Patient Had Laparoscopic Ovarian Drilling & Damaged Tubes, What To Do Next?

Question:

I am from the United Arab Emirates. I had problems with my periods earlier since beginning of my teenage, like the absence of periods for years. Then I started taking contraceptive pills for regularizing my periods but it didn't help me. After that I thought it would be ok after I got married but then I didn't get pregnant for 1 year. After that, I had Laparoscopic ovarian drilling done.

I take no medicine till now after the surgery I got my period twice on my own 28 days difference but on the 3rd month I didn't get my periods at all. I thought I got pregnant then but I had blood tests done twice but it showed me negative. Before the surgery I had taken injectables, Clomid and what not, but it didn't help me ovulate actually. Both of my tubes were blocked but now after the surgery one of them is working. The doctor said I have less hormone & right now I am on primolute to get periods. So after consuming primolute for 10 days when should I expect my periods???? and what has to be done for my hormones???

By the way my age is 21 and my height is 162 cm and have been married for 1 and half years . My husband's semen was tested and they said that it's normal. Thank you very much!

Answer:

It sounds like you have PCOD (polycystic ovarian disease). Ovarian drilling is a very, very old fashioned treatment for PCOD. It is a procedure whereby a laparoscope is inserted into the abdomen and a needle, electrode or laser is used to make holes (yes, holes) in the capsule of the ovary. In the past, it was used as the mainstay treatment for PCOS, and in some cases was successful in getting the ovaries to function normally, at least for a short while. But, it does not work in all cases, and the problem is that damage to the ovary can induce scar tissue around the ovary, tubes and pelvis, thereby rendering the patient infertile by obstructing movement of the egg to the tube. Contemporary fertility surgery preaches minimal tissue damage to prevent or reduce scar tissue formation. This procedure contradicts this philosophy, did not work in most cases and, in some cases, made the fertility problem worse. We don't use it very much in the U.S. any more, and I cannot recommend it.

You have two problems in regards to your fertility: (

Number One: because of the PCOD you don't ovulate and Number 2: you have a tubal problem.

First, let me deal with the tubal problem. In reality, there are NO surgeries that can correct a tubal problem. Surgery can be used to open the ends of the tubes, but the major damage is usually within the tube and this cannot be repaired. The fallopian tubes are not just pipes. Opening them is not enough. They are working organs with muscle layers and small hairlike cilia that help to move the egg and sperm together. Because this damage cannot be repaired, the only realistic treatment option is to proceed with IVF "in vitro fertilization". This allows us to bypass the tubes.

The second problem is PCOD. In this case the ovaries are difficult to ovulate safely (only allowing 2-3 eggs to ovulate). For that reason, the majority of PCOD women have to proceed with IVF. This is because we can extract all the eggs and control the number that are put back in. This is necessary because PCOD patients tend to over-respond to injectable medication, which is the only medication that will work to stimulate most PCOD ovaries. Clomid usually doesn't work.

So my recommendation is to see a fertility specialist and undergo IVF. The primolute is a progesterone, I believe, and is only being used to induce a period. It is not doing anything else.

Follow-Up Question:

So what do you say doctor, just Laparoscopic ovarian drilling and Clomid will not work after getting my periods thru primolute? I am waiting for my periods to come and so I can start with clomid and injections. This is the first clomid cycle after my surgery? Well, what I think is let me wait and see and then next we will go for IVF.

Follow-Up Answer:

Hello Again,

There is a good chance that the Clomid might stimulate your ovaries to ovulate. The ovarian drilling can sometimes make the ovaries more receptive to this medication. However, the chances are not good. The biggest problem that you have is a tubal problem. Because Clomid with either timed intercourse or IUI rely completely on the fact that there has to be normal tubes, if they are not, that is what will prevent you from getting pregnant.

In any case, miracles do happen and you may be the exception to the rule! So as long as you don't mind trying the Clomid, then it is okay to try.

Good Luck.

Sincerely,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

http://www.montereybayivf.com/