Dear Robert,

Firstly I’d like to say thank you for providing this service. I read in an interview that you’re up until all hours answering questions for desperate couples – please make sure you get some sleep too! My questions come to you one day after I had surgery for a laparoscopy and single tubal ligation (a lot more painful than I was led to believe it would be, but hey-ho). The ligation was recommended by my NHS gynaecologist who said that it would increase my chances of success of my upcoming IVF (a private specialist gave me the same advice). The tube that was clipped had hydrosalpinx and was completely blocked. They did a blue dye test on the other tube and said that unusually, considering the extent of the damage to the other, it was completely clear and therefore left unclipped (good news, I’m not sterilised). We discussed the causes of the single blockage. I believe that previous STD can be ruled out – I’ve always taken my sexual health very seriously and had annual screens right up until my marriage. The surgeon suggested that it might have been damaged by a childhood hernia I had on the same side as the scarred tube, but said it was impossible to really tell. My questions are: Do you agree that my IVF success rate is higher now that the damaged tube and the fluid inside is no longer able to impact my womb and implantation? But more importantly, I’m curious- does this mean that a natural conception might now be more likely, given that my healthy tube is now intact and womb not impacted by the fluid in the other? The surgeon said that there was no research to back this up, but this would seem like a logical assumption to me? I can’t find any stories like mine on the internet – most tubal ligations seem to be for both tubes. I’d also be really curious about your thoughts on the childhood hernia and where this is a likely cause of my infertility. I’ve summarised below the results of other tests and other data in case this too has any impact on your answer: My age: 36 Partner age: 37 Both healthy, BMIs under 26, neither of us have previous children My anti-mullarian hormone is 8.9 (blood test – have been told this is low but the internet seems to think its not too bad) Good follical count – one ovary had 3, the other 6 at last scan 2 fibroids – one 2x2cm, one 5x5cm – various consultants private and NHS have assured me the locations of these are not interfering with womb lining and that theres no need for removal before IVF cycle begins Partners sperm analysis fine, though occasional low morphology results or less than 2%. I’ve had occasional low day 21 progesterone results, indicating ovulation hadn’t occurred that month, though I generally get positive OPKs, combined with mild cramping, EWCM and spotting, suggesting that I am regularly ovulating. As we approach an IVF cycle I’m constantly asking myself if, following surgery, a natural pregnancy is now possible, or that a drug like clomid should be tried first? I’m loathe to suggest this to the consultant at moment in case it means were removed from the IVF waiting list we’ve been on for some time. It’s 3 years since we started trying and 2 since we first visited our GP to get the ball rolling on investigations. Many thanks for your time and commitment to your project. R

Reply…

Dear R,

Sorry – I am not going to be that helpful. I have been involved with research on the fallopian tube since 1970 – a long time – and I am willing to bet that you never had infection. Tubal blockage is nearly always bilateral and symmetrical. So having an hydrosalpinx on one side is rare. Without having seen your tubes down the laparoscope (have you any photos?) I’ll bet the price of a consultation (if this wasn’t due to your hernia operation which it undoubtedly could have been[1]), is what you have is a congenital hydrosalpinx – i.e. you were born with this abnormality. This would be easy to confirm on visual inspection as the appearance is quite characteristic particularly if there was an absence of adhesions between the tube and ovary.

Why sorry? Well, the evidence that clipping makes any difference to IVF success rates is really dubious. And yes, natural pregnancy is always possible if your opposite tube is definitely entirely healthy, but it will take longer to get pregnant because you only ovulate on that side, on average, half the time – less if the other ovary is more dominant as it is in some women. In general eggs do not usually cross from one side to the other after ovulation. So really you’ve only been trying less than eighteen months probably.

I would not try clomid unless there is definite evidence you are not ovulating. Any idea which ovary you usually shed an egg from? Pain, tenderness, ultrasound confirmation?

Probably no need to do anything about the fibroids.

[1] The tip of the fallopian tube can very uncommonly get caught in a hernial sac – whether it is an inguinal or femoral sac – and this could lead to a scarred end. More commonly, though, the tube becomes quite adherent to surround tissues and to the peritoneum – the lining inside your abdomen. But a surgeon would normally take care to avoid damage to the contents of the sac.
Warm wishes
Robert

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