HSG Shows Bilateral Proximal Occlusion

[Anonymous]

Hi All - So I got some bad news from my HSG test. Both my tubes are blocked right at the Uterus. My RE recommends moving straight to IVF which I tend to agree with. I'm 36 and TTCing for my first (and likely only) child and have no other causes of concern. My blood work and hormonal workup, ultrasounds and husbands SA are all good! I asked her about tubal recanalization if the blockage is minor due to blood or mucus and she seemed on the fence about it. Does anyone here have experience with recanalization / FTR? Were you able to get pregnant after? Thank you!!

[Anonymous]

This is really a personal choice. If your only issue is tubal, you may have success after clearing them. But I would ask about increased risks of ectopic pregnancy and success rates of the procedure under your particular circumstances. Also ask about the impact of blocked tubes on the uterine environment. I've heard that infection and/or mucus can travel to the uterus and make it more hostile to implantation. The last thing you want is to ignore the tube issue then have that impact your IVF cycle.

Ultimately, IVF may not be necessary, but is probably the fastest and most direct path to a baby. If you're leaning towards IVF anyways and wouldn't regret not trying every non-IVF option first, then go for it.

[Anonymous]

Thank you - this is really helpful.

Based on the HSG and Ultrasounds, my OB and RE have said that my uterus looks normal and also don't suspect any endometriosis. Do you know if there are additional tests to confirm what the impact of blocked tubes on the uterus may be?

Honestly, I'm torn - I'd much prefer to avoid IVF however yes, if that's the best and only option then so be it and I'm ready to move quickly.

[Anonymous]

Anonymous wrote:Thank you - this is really helpful.

Based on the HSG and Ultrasounds, my OB and RE have said that my uterus looks normal and also don't suspect any endometriosis. Do you know if there are additional tests to confirm what the impact of blocked tubes on the uterus may be?

Honestly, I'm torn - I'd much prefer to avoid IVF however yes, if that's the best and only option then so be it and I'm ready to move quickly.

I'm not sure if there are additional tests. Possibly an endometrial biopsy or hysteroscopy to look for inflammation in the lining? I've had two friends with tubal issues - one went right to IVF and said she doesn't regret it, but does wonder if the tubes caused some of her losses and thinks she could have ultimately had success without IVF after clearing the tubes. The other's RE won't do transfers until they remove her tubes. Not sure what her diagnosis is exactly, but significant enough to her RE that she's doing multiple retrieval cycles before the tube surgery and transfers. I think it matters what kind of blockage it is. If it's scar tissue, then it's probably fine to do IVF. If it's the kind that leaks fluid, then that can definitely impact the uterine environment. Were they able to guess at what kind of blockage it was?

I think you should get a second opinion if you're not sure. That is absolutely appropriate in these cases and could probably just be a virtual consult since you have all of your test results.

[Anonymous]

Anonymous wrote:This is really a personal choice. If your only issue is tubal, you may have success after clearing them. But I would ask about increased risks of ectopic pregnancy and success rates of the procedure under your particular circumstances. Also ask about the impact of blocked tubes on the uterine environment. I've heard that infection and/or mucus can travel to the uterus and make it more hostile to implantation. The last thing you want is to ignore the tube issue then have that impact your IVF cycle.

Ultimately, IVF may not be necessary, but is probably the fastest and most direct path to a baby. If you're leaning towards IVF anyways and wouldn't regret not trying every non-IVF option first, then go for it.

I have read tubal factor infertility lowers your chance of IVF success possibly because the tubes leak fluid into the uterus that is bad for implantation.

If there is any chance at all you want two then IVF is a no brainer

[Anonymous]

IVF was actually developed to overcome tubal factor infertility. The 'fluid' is usually the case of hydrosalpinx not proximal blockage.

[Anonymous]

I received the same diagnosis at age 29. I didn’t want to jump straight to (in my case) natural cycle IVF. I had a tubal recanalization done at INOVA Alexandria in 2012. Three cycles later, I still wasn’t pregnant. I did natural cycle IVF and was successful 3 times. At 36, I’d jump straight to IVF.

[Anonymous]

PP here. I think the only other test is a laparoscopy. I had one after my first C section to check for scar tissue, but the surgeon could also see my tubes. It’s minimally invasive, but I wouldn’t do it in your case.

[Anonymous]

OP here - My RE recommends a second HSG to confirm that it was not a spasm so we're going to start there and hold off the FTR. IVF does make sense as the next step.