Doctor's Answers (2)
We used to resort to surgery to unblock damaged and obstructed tubes. This was a time when IVF was in its infancy and results unpredictable. The situation has since changed for the better.
IVF results are much better and the discomfort much less than undergoing surgery to unblock a tube.
It is also now not recommended as first line treatment as the damaged tube would most likely have many areas of damage and blockages that it would be very difficult to retain a healthy portion of the tube-hence the reason you have had 2 ectopic pregnancies.
Unblocking the tube surgically would unfortunately predispose you to an unacceptable risk of recurrent ectopic pregnancies.
The safest and most reasonable option would be to bypass the tube through IVF.
Sorry to hear about your previous history of ectopic pregnancies. This has some relevance since the conditions that lead to an increased risk for ectopic pregnancy are likely to affect both tubes in the pelvis, rather than just one side (since both tubes are connected to the uterus within the pelvis).
Some of these conditions include infection, inflammation due to endometriosis, or could be related to surgery.
Surgery to correct the blockage has been available for many years. This consists of microsurgery which can be performed through keyhole or laparoscopic surgery. In certain circumstances, we can even perform reversal of sterilisation by joining the tubes back together.
The question is, whether it is worth the effort, with the availability of IVF. With microsurgery, success will depend on the site and extent of the blockage. Even with physical relief of the blockage, functionality may still be affected - say for example, infection may have affected the inner lining of the tube that transports the egg or embryo. Surgical success at the end of surgery also may not guarantee that the tubes will not close up again, if the factors for the inflammation which caused it in the first place are still present.
Then there is the risk for ectopic pregnancy, since the transportation of the embryo may be impeded within the unblocked tube. Also, with surgery, there is downtime and costs to be considered.
So for the above reasons, IVF is a very good alternative, since it bypasses the fallopian tubes and places the fertilised embryo within the uterus.
However, you should evaluate for the presence of any hydrosalpinx (swollen Fallopian tubes) before IVF, since this can lower the success rates of IVF by up to 25-30%, probably due to the buildup of toxic chemicals in the tube. If there is hydrosalpinx, it is usually recommended to deal with it first before IVF. This can be either in the form of clipping the tube or removing the tube, and less likely correcting the blockage. Hope this helps.
Dr Fong Yoke Fai