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Two blocked tubes.  Need some advice.

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  1. #1
    Val.
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    Two blocked tubes. Need some advice.

    Hi ladies. This is the first time I've posted in this forum, and am new to discussions on tubal issues. I really would appreciate some thoughts and advice.

    Yesterday I had an HSG which showed proximal tubal obstruction on both sides (that is, I believe, a blockage where the tube meets the uterus). My RE says this is often the easiest to treat. In outpatient OR, they could do a repeat HSG to make sure it was not a spasm or anything like that. If still blocked, they would do a hysteroscopy and try to unblock the tubes by dislodging the mucus, debris or adhesions or whatever is there. There's a chance it wouldn't work, but a very good chance it would work. He said that my uterine cavity looked perfectly, normal.

    Some background. I went through 2 years of IF treatment to conceive my DS 11 years ago, due to irregular cycles (didn't ovulate too often). 4 clomid and 5 inj/IUI. None of that worked, except for a chem pg on the second inj cycle (it took five tries total to get that chem preg). I conceived my son naturally just after the 5th inj cycle (which was the fourth cycle after the chem preg). My son is now almost 10 years, and I had gotten divorced from his dad.

    I'm now 41 years old. I didn't try to conceive again until last November with my new DH. We tried two times with no meds or anything, and got pregnant the second time. It turned out to be a chemical pregnancy/early miscarriage. That was in January. We saw an RE right away and he started us on femara to induce ovulation, with timed intercourse. This will be our third cycle and of that. I was not feeling comfortable with my RE and went to get a second opinion from another clinic. The new RE suggested the HSG and I did it the next day and found out about the probable tubal problems. Obviously at least one of them was open in January, but who knows what happened since... So, I will complete this medicated cycle anyway, because my only cost left is a $15 copay for the u/s, and there is still a possibility the HSG was not accurate.

    However, I need to make some serious decisions on what to do next, and it's complicated by my age. I have about $4K left in insurance for dr. visits and about $4500 for meds that will ONLY cover timed intercourse and meds, plus treatments. IUIS and IVFs or anything to go with those cycles are not covered. Our original plan had been to do about 3-4 femara/injectible cycles, with timed intercourse (all covered by insurance), then move to IVF (which we'd have to borrow money to do).

    My RE and I talked at length, and I basically have three options.

    1. Move straight to IVF to save time due to age. (about $15K out of pocket with this clinic, but they have 50% success rates with women over 40).

    2. Do the HSG/hysteroscopy, which will eat up most of my insurance, and try a cycle or two of timed intercourse with meds, before IVF.

    3. Do the HSG/hysteroscopy and then move to IVF. But, at least with tubes open, I have a shot at a natural pregnancy, since it just happened a couple months ago.

    So, my concern is my age. I'm 41, will be 42 in Nov. If I were even five years younger, I would definitely do the HSG and try to fix the tubes and put off IVF. But, now I'm not so sure. The other pro to doing IVF soon is that the sooner the better in terms of probably getting some good quality embryos to freeze and use later. If I just get pregnant on my own, I'd be 43 or so trying again, and my chances would be even lower.

    OK, so any thoughts? Has anyone had this type of tubal repair? Right now I'm leaning towards doing the HSG and hysteroscopy regardless because I believe miracles can happen, and if my tubes are open, you just never know. But, I don't want to do anything that could make things worse, or delay things too long. Then from there, not sure what to do.

    TIA for ANY thoughts....
    Val
    Me (47, pcos, antiphospholipid antibody syndrome) DH (45, low morphology)

    OE -16 medicated cycles
    5 IUIs
    1 IVF
    10 m/c
    2 healthy pregnancies

    Nov 2015 DE- fresh - received 6 high quality blasts
    fresh IVF eSET #1- BFP, but unexpected miscarriage at 12 week 1 day
    June 2016 FET eSET #2 -

    DS born 5/5/00
    DD born 5/8/11


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  3. #2
    CrystalAZ
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    I dunno. My tubes weren't able to be opened. Also, even if they do open your tubes, you have a much higher risk of ectopic if there's any scarring in there.

    And your tubes weren't necessarily open in January if your pg wasn't seen on an US. It could have been ectopic.

    I think in your case, I think I would go straight to IVF. Waiting a few cycles just delays it that much longer. This is just my gut feeling, and I am sure someone else may have a story that points toward going the other direction.

    Crystal


  4. #3
    nancydrew
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    When I had my HSG, showing bilateral blockage, the radiologist then injected my vein with something that was supposed to relax the tubes if it was a spasm, and re-did the test. (Didn't change anything in my case.) If you do go ahead with the HSG, ask if you can have this done.

    My blockage is in the middle of the tube. My RE told me that the further from the uterus is easiest to treat. So, not sure what information is correct there.

    If the HSG is covered, you might as well go for it and ease your mind. I wouldn't like to do IUI or timed intercourse knowing that everything is blocked = waste of time. (Even if it's not actually blocked, it would still feel like that, you know?) Because of your age, I am leaning toward IVF, but it's really a toss-up what you choose to do. Best of luck to you!
    My story:
    Ruptured ectopic -- left tube lost
    Second ectopic -- right tube saved
    IVF #1 -- fail


  5. #4
    Val.
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    Quote Originally Posted by CrystalAZ View Post
    I dunno. My tubes weren't able to be opened. Also, even if they do open your tubes, you have a much higher risk of ectopic if there's any scarring in there.

    And your tubes weren't necessarily open in January if your pg wasn't seen on an US. It could have been ectopic.

    I think in your case, I think I would go straight to IVF. Waiting a few cycles just delays it that much longer. This is just my gut feeling, and I am sure someone else may have a story that points toward going the other direction.

    Crystal
    Had to be at least a small opening, though, right? Or else how does the sperm get in there?? Even if they were mostly closed, they were open when I was younger. Wonder what would cause them to close up...
    Me (47, pcos, antiphospholipid antibody syndrome) DH (45, low morphology)

    OE -16 medicated cycles
    5 IUIs
    1 IVF
    10 m/c
    2 healthy pregnancies

    Nov 2015 DE- fresh - received 6 high quality blasts
    fresh IVF eSET #1- BFP, but unexpected miscarriage at 12 week 1 day
    June 2016 FET eSET #2 -

    DS born 5/5/00
    DD born 5/8/11


  6. #5
    Val.
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    Quote Originally Posted by nancydrew View Post
    When I had my HSG, showing bilateral blockage, the radiologist then injected my vein with something that was supposed to relax the tubes if it was a spasm, and re-did the test. (Didn't change anything in my case.) If you do go ahead with the HSG, ask if you can have this done.

    My blockage is in the middle of the tube. My RE told me that the further from the uterus is easiest to treat. So, not sure what information is correct there.

    If the HSG is covered, you might as well go for it and ease your mind. I wouldn't like to do IUI or timed intercourse knowing that everything is blocked = waste of time. (Even if it's not actually blocked, it would still feel like that, you know?) Because of your age, I am leaning toward IVF, but it's really a toss-up what you choose to do. Best of luck to you!
    Hi Crystal,
    I'm actually now considering doing both...the surgery and then IVF. I think knowing my tubes were cleared will give me SOME chance. Whereas if they're not, there's no chance. Yet, IVF does make sense at my age.

    Anyway, I also wanted to clarify. Distal tube repairs require more invasive procedures to treat them, but pregnancy rates after the surgery is often better. Proximal repair is an easier procedure, but pregnancy rates aren't has high after. Does that make sense?

    Did you ever have a clear HSG or were the tubes always blocked?
    Val
    Me (47, pcos, antiphospholipid antibody syndrome) DH (45, low morphology)

    OE -16 medicated cycles
    5 IUIs
    1 IVF
    10 m/c
    2 healthy pregnancies

    Nov 2015 DE- fresh - received 6 high quality blasts
    fresh IVF eSET #1- BFP, but unexpected miscarriage at 12 week 1 day
    June 2016 FET eSET #2 -

    DS born 5/5/00
    DD born 5/8/11


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