When should you check to see if your tubes may be blocked after tubal reversal?
Many infertility doctors will give advice about when to check for tubal blockage after reversing surgery but this advice is often very opinionated and not based on evidence.
We recently reviewed a list of ‘8 (biased) facts’ about tubal ligation reversal. Many of the items on this list were not facts at all, but were biased opinions against tubal reversal surgery.
All eight items can be seen in the first article in this series:
So Called “Facts” About Tubal Ligation Reversal.
This article deals with the 4th item on the list: An HSG x-ray is necessary two months after tubal reversal.
As experts who exclusively specialize in tubal surgery, we have a few thoughts we would like to share with our readers about testing for blocked tubes.
Dye Testing After Tubal Reversal
Unfortunately there is no concrete recommendation on when to test for tubal blockage after reversal surgery; however, there are a lot of professional opinions about this matter. It is natural when you have sterilization reversal surgery that you want a confirmation the surgery was successful. Sometimes when you seek this extra confirmation you may be unnecessarily spending your money and causing yourself unnecessary anxiety and stress.
When To Test For Tubal Blockage?
We advise the patients of A Personal Choice to test for tubal blockage after 12 full months of attempting pregnancy. If pregnancy has not occured after 12 months of trying then it is advisable to then consider a test for tubal blockage.
Here are some simple facts about tubal reversal at our center: chances of pregnancy after tubal reversal.
Approximately 70% of our patients will become pregnant within the first year.
This means 70% of our patients have real proof at least one tube is open. The other 30% do not and they can then consider a test for tubal blockage.
Of the 30% of patients who then have a HSG approximately 6% may have blockage of at least one tube.
So out of 100 of our patients approximately 94% will have at least one tube open after tubal reversal.
Why should all of these patients pay for an unnecessary x-ray for tubal blockage 2 months after reversal surgery? The best test for tubal blockage may be the test of time.
Testing For Tubal Blockage: What’s The Harm?
If patients get early testing for blockage some of them may be testing during the time when they have the greatest chance of pregnancy. Some women may be getting this test when they are very early in their pregnancy. These women may be exposing their pregnancies to unnecessary radiation. Now with sensitive pregnancy testing this may not happen very often, but it is a reason to exercise caution with early testing.
Test For Blocked Tubes: Risk
Testing for blocked tubes involves pushing dye through the cervix, into the uterine cavity, and through the tubes. There is always a risk bacteria could be pushed inside and cause a serious pelvic infection and also tubal blockage.
There is a greater probability that the tubes could spasm closed or a small piece of uterine lining could temporarily plug up the tubal opening, dye will not enter the tubes, and the x-ray will be interpreted as blocked tubes. The greatest risk for testing for tubal blockage is causing unnecessary anxiety because the test can often be interpreted incorrectly. Unless the x-ray dye enters the tubes and goes at least to the tubal anastomosis site, the test is inconclusive regarding whether the tubes are open or blocked.
When To Test For Blocked Tubes?
My two daughters have been evaluating each of the 8 ‘facts’ about tubal reversal given by an IVF expert. The fourth statement is not a fact at all but, rather, a heavily biased opinion intended to persuade women not to have tubal ligation reversal surgery.
In our experience most of our patients will become pregnant after tubal reversal and approximately 6% will have tubal blockage due to scar tissue formation.
Women who request early testing to diagnose blocked tubes may be causing themselves unnecessary anxiety about the validity of the x-ray results and financially paying for this anxiety out of their own pockets.
The next article in this series deals with the IVF experts fifth biased opinion: Tubal Reversal: What Infertility Test Do You Need?
Submitted by Dr. Charles Monteith
