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The Center for Fertility and Gynecology

Dear Dr. Marc.......Tubal Factor Infertility

By on May 16, 2014

Dear Dr. Marc,

At the age of 25 my husband and I decided to start having children. My first sadness came on July 15th 2012 when I lost my first baby that was stuck in one of my Fallopian tubes. After the surgery, the doctors said EVERYTHING LOOKS NORMAL WITH THE OTHER ONE, SURE YOU CAN TRY AGAIN. 

Sadly, on January 24th 2013, about seven months later, I lost my second baby and my other Fallopian tube.

Having a child on my own with my husband is now completely out of the question because I have no Fallopian tubes. My new route is IVF and I definitely want to do it before I am 30 because the higher the age, the more complications. 

What is my next step? Can I go to a consultation and have those genetic tests done before we go through that whole other process? The wounds are a bit fresh so I haven't really asked questions.

I think I'm just here asking for opinions on what I can start before I have to pay those thousands and thousands of dollars. By the way, I was 25 when this happened, good health, good weight, and healthy life style. So I'm in shock denial whatever the damn stages are, I am in all of them.  They can't give me a reason why this happened twice and why nothing was done to have prevented the second surgery.

Thank you so much,

Feeling Frustrated

 

Hi Feeling,

I’m sorry you have been through such an ordeal not only once but twice!  Between the pregnancy losses, the surgeries and the realization that you will need IVF, I am sure you feel overwhelmed and confused. I will try to answer your questions, but first I will shed some light on your condition.

You have what we call “tubal factor infertility.” In your case this is because your fallopian tubes have been removed, but it applies to anyone whose fallopian tubes are not functioning properly and therefore inhibiting the ability to conceive.  This usually happens when the tubes are damaged in some way.  The most common causes for tubal damage include: pelvic infections, abdominal surgeries, STDs, ruptured appendix, endometriosis and fibroids.  Importantly, up to 30% of women with damaged tubes do not have any of these risk factors.  For those women, it is possible that there was an infection or inflammatory process that they were not aware of.  None the less, as soon as a tube is damaged, the chance of an ectopic pregnancy increases.  Further, the greatest risk factor for an ectopic pregnancy is a prior ectopic pregnancy. 

After the first ectopic, even if the doctors checked your tubes and everything “looked fine,” you were still at increased risk for a second ectopic.  This is because looking at the tubes and making sure they are open does not necessarily mean that they are functioning properly.  Unfortunately, there is no good test to ensure tubal function.  Thus when tubes are open, doctors often recommend trying again.  Sadly this did not work for you.

In terms of next steps, IVF is an excellent option for you.  In fact, IVF was initially developed for women in your exact situation; young and healthy with the only factor preventing pregnancy being the tubes.  I am very optimistic for you in this regard   !

I recommend that you find a fertility specialist in your area and have a consultation.  You will want to make sure that the specialist is properly trained and competent in advanced reproductive techniques.  The best way to do this is to check that they are board certified in both OB/GYN and reproductive endocrinology and infertility (REI).  I know people across the country, so if you email me, I can point you in the right direction (drkalan@center4fertility.com)

As far as genetic testing, this will be something to discuss with the doctor.  In general, when people mention genetic testing, they mean one of two things.

1.       Genetic carrier testing:  This type of testing is performed on you and your husband to see if either of you are carriers for an autosomal recessive genetic disease.  This includes things like Cystic Fibrosis and Tay Sachs disease.  For autosomal recessive diseases, if you are a carrier, you will not be affected by the disease.  If however, both you and your husband are carries of the disease, then there is a 25% chance that your child will have the disease.  Genetic carrier testing is performed through a blood test and is usually covered by insurance.

2.       Preimplantation genetic diagnosis (PGD) is a form of genetic test performed on the embryos created through IVF.    When an embryo is 3 to 5 days old, some of the cells which comprise the embryo are removed through a biopsy.  The cells can then be tested for any genetic disease.  Most commonly, the cells are checked to ensure that they contain the correct number of chromosomes.  Numerical chromosomal errors lead to problems like Down’s Syndrome.  Additionally, if there is a specific disease that your child is at risk for, for example Cystic Fibrosis, this can be detected as well.  Further, some families check the gender of the embryos at this stage.

The decision to pursue PGD is a bit more complex, and while it is good to know that it is an option, I do not necessarily recommend it for all my patients.  It is definitely worth discussing with your doctor. 

The bottom line is that while you have been through a lot, IVF presents a wonderful option for you to have a healthy happy baby!  Good luck to you and feel free to reach out if you have any other questions.

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