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Infertility

Please Help...

11/07/2008

Question:

Hi. My husband and I have been trying to conceive for over 2 years now. He has been tested and is fine. I know I was able to get pregnant because I had gotten pregnant back when I was 18 and had an abortion performed by a registered Dr. and had no complications afterwards. I am currently 27 and my husband is 29, (age isn`t an issue yet) I had an HSG completed in January of last year. They "think" my left tube is blocked. They weren't sure if it`s truely blocked or if the spasms were stopping the dye. However, they did not see any issues from my cervix, uterus, or right tube. Any advice to help us conceive? We are trying to avoid the use of expensive drugs. (We don`t make a lot of extra money to spend on a chance of working at the cost of thousands per try) Please help.

Answer:

In cases of proximal tubal occlusion (where dye is not filling one of the tubes), there are 2 basic ways to determine whether this is tubal spasm or actual scar tissue:

1. SSG (selective salpingography) - this can be performed by an interventional radiologist.  An HSG is performed and a cather is placed through the tubal opening, allowing dye to be injected directly into the fallopian tube.  This prevents spasm from stopping dye from going through the tube.  If the dye does not go through, a wire can be placed to get past the area of blockage.  You may receive some pain medicine prior to the procedure.  This procedure is not offered in all centers.

2.  You can have a hysteroscopy (telescope through the uterus) which can see the tubal opening.  A catheter can then be placed through the tubal opening, similar to the procedure described above.  Dye is then injected.  At the same time, a laparoscopy (telescope through the bellybutton) can be placed to actually see the dye come out of the tubes.   This does require general anesthesia.

I would suggest that you speak with your physician about these possible options.

Treatment usually consists of fertility pills or shots combined with intrauterine insemination (injection of your husband's sperm into your uterus at the time of insemination).  The use of fertility pills plus insemination tends to be less expensive than other treatments.

If this were not successful, in vitro fertilization can be performed (stimulation of your ovaries to make extra eggs, removal of those eggs from you ovary followed by mixing with your husband's sperm, allowing fertilization of the eggs and growth into embryos; approximately 2 embryos would then be injected into your uterus). 

For more information:

Go to the Infertility health topic, where you can:

Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati