow you to by-pass the tubes and attempt a pregnancy by removing your eggs, fertilizing them in the laboratory and placing them directly into the uterus. At age 34, most women still have a number of good quality eggs, and, therefore, can expect good success rates using this approach.
Dr. Carl Herbert
At Thu Apr 19, 11:25:00 AM 2007,
Ratna said…
Dear Sir,
I am 40 year old Indian lady. I wanted an experts suggestion my doctor has treated me for DIAGNOSTIC LAPAROSCOPY to find out the position of fallopian tube.
The findings on Laparoscopy is : Per vaginal examination under anaesthesia revealed normal sized antenerted uterus, freely mobile, fornices clear, Utero cervical length 3" On laparoscpy , Uterus appears normal in size and contour. There are thick bands of adhesions between anterior surface of uterus and anterior peritoneal wall. No adhesions of fluid in pouch of douglas. Both the tubes normal looking. Ovaries are normal Chromopertubation done. Spill absent . No dye seen in left fallaopian tube. Floe of dye seen in right fallopian tube up to before fimbrial end. Beading present. Extravasation of dye seem. Endomentrial sampling done Tissue sent for PCR.
Can you please suggest me how can I proceed is IVF the only way out, or these tubes can be treated.
I will e very thankfull for the suggestion, In case i need to visit i will plan for the same.
Kind Regards
Ratna Khera
Delhi, India
At Fri Apr 20, 09:25:00 AM 2007,
Carl M. Herbert, MD said…
Dear Ratna Khera,
It is always a bit difficult to be certain about fallopian tubes when reading a report. However, I will give you what information I can. At the time of your laparoscopy, there were some adhesions in front of the uterus but fortunately not behind the uterus where the tubes and ovaries are located. These adhesions represent repair of some form of damage. The damage may have been caused by endometriosis or possibly infection. If the original cause was infection and the tubes were affected, there is usually adhesive disease involving the tubes and ovaries but in your case that was not seen. Nevertheless, no dye was seen going into the left tube (proximal tubal occlusion) and although there was dye in the right tube, no dye would spill out of the distal end. If this attempt at chromotubation reflects true obstruction, you will not be able to conceive as things are currently. I am uncertain how to interpret the comment about "beading" although tuberculous infections of the tube can create "pockets" which might be interpreted as "beads" and therefore, the endometrial cultures may be important to insure there is no evidence of tuberculosis. The extravasation means the dye went into the vascular(venous) system or lymphatic system. I am unsure of whether the origin of the extravasation was from the uterus or tubes. Most commonly the blue dye is seen in the vessels next to the uterus and the source is pressure inside the uterine cavity, not the tubes. This can also occur if the devise placed through the cevix to introduce the dye, accidently sticks into the uterine muscle. This would also compromise the process of chromotubation and possibly give a false picture of tubal occlusion as the dye cannot flow freely into the tubes. I bring this up as one example of the difficulties when interpreting operative reports. Your doctor who performed the surgery will have the best idea of your true situation.If there is real proximal tubal occlusion, it can often be opened with a tubal cannulation procedure. As you are undergoing a hysterosalpingogram type exam to see if there is real occlusion, you can have a small catheter with a delicate wire passed through the proximal portion of the tube and possibly treat the obstructed area. This might work for the left tube. The right tube is more difficult to assess because I cannot be certain if the inside of the tube is damaged and does not allow the dye to flow out the fimbriated end or if the end of the tube itself is damaged and closed. Fixing this tube might be significantly more difficult. Finally, you are now 40 years old and as a result, have some degree of fertility issues related to age. On the basis of your age, the difficulty of being certain about your tubes and the follow-up time needed for success even if surgical repair is possible, most fertility experts would recommend you move to IVF if possible. IVF will allow you to by-pass the tubes and, therefore, avoid problems conceiving and problems of a tubal pregnancy which can arise as a result of tubal damage, even after it is repaired. I hope this is helpful but be sure to speak further with your doctor/surgeon to get their opinion as that should be the best source of accurate information. Dr. Carl Herbert
At Fri Apr 27, 03:27:00 AM 2007,
Anonymous said…
Dear Doctor
Thank you very much for explaining my position. I do not now what went wrong while proceeding my Laparoscopy test and it was declared that it is not possible to concive without help of IVF. Today i am pregnent ( 7 weeks) without any medicine or treatment. How it happened can you please explain it to us.
Kind Regards
Ratna Khera
At Fri Apr 27, 06:28:00 PM 2007,
Carl M. Herbert, MD said…
Dear Ratna Khera,
Congratulations on being pregnant!!!Are you certain the pregnancy is in the uterine cavity and not in one of the tubes? If not, be sure to get an early ultrasound to locate the implantation site. Now, back to your laparoscopy. There are several explinations for a pregnancy after the findings you reported at laparoscopy. Fisrt, I mentioned the placement of the catheter which injects the dye during the surgery to evaluate tubal patency. If the catheter is accidently stuck too deeply into the uterus such that the end actually penetrates or is obstructed by the uterine muscle, the assessment of tubal patency will be misleading. I bring this up because of your comment regarding extravasation. Clearly, at least one of your tubes was open because the egg and sperm united and that can only happen if the is not complete bilateral occlusion. The dye test did show filling of the right tube but no spill. If there was a problem getting enough pressure or dye into the tube, it might not show spillage, even though the tube was patent. These are the problems I spoke of when attempting to interpret an operative note. Secondly, there was no dye seen entering the left tube, so perhaps there was proximal tubal spasm which prevented the passage of dye but the tube was actually open. A slight increase in pregnancies has been reported in certain groups of patients after laparoscopies (as well as hysterosalpingograms) so there may be some benefit to the attempts and/or completion of passing fluids into and through the fallopian tubes. Finally, remember diagnostic tests like HSG or laparoscopy create information which is interpreted to help make a diagnosis and plan treatment. However, there are pitfalls to interpretation of all tests and, therefore, both false positive and false negative results. Although no dye was seen flowing through your fallopian tubes and spilling freely from the ends, at least one of the tubes was open. A diagnosis of bilateral tubal occlusion was incorrect but consistant with what was observed at the time of your surgery. Again, congratulations and the very best wishes for a successful and uncomplicated pregnancy and delivery.
Dr. Carl Herbert
At Thu May 10, 04:23:00 AM 2007,
Anonymous said…
I had a laparoscope in september 2006,i was told that my left tube is blocked no dye.
I went to a different dr. who i told my story to and he put me on clomid for the 1st month,and then he game me a pregnyl injection the 2nd month and the 3rd month clomid again.What are my chances of conceiving???
At Mon May 14, 01:43:00 AM 2007,
Anonymous said…
Hi Dr Carl,
I do observe a vaginal discharge which is thick like a white paste.
Can you pls tell me if this can be a cause if infertility as well.
This is really uncomfortable and very itchy
Thank you in advance for your advice.
Krgds,
Nancy
Mauritius
At Tue May 15, 10:09:00 AM 2007,
Carl M. Herbert, MD said…
Dear Anonymous,
You were told your left tube did not transmit dye during a laparoscopy procedure in 2006. It is important to know whether the dye never entered the tube (proximal tubal occlusion) or filled the tubal but did not spill out the end because of distal tubal damage. Often, what appears to be proximal tubal obstruction (no dye entering the tube) is a problem of spasm in the uterine muscle and not true obstruction. If there is distal tubal damage/obstruction the cause is frequently some form of infection and the other tube, although not blocked, is often adversely affected. You only need one good tube to conceive, so even if the left tube is blocked, the right can work to produce the pregnancy if it is otherwise normal. The use of clomid and gonadotropins by your doctor is an attempt to have you ovulate an extra egg or two to increase the odds that at least one of the eggs will be picked up by one of your tubes and also to increase the odds that you will ovulate from your right ovary which is associated with the tube which was definitely open at laparoscopy. The odds that you will get pregnant has to do with many factors such as sperm count, your age, your response to these medications, and any other fertility factors , so I can't really give you a reliable number. If indeed one or both of your tubes are damaged and you don't conceive soon, it will be best for you to consult a fertility specialist who can offer you IVF.
Carl M. Herbert M.D.
At Wed May 16, 05:28:00 PM 2007,
Carl M. Herbert, MD said…
Dear Nancy,
A thick white discharge which itches is most commonly caused by yeast. However, there are other causes and you should definitely see your gynecologist for diagnosis and proper treatment. If the discharge contains white blood cells (pus) it may be caused by some dangerous bacteria which can damage your tubes. Properly treating any abnormal vaginal discharge will improve your fertility and should be done.
Dr. Carl M. Herbert
At Tue May 22, 08:24:00 AM 2007,
concerned mother said…
My daughter had the dye thing done and the dye went nowhere. Why? Now they are going to do an MRI. Why not an ultrasound?
At Tue May 22, 03:45:00 PM 2007,
Carl M. Herbert, MD said…
Dear Concerned Mother,
Your daughter had an HSG (dye test) and the dye "went nowhere". I assume the dye did not even enter the fallopian tubes so her diagnosis at this time is bilateral proximal tubal occlusion. I am not aware of how an MRI, which is quite expensive, will help clarify this diagnosis. If the tubes are also damaged and blocked distally, you might see fluid in the tubes (hydrosalpinx) but that can usually be found by ultrasound. The "blockage" seen on the dye test may simply represent spasm of the uterine muscle which prevents dye from entering the tubes. It may also represent mucus plugging or a minor membrane which can easily be removed by repeating the HSG procedure and using a small catheter and wire guide if needed to document or create open tubes. Therefore, the most common next step for your daughter would be a repeat HSG with possible tubal cannulation. If that is not available or doesn't work, the next step is usualy a laparoscopy so a doctor can look at the tubes and again attempt to push dye through them while your daughter is relaxed by the anesthesia. The doctor can also perform hysteroscopy (look inside the uterus) and the tubal cannulation procedure using a hysteroscope during that same anesthetic. If the tubes are badly damaged, scarred closed in the proximal part, your daughter will need to decide if she wants to have microsurgical repair or simply undergo IVF to get around the blocked tubes. Fortunately, many of what appear to be blocked tubes, are not and one of the simple procedures described above will work.
Dr. Carl M. Herbert
At Sat May 26, 04:46:00 PM 2007,
Anonymous said…
Dear Dr Carl
Suffering years of painful ovulation, I had an HSG in may 2006 & was advised that the dye did not spill out & that I had blocked & scarred fallopian tubes & would likely need IVF to concieve. However, only 7 weeks later I discovered I was pregnant. I must have concieved approx 1 week after having the HSG, so it did temporarily unblock them. Sadly I miscarried only a few days later.
I became pregnant again in April this year but sadly miscarried once again, at 8 wks this time. I am wondering if the scarred tubes could be harming the embryo when it is travelling to the utereus & therefore might be a reason for the 2 miscarriages now??
I have tried to research this matter on the internet however there seems to be no information whatsoever on scarred tubes being a reason for miscarrying.
Should I also be asking my own GP for testing into the reason as to why this has happened twice now. After the last miscarriage, I required to have a D&C & the hospital advised me that the embryo & contents would be sent to their lab for testing. What kind of testing would have been done & is it likely those results will be available for me to access now?
Many thanks in advance for your help
Charlie
At Sun May 27, 06:13:00 PM 2007,
Anonymous said…
i went for an laparoscopy on the 22nd of may 2007 i was told that my right tube was blocked and my left tube had a lot of scar tissue on it. What does this mean? Will i every have a baby naturally or will i have to have ivf? my heart is breaking.
At Thu May 31, 02:52:00 PM 2007,
Anonymous said…
Dear doctor
I have been try to get pregnant with no success I decided to see a gynecologist I was told that I have a hormone imbalance and stared taking treatments with no success gynecologist recommends HSG only to realizes that one of my fallopian is blocked an the other one is parsley blocked.
What are my chances of becoming pregnant?
I don’t know what to do.
I will be very thankful for the suggestion,
At Fri Jun 01, 08:41:00 AM 2007,
Anonymous said…
DEAR DOCTOR
I AM A 40 YR OLD INDIAN WOMEN - WHO RECENTLY WENT THRU A LAPROSCOPY & HSG AFTER WHICH THE DOCTORS HAVE DIAGNOISED THAT BOTH MY FALLOPIAN TUBES ARE BLOCKED AT THE POINT WHERE THEY JOIN THE UTERUS . I AM DISTRESSED . CAN I NEVER CONCIEVE??
EARLIER I HAD UNDERGONE A HYSTEROSALPINGOGRAPHY IN 2003 THE RESULTS OF WHICH SHOW BOTH TUBES FILLED & GOOD SPILL INTO THE PERITONEAL CAVITY ON THE LEFT SIDE & MINIMAL SPILL ON THE RIGHT SIDE . BOTH TUBES FILLED & SHOWED NORMAL CALIBER COURSE & OUTLINE
WHAT COULD HAVE CAUSED THE BLOCKAGES & WHAT IS THE SOLUTION . PLEASE HELP
At Tue Jun 12, 05:49:00 PM 2007,
Anonymous said…
Hello Dr. Herbert,
I just turned 34 in April ‘07. After 3-4 months of trying to conceive, I became pregnant in month 6 (after using ovulation predictor during month 5 and 6). Unfortunately, when I was approx 8-5 wks pregnant, we learned I had an ectopic pregnancy in my right tube. We tried medical treatment (methotrexate) but still suffered a rupture about 12 days after the injection. The tubal rupture caused the loss of 40% of my blood and my right tube was snipped. Apparently, the ectopic occurred close to the uterus. The MD that conducted the surgery, said she looked at the left tube from the outside and that it looked okay—though she did remove some tissue from around the tube. Both my MD and the MD that conducted the surgery have advised that I have a good chance of conceiving in the future and that it is more likely than not that I will have a pregnancy in the uterus—despite the elevated risk of a reoccurring ectopic in the left tube. Today marks 3 wks since the rupture. I am incredibly afraid of a reoccurring ectopic and another potential rupture. Due to this fear, I was informed that I could participate in IVF (to circumvent the tubes). Setting my fears aside, do you believe I am a good candidate for IVF? The following is additional information re: my medical history: I have been pregnant 2 other times in the past (once in 1987 and a second time in 1989). Both prior pregnancy were in the uterus and I elected to terminate them both. Also, after these pregnancies, when I was about 19 or 20 yrs old, I was diagnosed with chlamydia and gonorrhea. I do not know how long suffered from these STDs, but I was eventually treated with oral antibiotics. I do not know if these STDs ever developed to PID. Is it possible that these STDs developed into PID without my knowledge? Also, what part of the tube PID generally affect (if this is known info)?
Sincerely,
Anonymous
At Thu Jun 28, 06:04:00 AM 2007,
Anonymous said…
Dear Dr Herbert
Following a lap and dye last month, I was told I was 'highly unlikely' to conceive naturally. I have clubbed fimbria and loculated fallopian tubes following peritonitis aged ll. I am now 31. In the UK, the NHS does not offer tubal surgery. I'd welcome your opinion as a US doctor as to whether tubal surgery could help me, or if I'd be better aiming for IVF. Thanks so much. Emma.
At Sun Jul 29, 12:37:00 PM 2007,
Anonymous said…
We are currently trying for a baby and have been for 6 months. I am worried that I have damaged fallopian tubes due to contracting chlamydia when younger and having it possibly for 3 years. I have extremely regular periods and am ovulating (have done ovulation predictors tests for 3 months). Does this mean I should not be worried about conceiving, I am beginning to think I am unable?
At Thu Aug 09, 07:57:00 AM 2007,
Anonymous said…
Dear Dr Herbert,
Just want to share my happiness with all of you, did not yet perform a laparoscopy surgery, I am actually pregant, 5 weeks.
Guess this is the God will and a pure blessing.
Krgds,
Nancy
At Thu Aug 09, 06:40:00 PM 2007,
Anonymous said…
Dear Dr Carl,
I had HSG, and the result is. The proximal position of the left fallopian tube is opacified without peritoneal spill of contrast and the right fallopian tube is demonstrated and there is loculated peritoneal spill. I had the HSG done after my surgery. It was abdominal myomectomy to remove fibroid. What do they mean by this result and is it possible for me to conceive naturally? And is my fallopian tube ok?
hope to hear from you soon. thanks
At Thu Aug 09, 06:43:00 PM 2007,
niike said…
Dear Dr Carl,
I had HSG, and the result is. The proximal position of the left fallopian tube is opacified without peritoneal spill of contrast and the right fallopian tube is demonstrated and there is loculated peritoneal spill. I had the HSG done after my surgery. It was abdominal myomectomy to remove fibroid. What do they mean by this result and is it possible for me to conceive naturally? And is my fallopian tube ok?
thanks. hope to hear from you soon.
At Tue Aug 21, 07:40:00 AM 2007,
Anonymous said…
Dear Doctor,
Wondered if i could have you opinion on my situation?
I have been trying to concieve for 3 years with no sucess and had a lap and dye test which showed my tubes were not blocked but they did discover that i had adhesions and scaring from peritenitus. I had an operation that removed the adhesions etc last month i am young - in my early twenties what do you think my chances of sucess of a natural pregnancy are and how long would you think it should take to get pregnant after this surgery?
Any help/advise appreciated.
Thanks Em
At Tue Aug 21, 07:50:00 PM 2007,
Anonymous said…
Hi Dr Herbert,
I really need your advise...I am 34 years old mother of 2 ages 15 and 11. We had been trying to conceive for 3 years. The gyne sent me for an hsg which showed a blocked tube. My gyne then sent me to a fertility specialist. That was a year and a half ago.. In that time, I tried clomid in dec of 05. Did not work. Dr did not like the size of my lining did a biopsy which showed hyperplasia. so he did a D and C with hysteroscopy. I had polyps removed and Tissue came back ok. But he put me on progesterone for 3 months. The first month off of progesterone and ttc we found out I was pregnant with twins. Unfortunately it ended with a missed miscarriage at 9 weeks. We have been ttc again since dec 06 with no luck. I was on Letrozole for two months then this month I did Letrozole and a trigger shot. Unfortunately it did not work. Now my dr. wants me to do an iui which my insurance doesn’t cover... I am so scared that it is useless.... I am scared that I still have a blocked tube and my pregnancy was just a fluke.. I have painful ovulation each month which I read was a sign of blocked tubes... I am just at my wits end... We want to have another baby more than anything right now but am I wasting my time with an iui??? My fertility dr. never acted very concerned over the hsg results. Which I don’t understand... All of my blood work is good hubby checked out ok, and I produced follicles last month before trigger. on one side I had a 24 & 15 other side 15 & 13.. What should I do next PLEASE HELP ME!!!!!!!!!!!!!!!!!!!!
Thank you for any advice or comments..
Sincerely
babydreamer...
At Sat Sep 15, 01:17:00 PM 2007,
Anonymous said…
Hi Dr. Herbert,
I am 30 years old and have had infertility for the past 4 years. I have tried 11 IUIs with no success. I have recently had laparoscopy surgery which revealed only minimal endometriosis (endocoagulated). I was told I have only a fair chance of conceiving naturally because I have abnormal tubes (phimosis, yellow fimbria). Would you recommend surgery for this, and if so what kind? I am not against IVF, but want to be able to afford a couple children.
Thanks so much for your help,
Hollie
At Mon Sep 17, 08:56:00 AM 2007,
Anonymous said…
Dear Dr., I have had 2 ectopic pregnancies one on each side, my first one was in feb. 2005 on my left side and was successfully treated with methotrexate saving the tube (that one occurred at 5 wks) I got pregnant almost immediately after that one at the end of march and had another ectopic and rupture in the right tube (this one occured at the end of may) the MD ended up having to cut and burn the tube because of a blood clot that was underneath the pregnancy. Now during the surgery the Dr. looked at the left tube and said it appeared to look normal. 4 months later I had a dye test and the left tube spilled freely it appeared fine, the right tube had no fluid spill because of the surgery. shortly after the dye test we began to try and conceive again with no luck of a pregnancy. After about 2 years of trying, of course missing a couple ovulations, we decided to go to a fertility specialist, I had ultrasounds done,I have normal menstrual cycles, had another dye test done this was in Aug 2007, the tube again had free spillage, and then Aug 30th I had a laparoscopy and hysteroscopy done. during my followup appointment on sept 10th the Dr. said I had no adhesions or anything else that needed treatment(removal). However I had some options I could try clomid, clomid with iui, injectables, or ivf...he also said that because i have had 2 ectopics one in each side that there could be something else wrong with the tube and my chances for another ectopic have increased. Could the cillia in my tube be damamged? and if it is does it totally prevent me from having a normal pregnancy? I have the prescription for clomid but am afraid it will be a waste to even try that if the cillia is damaged...please help me
At Mon Sep 17, 10:54:00 PM 2007,
Anonymous said…
Dear Doctor, I am 23 years old and i have a past history of PID, Overian cysts and also after HSG X-ray i have been diagnosed with two blocked fallopian tubes, that is, hydrosalphinges. I had surgey to remove the cysts earlier this year. After having the two HSG X-rays i suffered serious infection and was hospitalised. The 1st time i did HSG X-ray in June this year i did not suffer Hydrsalphinges. However a doctor did a small surgical procedure where i was put under anestethic and a solution with steriods & antibiotics etc was introduced into my tubes under pressure through my vaginal passage. No cutting was done. After this procedure was done, another HSG Xray was done to see if there was any success in clearing the tubes, but instead the tubes showed not only to be blocked, but also showed swollen at the ends close to the overies (hydrosalphinges) as stated on my x-ray. I am almost always in alot of pelvic pain and always have a high fever. I dont have children but i am married four years. I am confused if i should remove my tubes? Or should i try repairing them? Or will these dredful infections re-ocour? Or should i remove the tubes and them try IVF? The doctor's i have seen so far has said that they can't gurantee that i won't become re-infected. I am worried about my health since it has taken a toll on my job, my marriage, and my life. Also these procedures are very costly for me. I feel very depressed. Please help me. :(
From Trinidad...
At Fri Oct 05, 04:07:00 AM 2007,
Anonymous said…
Having posted on this site some time ago, my worry that having had chlamydia for possibly 3 or more years, I was concerned that I had damaged fallopain tubes and may not be able to conceive. Joyous news, I am 9 weeks pregnant! I hope this is helpful to you, if I had heard of someone who had my health history, being able to concieve it would have helped me no end. I hope you are all as lucky, all the best,
At Mon Nov 05, 10:52:00 AM 2007,
Anonymous said…
Hi Dr. Herbert , I'm 22 and i had a HSG about 4wks ago and the report said that my left tube was patent and the right tube was blocked, however my doctor told me that both are bocked and what seemed to be patentcy of my left tube was extravasation. I'm schedule for a laparscopy next month, i'm hoping this helps because i've been pregnant before twice but i terminated those pregnancies, wouldn't this suggest i can still have children?
At Mon Nov 05, 04:44:00 PM 2007,
Anonymous said…
dear doctor, i have had both the laproscopy and the hsg test and the doctors tell me im fine. but still no luck getting pregnant, im and older women with some hope of having atleast one more child, is there any advise you can give me to conceive without IVF
At Sat Nov 10, 09:25:00 PM 2007,
Anonymous said…
Im 32 years old and i just found out that i have an inflamed fallopian tube and i was put on antibiotics i was wondering if there was still a chance for me to concieve?
At Tue Nov 27, 06:28:00 PM 2007,
anonymous said…
anonymous
Dr carl herbert i am a 34 year old
i have two kids and have had one miscarriage due to fibroyds push the baby out. ihad the surgery to remove the fibroyds has been 4 yrs
now and i want to have another child my kids are 12&9 . i took the dye test and the right filopian tube the dye went threw but did not drip out like it was suppose to. the left tube my doctor said was inactive.so she refered me to a specialist which invetro cost to much fro my buget. so is there another way i can go can my tube be open with out invetro? i am about to lose my mind.
At Tue Dec 04, 11:36:00 PM 2007,
Anonymous said…
Two months back a laporoscopy test revealed that my fallopian tubes are blocked. Is there anything i can do to unblocked them.
Thank you!
Anonymous
At Wed Dec 05, 07:21:00 PM 2007,
Anonymous said…
DR CARL I WANTED TO KNOW IS THERE A CHANCE THAT THE FILOPIAN TUBE BE OPEN. I TOOK THE DYE TEST AND IT WENT THROUGH. BUT IT DIDN'T LEAK OUT. SO NOW THE DOCTOR REFERED ME TO A SPECIALIST. IAM DESPRATE TO KOW WHAT ARE MY CHANCES OF CONCIEVING.I HAVE TWO BOYS ONE 9 AND ONE 12 AND HAVD A MISCARRIAGE DUE TO FYBROYDS WHICH I HAD THOSE REMOVE AND THE DOCTOR SAID I HAVE ONE INACTIVE FILOPIAN TUBE AND THE OTHER IS SOME HOW BLOCK ANT THE END AND IT CAN'T DELIVER TO THE EGG ? PLEASE TELL ME WHAT TO DO.
At Sun Dec 16, 10:37:00 AM 2007,
Anonymous said…
Dear Dr ,about 11 yers ago i had my tubes tied i decide i want another baby how do i go about having this reverse?
At Wed Dec 19, 11:29:00 AM 2007,
midnightrider35 said…
i am 39 years of age ,female, and have had 4 kids, now i am in the stage of trying to have another, went to a fertility clinic and found out my tubes were blocked, an attemped to reopened then , only opened one, the other unsucessful. since my tube was open i seem to be only ovulation from the closed side. is there still a possiblity of getting pregnant. i don't wish to use ivf
At Thu Jan 10, 01:24:00 PM 2008,
Anonymous said…
hi i am 31 yrs old and suffered an ectopic pregnancy in 2005 both my doctor tells me that both my tubes are blocked i really want another child me and my partner would like to do ivf but its too expensive and because i have a child allready we cannot get nhs. if we was going to go for ivf what procedure woul we need because as far as i know everthing else is fine. please dr help us
At Tue Apr 22, 03:25:00 PM 2008,
kathleen said…
i am 34 yrs old and have been trying 4 8 yrs to get pregnaant my husband has since left and had a baby. i am now trying 4 4 mths with another partner . i ha da myomectomy 2 yrs ago and did an hsg yesterday which shows :the uterine cavity is distended and filling detects are shown suggesting uterine fibriods. the right tube is patent .spill is demonstrated at the fimbral end of the right tube. the left is proximally obstructed. what are chances is there any hope for me
kathleen
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