Question of the Day: Blocked Tubes and IVF

Question of the Day:

My doctor said she will remove my left blocked tube to help IVF without mentioning whether I have a hydrosalpinx. Is it possible that my tube doesn't have this condition? Do they have to remove a blocked tube no matter whether it has a hydrosalpinx? I am frustrated because they don't tell you enough and I cannot ask suitable questions as obviously I don't know enough as a patient.

DrG answers:

So first of all we need to define "hydrosalpinx." This term literally means a water/fluid filled tube as "hydro" is latin for water and "saplinx" means tube. So a hydrosalpinx is a fallopian tube that has become blocked at the end that is furthest from where the tube attaches to the uterus. The far end of the tube has the fimbria which are delicate finger-like projections that allow the tube to capture the egg as it is released from the ovary. Unfortunately, if the fimbria become damaged by infection or trauma (surgery) or inflammation (endometriosis) then they can clump together effective sealing off the end of the tube. Since the tube produces fluid from the cells lining the inside, this fluid begins to accumulate once the end becomes sealed and a hydrosalpinx is formed.

The fluid within a hydrosalpinx contains inflammatorty proteins that apparently decrease implantation rates both in spontaneous conceptions (if the other tube is normal) or in IVF when embryos are transferred into the uterus. So most REs recommend that patients undergo a surgery to prevent the fluid from backing up into the uterus. This procedure may be removal of the tube or performing a tubal ligation to simply divide/block the tube. Less commonly, patients undergo a hysteroscopic procedure to occlude the tube as it exits the uterus (Essure). Patients must wait several months after an Essure procedure and have a follow-up hysterosalpingogram to confirm occlusion of the tube.

Tubes that are open but abnormal may not need to be removed but doing so may further decrease the possibility of an ectopic (tubal) pregnancy occurring after IVF. Tubes that are very abnormal may progress to a hydrosalpinx so again removal may be justified depending on the laparoscopic findings. Tubes that look normal but have proximal occlusion with no dye entering the tube do not need removal in my opinion.

The final comment of the post is particularly disturbing to me.There is no reason that patients should feel that they cannot ask their doctor appropriate questions. How very sad….My patients certainly don't appear shy at asking my opinion...