Question:
Hi,
My name is Lindsay; I’m from Atlanta, Ga. I recently underwent emergency surgery to remove my left Fallopian tube that had ruptured due to an ectopic pregnancy. I lost a severe amount of blood, resulting in receiving 5 blood transfusions. My husband and I have a 20 month old daughter, and we are/were trying to conceive again.
My question is: The doctor that performed the surgery stated that my right ( intact) tube ” looks great”. I explained this to my normal doctor (works in same practice) and I was told that we really don’t know what the inside looks like and that she would recommend an HSG test to look at my right tube. I have read in other places that an HSG test is not always a reliable way to determine a future uterine pregnancy. I do not want to go thru any testing that is not absolutely necessary. My doctor also advised my husband and I not to try and conceive for several months. We defiantly want to have another biological child, God willing. IVF is financially not feasible for us. Is it ok to try and conceive naturally? I don’t mind waiting until I fully heal (surgery was 2 weeks ago). I’m just confused on trying to conceive naturally first or waiting many months and getting an HSG test done first. I have considered making an appointment with the doctor who performed the surgery. Please tell me you thoughts and it suggestions! I am so confused and quite frankly, emotionally wrecked!!
Answer:
Hello Lindsay from the U.S. (Georgia),
Your doctor’s advice is both correct and incorrect. Just because a tube looks normal from the outside does not mean it is normal inside, the important part. The reason an ectopic occurs is that there was probably micro adhesions within the tube that caused the embryo to get stuck and thereby implant at that point. It was caused by something in the past, usually some type of infection or inflammation leading to the scarring. More than likely the same thing has occurred on the opposite side but there is no way to know for sure. An HSG would be indicated as a preliminary test to see if the tube is even open. If it is blocked then you know that natural pregnancy is not possible. If it is open, then you have to make a guess as to whether or not it is normal. Since there is no way to know this, that is no technology exists to check the insides of a tube and the HSG is not sensitive enough, then you’ll have to take the chance of another ectopic. The only other option would be to do IVF since the tube would then by bypassed. You did not say how old you were, but if you are still young (<35) then you might be able to save enough for IVF in the eventuality that you would need to do it.
In terms of when you can start trying again, two things need to happen first. One, you need to heal from the surgery and that will take 6 weeks. Even though you might feel great and recovered, the insides take that long. Second, the pregnancy needs to resolve itself completely and the ovary needs to reset to start ovulating again. That can take 4-6 weeks. You’ll know because you’ll start having regular periods again. Once these two things happen, then you can start trying again.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
