# Investigations for blocked tubes after pelvic inflammatory disease?



## Lulu40 (Nov 20, 2009)

I had pelvic inflammatory disease in my mid-twenties and have been told that I suffered some scarring and adhesions to my fallopian tubes.

I was thinking that I should ask my GP for a referral to undergo investigations to see if my tubes are blocked or whether they need unblocking.

But then I read this:

HyCoSy (Hysterosalpingo Contrast Sonography)

HyCoSy is a non-invasive ultrasound procedure usually performed before day 12 of your cycle.  It takes approximately 15-20 minutes and involves passing a thin catheter through the cervix and into the womb.  A special fluid that can be seen on the scan is injected through the catheter and its passage through the womb and fallopian tubes is observed.  It is a good idea to take some form of analgesia prior to the procedure, eg Paracetamol.  To reduce the risk of infection you will be prescribed a course of antibiotics.  The HyCoSy is not appropriate for some women, eg if you have had a history of pelvic inflammatory disease or previous tubal surgery.


How can they check whether or not my tubes are blocked, if the scanning procedure itself isn't recommended for women with a history of pelvic inflammatory disease?


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## Lulu40 (Nov 20, 2009)

Hello, could a moderator move this to a more suitable forum, please?  Thank you.


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi there

I'm assuming that if you were told that you had scarring/adhesions on your tubes that you had a laparoscopy....which would've been several years ago ?  Have you had any subsequent investigations ?  Where you advised that your tubes were blocked or was it just that there was some scarring/adhesions....and did you have the adhesions removed during the laparoscopy ?

How long have you been ttc ?  If you're in your 40's and you've not already been referred to a fertility consultant then I'd say that should be your first move and then they will be able to advise on what investigations need to be carried out, if any.  

I've never had a HyCosy but I did have an HSG (hysterosalpingogram) which is very similar.  This was carried out 20+ years ago (when I was 19/20) following a laparoscopy and dye which had diagnosed endometriosis, adhesions and blocked tubes (I've since had many more lap/dyes).....I also had PID in my early 20's.  Whilst both my tubes were found to be blocked during the first lap/dye, the force of the dye during the HSG pushed through the obstructions (old blood and endo) and my tubes are now clear although they do remain damaged/sluggish but I've managed to conceive 4 times naturally.

Another way of checking patency of tubes (ie whether they're blocked or not) is by having another laparoscopy and dye.  Have you had subsequent bouts of PID or was it this single time back in your 20's....if you've not got a history of recurrent PID then I can't see that having an HSG or HyCosy would be a problem.

Have you had any more laparoscopies or was it just that one years ago ?  When you had the laparoscopy (or laparoscopies) did they not advise you that they would flush dye through your tubes to check patency as often they do this at the same time ?

Hope that helps
Take care
Natasha


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## Lulu40 (Nov 20, 2009)

Thanks Natasha.

I must admit, I kind of feel a bit of a fraud, because I don't have a fertility consultant at the moment, and I'm not currently in a relationship and not TTC.  

I knew I might have some problems because of PID in my twenties.  But more recently, a couple of years ago I had surgery to remove fibroids, and I'd had the surgery in the Middle East, because I'd been living and working there.  

I came back home last summer, and my GP sent me for an ultrasound check up and apparently I don't have any recurring problems with fibroids/cysts.  But she recommended I have the AMH tests.

I met a really lovely man last year, we lived together for a few months, because he'd split up from a former partner, had been crashing on a friend's sofa, he ended up staying at mine while he was in the process of buying a house.

I was totally luvd up and living in domestic bliss.  And then I got the results of the AMH test, 0.3 pmol, and letter said that they wouldn't recommend IVF for someone with very low/undetectable readings (although from what I've been reading here, things aren't necessarily so gloomy).

We're no longer seeing one another, in a nutshell.  He's only 37 and he loves children and I think it's an issue for him.

I potentially have three issues:

Low AMH
Possible blocked tubes
Possible complications from fibroids/cysts

Oh, yeah, and I'm 40 and single.    

My GP won't be able to refer me to a fertility clinic on the NHS.  

I don't know if having the scans to check out my tubes would be classed as routine gynaecological surgery, or whether it would definitely be classed as fertility treatment?

I had laparoscopy in my mid-twenties for PID.  No further investigations.

I had a myomectomy in my late-thirties and they opened me up but didn't mention anything about my tubes afterwards.

I don't have a job at the moment and so can't really pay major amounts for the investigations privately (although I did pay for the AMH test).  

Once I get a job, though, I can maybe either get a bank loan or potentially mortgage my apartment, which I currently own outright.  I can't do that at the moment, as I have no way of making mortgage payments.

I guess I'm starting out, with several potential problems (tubes/AMH/fibroids) and several practical problems (single, 40, don't have a job and am not made of money, although I do have an asset I can tap into), and totally clueless and feeling a bit helpless and hopeless, since I don't think my GP can refer me for investigations.


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

sometimes our life paths never quite go how we envisaged do they ? 

I'm not overly clued up about IVF treatment with low AMH levels but I do know that there are ladies out there who have low AMH and high FSH but have still gone through IVF with success....have a look at this thread...

http://www.fertilityfriends.co.uk/forum/index.php?topic=215806.720

There's also a separate board for ladies who are single and ttc (with donor sperm and some with donor eggs too) so maybe have a chat to some of them

http://www.fertilityfriends.co.uk/forum/index.php?board=403.0

As for NHS referal, frustratingly at 40 you are over the age for any NHS fertility funding but you can still get a referal to a gynae for further investigations regarding tubal problems, fibroids and cysts....these wouldn't necessarily be classed as fertility related but just gynae.

Thankfully I have private healthcare but it doesn't cover for any fertility related procedures but since I have endo (and other gynae things - polyps etc) I can get laparoscopies and hysteroscopies (where they look directly inside womb) covered by my insurers.......and our fertility consultant is very good and doesn't write anything about fertility or related fertility treatments down on the insurance forms.

If your GP won't refer you to an NHS gynae and you're not entitled to NHS referal to fertility specialist, could you not afford to pay privately for at least an initial consultation with fertility specialist....around £200 ? Maybe that would be your first move.....and also see if your GP will do the standard hormone blood tests for you on NHS....at least that would get the ball rolling.

I suppose if you're not actually ttc at the moment and not financially able to afford any IUI or IVF with donor sperm then that may be a little difficult in terms of what any fertility consultant can offer, other than possibly further investigations.........in which case I would push your GP for a referal to NHS gynae (or again, pay privately to see consultant gynae) so at least you can discuss your concerns and options.

Take care
Natasha


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## Lulu40 (Nov 20, 2009)

That's the thing.  Even when I knew that I might have fertility problems, it never occurred to me that running out of eggs, or using donor sperm would be what I'd end up doing, because I always envisioned meeting someone and starting a family.  I don't know if I'm cut out to do it alone.

My flat has three bedrooms, so I can potentially rent a couple of rooms out, and maybe use that money to pay for investigations and stuff.

I guess having read some of the stories about low AMH here, I wish I'd come here and read all that information, and maybe felt there was some hope...

But at the time I got my AMH results, and the letter was pretty conclusive about not recommending proceeding to IVF, so I thought that door was definitely closing.  And I suspected my tubes might be blocked and so I possibly/probably wouldn't be able to conceive naturally...

Well, I just told this guy that I couldn't have children.  And burst into tears.  Pretty much howled inconsolably.  

If I'd known then that there might be a bit of hope, then maybe we'd still be together?  

But we're not.  And now I don't know what to do.  

Part of me thinks that I need the investigations, because otherwise, if I end up dating someone else, what am I supposed to tell them?  I think I need to know whether my tubes are blocked.

I thought those investigations might be just classed as fertility treatment and I'd be excluded, but you've given me some hope, Natasha, I'll get on to my GP and ask for a gynae referral.  

I haven't had the FSH test yet, my GP suggested it, but then the ultrasoundologist recommended I get the AMH test instead, and since she herself had had fertility treatment, I went with what she said.

I guess that if I'm not suitable for IVF due to low AMH, then perhaps checking out my tubes and hoping for a natural conception might be my only option.  

Although the man that I wanted to have children with, because he's pretty amazing, well, we're kind of still friends, but he's made it clear that he doesn't want to be in a relationship with me.


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## handy1 (Dec 16, 2009)

Hi Lulu40

I don't think a low AMH is a contraindication to IVF... I have the same poblem like you fibroids and lowAMH and hopefully i will go through the IVF route soon. 
Don't worry that much we all don't know what the future holds.

Handy


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## Lulu40 (Nov 20, 2009)

Oh, that's really bizarre, because this is the text of the letter I received:



AMH test results letter said:


> I have received the result of your AMH blood test that you had on 16th November 2009. The result is 0.30pmol/l. This falls into the 'very low/undetectable' range.
> 
> This test is designed to tell us what your ovarian fertility potential is, or what your ovarian reserve is. This means that your ovarian reserve is extremely low. The relevance of this is that if we were to stimulate you to try to produce eggs in the context of IVF treatment, you would probably have an extremely poor response and may indeed produce no eggs at all.
> 
> We would normally advise women with AMH levels as low as this not to proceed to treatment on the basis that the likely outcome would be very poor.


Now I'm really confused. 

I'll post in the low AMH forum and see what other people say.

I'll be gutted if they misled me, because I think this result, and my having to tell this chap I was living with that I couldn't have children had an impact, basically, I suspect it's a major reason why he didn't want to be with me.


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## handy1 (Dec 16, 2009)

I am devastated as well when I knew about my AMH level. My consultant (who operated on my fibroids) was not really negative about it  , on the contrary he said lets be positive and he refered me urgently to his fertility consultant colleague. We had one oppointment with the fertility nurse to organize our investigation before meeting the consultant. My husband started his semen analysis and I am going to repeat the AMH, FSH and progesterone , chlamydia and rubbela. She also said the consultant told her there is no need for HSG as we will go straight to IVF to save time, of course because of my age.

I asked her specifically whether the AMH will mean very poor response. She said we will never know unless we try and that they do had cases with low AMH that were sucessfull.

So Lulu , I am trying to positive as they say.  I will never know what will happen unless I try it and give myself the chance. I am praying that it will work. I hope god will give me the child i am yearning for to nuture and love.

Handy


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