”Doctor, I have not been pregnant for one year after marriage, and I have had a tubal imaging which indicates pelvic adhesions and fluid in the fallopian tubes. A doctor suggested me to do laparoscopy, but there is a possibility that I still can’t conceive and may have to do IVF, please give me some advice! Thank you!”
Me: Regarding tubal obstruction, laparoscopy is the gold standard diagnostic basis. I have always advocated for girls with suspected tubal obstruction to opt for laparoscopy directly, although guidelines do not recommend it, but I personally prefer this approach. The laparoscopy is the gold standard. The laparoscope can see most clearly whether the fallopian tubes are open or not, and it can also separate the adhesions directly, and if the tubes are waterlogged, the surgery will be done at the same time. The laparoscope can see that the tubes are open, that they are indeed open, and it can confirm that they are open and free of adhesions. Laparoscopy can also detect problems that were not anticipated, such as early endometriosis or ovarian cysts that may be present in some cases.
But there are problems with choosing to have direct laparoscopic surgery, what problems?
1. The high cost of the surgery is probably the most difficult reality for Chinese people to accept, especially for those who have difficulty getting pregnant, many of whom are actually not rich. They often run around seeking medical help for the pregnancy of their children, and their work to earn money is wasted.
2, after all, this is a surgery, surgery is traumatic, there are risks, no matter what the probability, this surgery also general anesthesia, anesthesia is also risky, especially general anesthesia, anesthesia risk may also be fatal, no matter how low the probability. This is probably the most important issue for our doctors.
If all women undergo laparoscopy directly, it will cost a lot of money, but if we put tubal imaging in the front, as the first step of screening, we can screen out many women with clear tubes and avoid laparoscopy, which will save a lot of money for the society.
But for someone, she may be more concerned about the doctor being able to give a clear conclusion that one is one and two is two. However, a tubal imaging may not be able to give such a conclusion, because in women with a clear result, there may be individual pelvic adhesions, and although the fallopian tubes are clear, sometimes the tubes and ovaries may not be together, and there may be adhesions in between. Of course, this is not a rare occurrence in some cases, but in women who have a clear tubal imaging, the pelvic cavity is generally in good condition.
For women with blocked tubes, this does not save money, as laparoscopic surgery is needed to clarify the blockage, its location and whether there is a chance of surgical solution. For those who report descriptive language such as “open but not open”, “adhesions upraised”, “not open”, etc., it gives the doctor an egg on his face. What the hell are you telling the patient about patency or non-patency? This is why these patients also need laparoscopic clarification.
”Doctor, do I have a good chance of getting pregnant if I have a laparoscopy?”
Me: This is a question that almost every patient asks, and from the patient’s point of view of thinking, it is logical to ask this question and all feel that they should get a reasonable answer. But all doctors let their patients down, and I am no exception. This is an unanswerable question.
1. we don’t know if your tubes can be surgically opened before the surgery.
2. Even if you can make it through the surgery, we don’t know if you will be able to conceive. There is not only the problem of patency of the fallopian tube, but also the problem of the function of the tube wall, the peristaltic ability of the smooth muscle of the fallopian tube, the oscillatory transport ability of the cilia in the inner wall, etc. These functional factors are not detectable.
Therefore, no doctor can answer this question.
”Doctor, then I still want to do IVF directly, my family is also financially difficult, the surgery cost more than 10,000 can not still have to do IVF, it is better to do IVF directly.”
Me: That’s not how the account works either. There is no way for us to predict the economic cost of IVF or laparoscopic surgery. But we can provide an optimal clinical pathway. For example, as I mentioned earlier, the question of whether to do imaging or direct laparoscopy first, the clinical guidelines state that imaging should be done first, and then laparoscopy should be done if there are problems with imaging.
For women considering tubal obstruction, laparoscopy should definitely be done first to clarify the specific situation of the pelvis before the next step. Don’t have the luxury of getting it right in one step, lower your expectations a bit and you will feel better when you get pregnant with a vengeance, and your heart will not only not fall short, but be full of surprises. On the contrary, some people count the success rate and economic accounts together, in short, neither end wants to lose, the idea is very good, but the result may be that even if pregnant, but also lamented spending more money, not happy, not to mention those who spent the money down the drain.
Before doing IVF, it is necessary to have a laparoscopy. There are three reasons.
1. Laparoscopy can give a clearer picture of the pelvis; how do you know it must be blocked fallopian tubes? How do you know you only have blocked fallopian tubes, and what if you don’t?
2. laparoscopic surgery may provide an additional chance of natural conception. How do you know you can’t get pregnant naturally before the surgery is done? Who knows if you’ve never tried, ask your doctor? Do you think the doctor is a god or a goddess?
If you are determined to do IVF, it is better to have your tubes ligated first and then do IVF if your pelvic cavity is really bad and your fallopian tubes are miserable. If your fallopian tubes are completely inaccessible, you will not be able to conceive naturally, and you will not even have a chance to conceive an ectopic pregnancy (the prerequisite for conceiving an ectopic pregnancy is that your fallopian tubes should be open, but not necessarily “open”). But with IVF, you not only have a chance to have an intrauterine pregnancy, but also a chance to have an ectopic pregnancy. It is not uncommon to have an ectopic pregnancy with IVF.
Finally, a word about the cost. There are definitely differences in medical costs from place to place, but by and large, the full cost of laparoscopic surgery is just over $10,000, while the cost of IVF is tens of thousands of dollars a time. The term “once” refers to a single IVF procedure, not a single successful pregnancy. Now the success rate of IVF has been greatly improved, some reports can reach 40 to 50%, but still many people do many times can not succeed, either because the economy can not bear, or because the body can not bear finally gave up!
Even if you ask a thousand times and ask a thousand doctors, the answer will be more or less the same. Who knows? The only way to know is to try! To put it more euphemistically, “There is hope, let’s try!” To put it more directly, “I don’t know, I may or may not be able to conceive!” If you ask about the probability, the doctor will either refuse to answer or just make up a number for you to hear. If you’re serious about your studies, you may say that the data from the xx literature sounds authoritative, but it won’t be of much use to you personally. If you say “no problem, you will be able to get pregnant”, it is not a “magic” level doctor, it is definitely a “magic” level!
The article just came out, there are students reply their success rate has reached more than 60%, is very good news, but such a boost, for many people, still time to bump the odds of things.