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Should Hydrosalpinx Be Removed Before An IVF Procedure?
Question: Hi,
I had two failed IVF and the second Dr attributed it to my egg quality saying that my eggs have some vaccum spots and some granular inclusion. I have dilated but open fallopian tubes - bad on right side and slightly ok on left side. I also have an endometrioma in my left ovary. My AMH is 3.6 and AFC is 9-12 in both ovaries together. FSH and LH on day 2 is normal. Uterus normal. Periods normal.
My new doctor is recommending that I have my tubes disconnected (not removed) from the uterus before we attempt the next IVF. She is suggesting a laparascopy for the same.
My concern is that is the hydrosalpinx so bad to work upon? When my earlier dr already said I have issues with my egg quality wont the disconnection of tubes cause more trouble to my egg quality coz of impaired blood flow to ovaries? Cant an antibiotic course along with IVF produce some better results sparing the laparascopy - cant the hydros be drained at the time of egg pickup? Iam can later even have a frozen cycle after the hydro is drained. Coz some of my scans already show that I have some adhesions n scar tissues coz of endometriosis. Please advice. Iam in a do or die situation.
I had two failed IVF and the second Dr attributed it to my egg quality saying that my eggs have some vaccum spots and some granular inclusion. I have dilated but open fallopian tubes - bad on right side and slightly ok on left side. I also have an endometrioma in my left ovary. My AMH is 3.6 and AFC is 9-12 in both ovaries together. FSH and LH on day 2 is normal. Uterus normal. Periods normal.
My new doctor is recommending that I have my tubes disconnected (not removed) from the uterus before we attempt the next IVF. She is suggesting a laparascopy for the same.
My concern is that is the hydrosalpinx so bad to work upon? When my earlier dr already said I have issues with my egg quality wont the disconnection of tubes cause more trouble to my egg quality coz of impaired blood flow to ovaries? Cant an antibiotic course along with IVF produce some better results sparing the laparascopy - cant the hydros be drained at the time of egg pickup? Iam can later even have a frozen cycle after the hydro is drained. Coz some of my scans already show that I have some adhesions n scar tissues coz of endometriosis. Please advice. Iam in a do or die situation.
Brief Answer:
important to get tubes tied
Detailed Answer:
Hello mam, I understand your health concern.
After 2 failed IVF cycles, it is important to remove all possible factors that might have caused the same.
Hydrosalpinx ideally should always be removed before planning for IVF because the fluid in it is toxic to the embryo as it has a lot of inflammatory mediators.
Tube has no role in providing blood supply to ovary so don't worry about that.
Endometriosis improves after conception so it is better to conceive as soon as possible without delay due to decision related issues.
Don't hesitate in getting the tubes tied because they are of no help now and are only going to create hurdles in conception and nothing else.
Antibiotics will not cure the hydrosalpinx part so don't think that way.
Wish you all the best for your next cycle.
important to get tubes tied
Detailed Answer:
Hello mam, I understand your health concern.
After 2 failed IVF cycles, it is important to remove all possible factors that might have caused the same.
Hydrosalpinx ideally should always be removed before planning for IVF because the fluid in it is toxic to the embryo as it has a lot of inflammatory mediators.
Tube has no role in providing blood supply to ovary so don't worry about that.
Endometriosis improves after conception so it is better to conceive as soon as possible without delay due to decision related issues.
Don't hesitate in getting the tubes tied because they are of no help now and are only going to create hurdles in conception and nothing else.
Antibiotics will not cure the hydrosalpinx part so don't think that way.
Wish you all the best for your next cycle.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks for your reply dr. I might sound stupid. But my query is though my tubes are dilated, they are not blocked. So wont a laparascopy to just flush out the tubes cause any good? Can i not take one more chance like that? Isnt there even a remote possibility for that? Iam open to another IVF too after my tubes are flushed. I wont even try for natural conception despite my hubby's sperm count n quality being excellent coz i am 32 already. So pls tell me.... will a flusing of the tubes and doing minimal regression of endometriosis implants via laparascopy cause any good? Because my doctor herself told me that the tubal removal will hamper my egg quality.
Brief Answer:
no effects on egg quality
Detailed Answer:
I don't know why your gynecologist said like that or may be you misinterpreted because tying the tubes have no effects on ovaries or egg quality.
But flushing the patent dilated tubes without tying via laparoscopy will only increase the chances of ectopic pregnancy and the fluid flushed will reaccumulate within no time so there is no therapeutic advantage.
Don't keep reservation in your mind and opt for tying up of tubes and proceed with IVF with full belief.
Hoping for the best.
no effects on egg quality
Detailed Answer:
I don't know why your gynecologist said like that or may be you misinterpreted because tying the tubes have no effects on ovaries or egg quality.
But flushing the patent dilated tubes without tying via laparoscopy will only increase the chances of ectopic pregnancy and the fluid flushed will reaccumulate within no time so there is no therapeutic advantage.
Don't keep reservation in your mind and opt for tying up of tubes and proceed with IVF with full belief.
Hoping for the best.
Above answer was peer-reviewed by :
Dr. Prasad
Hi thanks for yr reply. Jus wanted to know if u hv seen my hsg report online? Is it very bad? One of the other reasons I am hesitant abt surgery s tht I had palpitations last yr n had to b given an injection to control d same. My trigger point for palpitation (tachycardia) was pain. Thts one of d reasons y Iam still having second thoughts about cutting off my tubes n d pain associated with it.
Pls tell me of any other option available. Plssss
Pls tell me of any other option available. Plssss
Brief Answer:
no problem
Detailed Answer:
It is clearly suggestive of hydrosalpinx and should be removed in case of next trial for IVF.
Anxiety reaction needs to be taken care by the anaesthetist and you will anyways need anesthesia for retrieval of eggs in ovum pick up so that should not be a reason to defer from surgery.
Don't be scared as everything will be fine soon.
no problem
Detailed Answer:
It is clearly suggestive of hydrosalpinx and should be removed in case of next trial for IVF.
Anxiety reaction needs to be taken care by the anaesthetist and you will anyways need anesthesia for retrieval of eggs in ovum pick up so that should not be a reason to defer from surgery.
Don't be scared as everything will be fine soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank u.
Brief Answer:
welcome
Detailed Answer:
You are most welcome.
Take everything with a good spirit.
I practice in infertility and I know the common reservation in the minds of patients but once you conceive and deliver a healthy baby you will forget this whole fiasco forever.
Take care.
In case you have any questions in future you can contact me directly on http://bit.ly/drmanishajain
welcome
Detailed Answer:
You are most welcome.
Take everything with a good spirit.
I practice in infertility and I know the common reservation in the minds of patients but once you conceive and deliver a healthy baby you will forget this whole fiasco forever.
Take care.
In case you have any questions in future you can contact me directly on http://bit.ly/drmanishajain
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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