Wednesday, March 31, 2010
Patient Has Only One Tube, One Ovary & A History Of Ectopic Pregnancy: What Are Her Chances Of Conceiving?
Thank you for taking the time to answer my question. I am a 27 year old female with a history of endometriosis. I had my left ovary removed two years ago due to a cyst. My Dr found endometriosis that had pulled my bowels up to my uterus and did a laparotomy a few months later to correct this. I was then put on 10 months of Lupron injections to try and keep the endo from growing so fast and got pregnant two months after coming off of them. However, that resulted in an ectopic when I was only about 3 or 4 weeks along. My tube ruptured and he had to remove it. He also found more endo that he was able to remove. So I now I'm left with a right ovary and a left tube. It's been 5 months since my ectopic and I have yet to get pregnant again.
I've switched to a high-risk OB/GYN. He did an HSG and my tube looked good. He also put me on 50mg of Clomid days 3-7. I had two ultrasounds to show that I had indeed ovulated and then he started me on progesterone suppositories (my progesterone in my first pregnancy was 7). It has been over a month since my last cycle, but all of my pregnancy tests have come back negative, so I believe the progesterone has delayed my period. My question is, do you think there is a chance of me conceiving again. My Dr told me to be saving for IVF (which my husband and I cannot afford right now). I would like to have 3 or 4 kids, but I don't know if that's possible now. I'm devastated over this and I would appreciate any advice you can give me.
Thank you. K. from the U.S.
Hello Kasey from the U.S.,
Normally, it is possible to get pregnant when you only have one tube and one ovary that are opposite from each other. In fact, in nature, the egg ovulated from one ovary, say the right side, does not necessarily go into the right tube. This is a misunderstanding. The Fallopian tubes actually hang 2 cms (1 inch) down below the ovary and the egg can be ovulated from any part of the ovary. In reality, the egg is expelled from the ovary with all the fluid that surrounds it in the follicle. That fluid rushes out taking the egg with it. It then falls into a space called the culdesac located behind the uterus, where the ends of the fallopian tubes hang. Then by simple fluid motion (think of a spec of dust in a small puddle of water), the egg either contacts one tube or the other. It does not always find a tube. So in this way, it can contact either the right tube or the left tube and in your case, it can contact the opposite tube.
I think you might have another problems, however. Maybe two major problems. One is that you have endometriosis. That is a pelvic disease whereby the endometriotic implants cause an inflammation in the pelvis. This inflammation can attack and destroy the egg before it has a chance to be picked up by the tube. The second issue is that you have have multiple pelvic surgeries. Surgery tends to cause scar tissue in the pelvis and culdesac. Scar tissue (adhesions) are like spider webs in the pelvis and can block the egg and tube from getting together. There is a third problem as well, but not one that will prevent you from getting pregnant, but one that could be devastating, and that is that you have a history of ectopic pregnancy. Ectopics occur when the egg gets caught in tube, and is usually the result of scar tissue within the tube. This is most often from a previous infection that got into the tube and caused formation of the scar tissue from inflammation. It does not necessarily need to be bad enough to block the tube so the tubes would be open on HSG, as in your case. It could mean that there is scar tissue in the remaining tube, that could either prevent the egg and sperm from getting together i.e. damage the structure within the tube so that it is not functional, or lead to another ectopic.
With all of this going on, IVF is in fact the best treatment for you. Try to find a center that may help you with a financial plan (we have many) that fits your budget, even if it is far away. Your Ob/Gyn can monitor you for the IVF clinic if it is too far for you to visit.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.