The following measures are often used in the diagnosis and treatment of infertility, but they are not suitable for all infertility patients, some are suitable and some are not, and it is necessary to clarify who is suitable and who is not after detailed communication between doctors and patients.
1. Tubal lavage
In the past, it was the most commonly used method to check the fallopian tubes, but today, with the widespread use of laparoscopy, it has been proved that tubal lavage as a means to determine whether the fallopian tubes are useful or not is no longer very meaningful. For tubal examination, imaging should be the first choice.
Accuracy is one reason, but more importantly: multiple passages will likely lead to 2 serious consequences: tubal infection and pelvic endometriosis! There are two reasons for this: firstly, the operation from the vagina is not completely sterile, no matter how sterile it is; secondly, the lavage may lead to the shedding of the endometrium and the shedding of the active tissue along the fallopian tube into the abdominal cavity together with the intrauterine fluid. This can be avoided if the lavage is accompanied by abdominal irrigation, but this can only be done laparoscopically.
As for B-ultrasound and hysteroscopic intubation, the results are actually the same as those of normal lavage, but the only difference is the cost.
For infertility, tubal examination is necessary, but it is recommended to minimize the number of examinations, so imaging once is sufficient.
As a common treatment after many laparoscopic procedures, lavage should also be recommended to be avoided as much as possible! It’s too bad that a good deal of tummy trouble can lead to bad consequences because of a routine method made by an old-fashioned thinking. As for having another imaging test as soon as possible after the surgery, personally I think that is a researchable need.
Before 10 years ago, I also often called for a laparoscopy, but since I have done many laparoscopic procedures, I will not call for a laparoscopy anymore.
2. Hysteroscopy
Hysteroscopy is also very commonly used for infertility and menstrual disorders. For some patients without fertility requirements, a simple hysteroscopy does not produce anything (in fact, or it does, just because fertility is not considered and does not need to be a concern), while for people with fertility disorders, a simple hysteroscopy is dangerous, and this danger does not mean that it leads to a risk to life, but to an increased risk of fertility difficulties!
The particular operation of hysteroscopy is more likely to cause tubal infections and lead to endometriosis than lavage! Especially with microscopic surgical operations, if the tubes are open, then a lot of intrauterine fluid and broken endometrial tissue will enter the abdominal cavity (laparoscopy can prove this unless the tubes are blocked) and this is not something to play with.
Therefore, for those who have never had children, I do not advocate simple hysteroscopic surgery unless there is really no other way.
3.Ovulation promotion treatment
I have always advocated that for women with normal ovulation, ovulation treatment does not increase the chance of pregnancy, but rather decreases the chance of natural pregnancy. Of course, the occasional use of some low-potency ovulation drugs will not have any effect, but the reality today is that this is not the case, and doctors with very trendy ideas have even abandoned the traditional clomiphene drug for many reasons, so I will not discuss it in depth here. Once used are second- or even third-line ovulation-promoting drugs. Personally, I think these should be used in assisted reproductive technology rather than in routine outpatient treatment.
For women who are not ovulating, it is justifiable to undergo all kinds of ovulation promotion for fertility. For women who are ovulating, it is a pity that they have to undergo a lot of ovulation treatment.
Excessive ovulation promotion, long-term efficient ovulation promotion will probably bring about the end of premature ovarian failure!
4.Laparoscopy
In fact, as long as infertility is present, it makes sense to do a laparoscopy, because at once the environmental structure and even the functional state of the entire internal reproductive organs can be clarified. However, because of special circumstances (mainly the cost and the scope of surgery), it is not yet the most routine means of examination in our country. However, the current laparoscopy is still suspected of being abused. The level of technology and the conditions of the hospital may affect the outcome of the procedure. Therefore, I personally advocate that laparoscopy should also be done when it is very necessary. For several common causes of infertility: tubal factors, endometriosis, polycystic, etc., every patient has a chance to conceive naturally as long as it is not absolute infertility or very special personal factors, and the patient should be given sufficient time to try to conceive.
In my clinic, there are quite a few cases where the doctor recommended surgery, or even I recommended surgery, but all of them were able to conceive naturally through TCM treatment before surgery.
And even after surgery, it is not a guarantee to get pregnant.
5.The problem of removing or ligating the fallopian tubes for IVF
Because of IVF, the diseased fallopian tubes should be ligated or removed (common in tubal effusion) because it may increase the success rate of IVF, but know that it is “possible”! And no matter how hard you try, we all know what the success rate of IVF is at the moment.
Personally, I think that even if there is fluid in the fallopian tube, it can be treated laparoscopically or even under ultrasound and transplanted as soon as possible, leaving a hope for others!
The chance of natural pregnancy after surgery is not high, but it is not the same as no, at least my experience proves that even if the water is very serious, there is still a chance of natural fertility, just do not know when the opportunity appears.
Once the tubes are cut, it means that if there is no successful IVF, the chance of having a baby will be lost forever, and then we will have to do IVF all the time. And once IVF fails, how much will it affect women physically and mentally?
I think, as a doctor in the field of reproduction, should be more humane than other disciplines, should give people to keep a little hope, even if it is a little.
6. The use of anti-adhesive agents in reproductive surgery
Various anti-adhesion agents have brought satisfactory results in abdominal surgery (including, of course, obstetrics and gynecology), and their intraoperative use plays an important role in preventing abdominal organ adhesions or obstruction, but if they are applied to reproductive surgery without consideration or choice, they may bring counterproductive results. Too sensitive to say much about it, just a suggestion, be cautious!
The instructions of the drug and the good starting point of the doctor may also be factors that increase the difficulty of getting pregnant!
History proves that medical progress is indeed all based on many failures and lessons learned, and unpredictable failures and lessons cannot be avoided, except that, for lessons already known, if one cannot yet wake up, then what comes is not progress but regression.
Once again: what is written above is only a personal opinion and does not mean it is correct!