Fallopian Tubes Obstruction - Conception Without Ivf?? Posted: 10-13-06 00:36am
Me, a woman -- 41 years of age, has a
problem:
diagnosis of bilateral tubal obstruction!
2 specialists recommend
ivf, but we want to investigate the cause
of the obstruction and which
other possibilities there are.
gynaecologist' comments on the cloud like
formations on the hsg:
''the images seem most suggestive of
post-inflammatory tubal blockage.
The 'clouds' look to me as if the contrast
medium has been blocked from
entering the tubes and has possibly to
some extent been forced into the
little blood vessels close to the cornu of
your uterus on both sides
(...)''
one doctor diagnosed that the obstruction
came from a former infection
but she does not recall any such
inflammation ... Salpingitis isthmica
nodosa http://www.Jansen.C
om.Au/silver/13_e.Htm#sin
========
letter of another doctor:
in particular I must agree that the hsg
appearance of your proximal
fallopian tube does suggest the
possibility of post inflammatory
blockage of both tubes (rather than the
somewhat unlikely possibility
that the fibroids have blocked your
tubes). It was useful to view the
hysteroscopy images from your procedure in
2003, when you underwent
endometrial polypectomy - at that stage,
on these images, there was no
suggestion of a component of the fibroids
impinging on your uterine
cavity (although it must be said that this
was 3 years ago).
In summary, we have discussed the options
for management henceforth as
follows: '''proceed with ivf''' this
may well be a sensible first
choice ....
Diagnostic hysteroscopy with laparoscopy
and dye studies would
certainly give you more information about
whether the fallopian tubes
are indeed blocked proximally and might
add to the clarity of why this
had occurred.
Myomectomy. Even if determined to be
appropriate on hysteroscopic
appearances, certainly has risks
associated with transcervical fibroid
resection and firm evidence of benefit of
myomectomy in improving
fertility is lacking.
Concept of recanalisation of the fallopian
tube by transcervical
hysteroscopic technique ...
As highlighted by you from your internet
research, but I am not at all
certain that this is available in (this
country), indeed I would regard
this approach as unsupported by firm
evidence.
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