Me, a woman -- 41 years of age, has a problem:
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.Jp
g
http://www.250kb.De/u/061007/j/f7899ae1.Jp
g
letter from radiology clinic after hsg was performed:
http://www.250kb.De/u/061007/j/dd1ac4c6.Jp
g
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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
(...)''
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what do you think about selective salpingography?
Http://www.Centerforhumanreprod.Com/treat_
gyne.Html#select
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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#s
in
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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.
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related links:
http://rad.Usuhs.Mil/medpix/medpix.Html?&a
mp;mode=slide_sorter&pt_id=7659
http://brighamrad.Harvard.Edu/cases/bwh/hc
ache/56/full.Html
