Request Comments! -- Blocked Fallopians -- Conception without IVF

A woman -- 41 years of age.

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.

Hysterosalpingogram showed no dye flow:

http://www.250kb.de/u/061007/j/0738281b.jpg
http://www.250kb.de/u/061007/j/f7899ae1.jpg

letter from Radiology Clinic after HSG was performed:
http://www.250kb.de/u/061007/j/dd1ac4c6.jpg

==========

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
(...)''

=========

What do you think about selective salpingography?
http://www.centerforhumanreprod.com/...ne.html#select

========

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.com.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.

========
========

Related links:

http://rad.usuhs.mil/medpix/medpix.h...ter&pt_id=7659
http://brighamrad.harvard.edu/Cases/...e/56/full.html

wrote in message
ups.com...
A woman -- 41 years of age.

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.

Hysterosalpingogram showed no dye flow:


Hysteroscopy is an obvious next step. If the tubal ostia are clear on that
exam, selective salpingography with dye, possible intraoperative flouroscopy
and concomitant laparoscopy. The tubes need to be visualized and evaluated
as to whether adhesiolysis can re-establish tubal patency, assuming the
cause is not submucosal fibroids.

IMHO, the end result is likely to be that IVF will be the only way to effect
a pregnancy, but the above may be worth trying if the patient wants to go to
that exent to avoid IVF.

HMc

Howard McCollister wrote:
wrote in message
ups.com...
A woman -- 41 years of age.

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.

Hysterosalpingogram showed no dye flow:


Hysteroscopy is an obvious next step. If the tubal ostia are clear on that
exam, selective salpingography with dye, possible intraoperative flouroscopy
and concomitant laparoscopy. The tubes need to be visualized and evaluated
as to whether adhesiolysis can re-establish tubal patency, assuming the
cause is not submucosal fibroids.

IMHO, the end result is likely to be that IVF will be the only way to effect
a pregnancy, but the above may be worth trying if the patient wants to go to
that exent to avoid IVF.

HMc

Hi there,

thank you very much for your reply!

Is there any other possibilities since a Gyn here suggested
hysteroscopy+laparoscopy with dye studies.I would have to pay that
privately (about 4000 USD) which is the exact ammount for IVF.
Furthermore a radiologist/specialist gonna take a look on the HSG scans
in these day and will advise me if selective salpingogram (where a
cannula is put into the tubes to open them) could be done, but then
again I am very unsure about that because of my age and the risc of
ectopic pregnancy.

Ivf could be on the plan in december.

Good luck to every woman who is in the same position like me.
)

Howard McCollister wrote:
wrote in message
ups.com...
A woman -- 41 years of age.

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.

Hysterosalpingogram showed no dye flow:


Hysteroscopy is an obvious next step. If the tubal ostia are clear on that
exam, selective salpingography with dye, possible intraoperative flouroscopy
and concomitant laparoscopy. The tubes need to be visualized and evaluated
as to whether adhesiolysis can re-establish tubal patency, assuming the
cause is not submucosal fibroids.

IMHO, the end result is likely to be that IVF will be the only way to effect
a pregnancy, but the above may be worth trying if the patient wants to go to
that exent to avoid IVF.

HMc

Hi there,

thank you very much for your reply!

Is there any other possibilities since a Gyn here suggested
hysteroscopy+laparoscopy with dye studies.I would have to pay that
privately (about 4000 USD) which is the exact ammount for IVF.
Furthermore a radiologist/specialist gonna take a look on the HSG scans
in these day and will advise me if selective salpingogram (where a
cannula is put into the tubes to open them) could be done, but then
again I am very unsure about that because of my age and the risc of
ectopic pregnancy.

Ivf could be on the plan in december.

Good luck to every woman who is in the same position like me.
)

wrote in message
oups.com...


Is there any other possibilities since a Gyn here suggested
hysteroscopy+laparoscopy with dye studies.I would have to pay that
privately (about 4000 USD) which is the exact ammount for IVF.
Furthermore a radiologist/specialist gonna take a look on the HSG scans
in these day and will advise me if selective salpingogram (where a
cannula is put into the tubes to open them) could be done, but then
again I am very unsure about that because of my age and the risc of
ectopic pregnancy.

Ivf could be on the plan in december.


You could be spending $4000 for the hysteroscopy/laparoscopy only to find
out the tubes are irrecoverable and you'll have to spend another $4000 for
the IVF. Best to cut your losses and just go for the IVF, IMHO.

HMc

Howard McCollister wrote:
wrote in message
oups.com...


Is there any other possibilities since a Gyn here suggested
hysteroscopy+laparoscopy with dye studies.I would have to pay that
privately (about 4000 USD) which is the exact ammount for IVF.
Furthermore a radiologist/specialist gonna take a look on the HSG scans
in these day and will advise me if selective salpingogram (where a
cannula is put into the tubes to open them) could be done, but then
again I am very unsure about that because of my age and the risc of
ectopic pregnancy.

Ivf could be on the plan in december.


You could be spending $4000 for the hysteroscopy/laparoscopy only to find
out the tubes are irrecoverable and you'll have to spend another $4000 for
the IVF. Best to cut your losses and just go for the IVF, IMHO.

HMc

Thank you for you help. Are you a professional, like a doctor or gp?
Your opinion sounds so.
best regards

wrote in message
ups.com...


Thank you for you help. Are you a professional, like a doctor or gp?
Your opinion sounds so.
best regards


Yes, I'm a laparoendoscopic surgeon.

HMc

....and HMc is the best one.
I had pancreatitis, followed his instructions to remove gallblader and am
now trouble-free!
DP
"Howard McCollister" wrote in message
...

wrote in message
ups.com...


Thank you for you help. Are you a professional, like a doctor or gp?
Your opinion sounds so.
best regards


Yes, I'm a laparoendoscopic surgeon.

HMc