Tuesday, 27 August 2013

Why should hydrosalpinx be repaired before IVF?

When the fimbria of the fallopian tubes become damaged, it may result in a tube that is blocked at the very distal end; the part farthest away from the uterus. If the tube then becomes filled with fluid, it is called a hydrosalpinx (“hydro” refers to water; “salpinx” refers to the fallopian tube itself). Women who have a hydrosalpinx should have their fallopian tubes either removed or cut prior to undergoing IVF. The surgery usually involves a simple outpatient procedure called laparoscopy. The tubes are cut or removed so that the tubal fluid, which would be toxic to an embryo or adversely affect the receptivity of the endometrial lining, does not flow backward into the uterine cavity, preventing implantation of the embryo.

It is now well recognized that women with an untreated hydrosalpinx have a substantially reduced chance for pregnancy with IVF. In addition, an untreated hydrosalpinx may increase the chance that a woman will experience a spontaneous abortion or miscarriage. For all these reasons, treating a hydrosalpinx should both increase the IVF pregnancy rate and decrease the chances for an early pregnancy loss. A patient with a single normal fallopian tube and a hydrosalpinx will also have a higher chance of achieving a spontaneous pregnancy after removal or ligation of the damaged tube. A hydrosalpinx, if present, is usually identified during the infertility diagnostic evaluation with a Hysterosalpingogram (HSG). This simple x-ray study should be performed in all infertile women unless a diagnostic laparoscopy has already been performed. Preoperatively, we advise all patients that we recommend removal or ligation of her tube(s) if a hydrosalpinx is discovered at laparoscopy.

Hydrosalpinx, Infertility and IVF
A hydrosalpinx is a blockage of the far end of a woman’s fallopian tube which results in the accumulation of fluid within the tube. The condition can affect one or both fallopian tubes. Often the affected area can become substantially swollen and grow even as big as a few centimeters in diameter.

Usually, there are few symptoms noticed by patients although some women may suffer from abdominal or pelvic pain. The most common mean by which a woman becomes aware that she has this problem is the development of infertility. Women, who are not trying to get pregnant and have no pain, may go undiagnosed.

Hydrosalpinx Impact on Fertility
As mentioned previously, the main presentation of a hydrosalpinx is infertility. The fallopian tube plays a crucial role in establishing a pregnancy. As sperm enter the vagina, they travel through the opening of the uterus (cervix), through the uterus, and into the fallopian tubes. If intercourse happens at the time of ovulation, then an egg may be present in one of the fallopian tubes. A sperm can fertilize the egg forming an embryo. Afterwards, the embryo migrates down the fallopian tube into the uterus. If the embryo implants into the uterus, a pregnancy has been established.

However, if this tube is blocked, the egg cannot be captured by the fallopian tube and the egg and sperm are prevented from meeting. Thus fertilization cannot occur and pregnancy is prevented. In addition, when women have one tube which is open, their chances for pregnancy are reduced if they have a hydrosalpinx on the other tube.

Probable Reasons for a lesser Success
There are various theories that try and explain why the success rates in these patients are so much lower. One suggests that the flow of fluid into the uterus could interfere with and hinder implantation of an embryo. This fluid could contain lower levels of proteins, various amounts of debris, and other toxic substances found in the body that are harmful to the embryo itself or possibly the lining of the uterus. Another theory states that the fluid is a mechanical flush for the uterus, sweeping away the embryo. It is not known whether these effects would be worse if both fallopian tubes are affected, although that is thought to be the case.

Hydrosalpinx also impacts the Success of IVF
In vitro fertilization bypasses fallopian tube blockage by extracting the eggs directly from the ovary and fertilizing them in the laboratory. The embryos are then placed directly into the uterus. Thus, the fallopian tubes are completely bypassed. With the growing success of IVF and other fertility treatments in the past years, many women suffering from a hydrosalpinx are turning to these treatments to enhance their chances of pregnancy. However, there is substantial evidence to suggest that the success of in vitro fertilization is significantly lower for women with hydrosalpinx compared to other causes of infertility.

·         The overall pregnancy rate was shown to decrease in the women with the hydrosalpinx. The women with no blockage had a pregnancy rate of high compared to the women with the hydrosalpinx.

·         The implantation rate, which looks at how many transferred embryos were able to implant in the uterine wall, also decreased in the women with a hydrosalpinx.

·         The delivery rate decreased drastically as well. Almost twice as many women delivered without a hydrosalpinx higher than with a hydrosalpinx.

·         The delivery rate was lower in part because less women became pregnant but also because more of the women miscarried. Early loss in pregnancy was seen more often in the women affected than not.

Generally, for a woman with hydrosalpinx trying IVF, the chances for pregnancy are greatly reduced compared to the average infertile woman. While the possibility for pregnancy still exists in these patients, these women should be counseled that their chances for live birth are significantly lower if they have a hydrosalpinx.

Treatment Options for Hydrosalpinx to improve Fertility

Salpingectomy

The complete surgical removal of a fallopian tube is called a salpingectomy. The procedure can be done laparoscopically or with a standard surgery performed by making a horizontal incision in the abdomen just above the pubic hair line. Both procedures are performed under general anesthesia so that the patient is completely asleep.

Laparoscopy is a minimally invasive way of performing surgery. An small fiber optic telescope is inserted in a small incision just below the navel. This allows the reproductive surgeon to see into the abdomen and pelvis. Two additional incisions of about one centimeter each are made above the pubic hair line. Through these small incisions, instruments can be placed that allow the reproductive surgeon to detach the tube from the uterus and blood vessels and to remove it from the abdomen. Laparoscopy is the preferred method for performing a salpingectomy since no overnight hospitalization is required and the smaller incisions are associated with a shorter recovery time.

Tubal Ligation

Tubal ligation is when the fallopian tubes are either severed or pinched shut, but not removed. It is often referred to as getting one’s “tubes tied.” This can also be done laparoscopically, abdominally, or even vaginally. The most common way to seal the tubes is by using a cauterizing clamp which when applied to the outside of the tube, will seal it shut. Other methods include placing strong, tight rings or rubber bands around the tube that pinch them closed. Theoretically, by blocking the fluid from entering the uterine cavity, this may restore a normal chance for achieving pregnancy. The most common use of tubal ligation is as a permanent form of birth control. It is generally not considered to be reversible.

Hydrosalpinges, is surgery to remove it better than just ligating it?

·         Removing the hydros by cutting them off and taking them out of the body
·         Ligating or clipping them prior to IVF
·         Opening the end of the tube and leaving them in place (not usually recommended)
We know that on the average success is higher after surgically "fixing the hydros" However, it is not clear whether surgery to remove the tube vs. clipping or burning it close to the uterus and leaving the hydro in place is any different.

·         There is some concern that removal of the tube could have a negative impact on the blood supply to the ovary. This might result in reduced ovarian response to the IVF medications.
·         A reduced response to stimulation means fewer eggs to work with and a lower chance for pregnancy. The number of eggs retrieved correlates with the chance for IVF success.

How much higher is IVF success after hydro surgery?
The improvement in IVF success rates in studies is substantial but not huge. Some studies suggest that a woman under 35 might have a 35% success rate without surgery and a 50% success rate after having hydros removed. IVF success rates are very clinic-dependent. Therefore, decision making about treating hydros is not a clear-cut "black and white" situation. It is a grey area - and fertility doctors don't all agree about how to treat women with hydros.

·         Some doctors say you need to have surgery because it improves the chance for success
·         Some prefer not do surgery, and go to IVF - and if the first cycle fails, then think about whether to do surgery before the next IVF attempt.
·         Some doctors’ say it should be whatever the woman wants - have the surgery to fix the hydros, or don't have the surgery and accept a lower chance for success.
·         At our clinic we discuss surgery as an option and educate patients so that they can decide whether they want surgery first - or to go straight to IVF.


What causes hydrosalpinx?

Hydrosalpinx is often caused by tubal infection such as pelvic inflammatory disease (PID). The infection causes the tubes to become inflamed. After healing is finished the tubes are often blocked with residual fluid inside. Continued fluid buildup over time dilates the tube more resulting in hydrosalpinges of various sizes.

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  4. what would i have done if not prince idialu the great herbalist who save me from been a barring woman,after my fist child with my formal husband after 5 years when we bot separated i lost the child and then my tube was already tied what to do,till i got this wonderful man who God has assign to be my life partner single without a child and now my tube are tied when i got to the hospital i was told the reversal cost the sum of $5000 which i do not have because i do not need to tell my husband this because of the love i have for him.till one day a friend of my told me about a great man who treat with roots and herbs which i never believe it will work i just said let me give a trier one months after the treatment with the roots and herbs of prince idialu i got pregnant exact week i was told and now am 4 months pregnant and i want to say a very big thanks to prince idialu for his help you can reach him for confirmation via:princeidialu@outlook.com or call +2348107996889(LINDA)

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  5. Wendy & Husband: babakule thanks for your herbal herbs product.

    it is indeed a testimony! After 5 years struggling, 5 years of crying every single month when that ugly red visitor arrived , I fell pregnant with my little girl. God is indeed faithful!I’ll NEVER forget your prayers for me when I was struggling to fall pregnant. My little girl turns 3 next month and I always think of you. You took me as your younger sister and encouraged me with your herbal herbs product which i ordered for with the little cost of order and you actually sent it to me with the address that i email you. when I’d lost all hope. May God continue to use you to bring hope to the thousands of women out there. You are loved and appreciated. Wendy.babakule@outlook.com

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  6. Greetings to babakule ! Just wanted to let you know that the little baby boy The Lord blessed us with through your herbal herbs productbturned 5 on yesterday. We give God all the glory every day, you prayed for us then and our heart’s desire is for a baby girl now.
    He is the same God that when the doctor told me my fallopian tubes were bent, had scar tissue, endometriosis and cysts and that I would have to do invitro!…God gave us that baby without invitro!
    And also it was 7 months later, God’s number of perfection! GOD BLESS YOU babakule …and forgive me for not emailing sooner. I am sending a picture of Jaycee Jeremiah to those who want to see it; he is every bit of what we prayed for glory to God!babakule@outlook.

    ReplyDelete


  7. We are Blessed with a baby boy using your natural herbal herbs product:“WOMAN, YOU ARE NOT INFERTILE”
    Thank you babakule, my husband and I have been married for 8 years. We had difficulties conceiving until I started reading one of your testifier of your natural herbal herbs product, “WOMAN, YOU ARE NOT INFERTILE” we were introduced to it by our family friend David and Oumaki whom God also used your herbs to bless.
    The herbs gave me hope and new courage. After three months of ordered of the herbal herbs I was pregnant. God has done great things for us, we give him all the praise.
    Our son is turning 1year on the 14 November 2012. His name is mercy . We thank God for your life and hope that you continue giving hope to many more couples. cherish (South Africa)babakule@outlook.com

    ReplyDelete
  8. i was married for over 2years but i could not get any child.i tried all i could but nothing good came out from it.so i learned to contacted this great man who gave me his herbal medicine. so i kept on the instruction and i made used of it.after some few weeks i got pregnant so now am 6months pregnant waiting to see my baby girl.thanks to you .indeed you are a nice and great man.this is the man address:ogbefiherbalcenter@outlook.com

    ReplyDelete
  9. i was married for over 2years but i could not get any child.i tried all i could but nothing good came out from it.so i learned to contacted this great man who gave me his herbal medicine. so i kept on the instruction and i made used of it.after some few weeks i got pregnant so now am 6months pregnant waiting to see my baby girl.thanks to you .indeed you are a nice and great man.this is the man address:ogbefiherbalcenter@outlook.com

    ReplyDelete
  10. Greetings to babakule ! Just wanted to let you know that the little baby boy The Lord blessed us with through your herbal herbs productbturned 5 on yesterday. We give God all the glory every day, you prayed for us then and our heart’s desire is for a baby girl now.
    He is the same God that when the doctor told me my fallopian tubes were bent, had scar tissue, endometriosis and cysts and that I would have to do invitro!…God gave us that baby without invitro!
    And also it was 7 months later, God’s number of perfection! GOD BLESS YOU babakule …and forgive me for not emailing sooner. I am sending a picture of Jaycee Jeremiah to those who want to see it; he is every bit of what we prayed for glory to God!babakule@outlook.com

    ReplyDelete

  11. DR OGBEFI is a real life Hero! My Wife and I cannot thank him enough for the blessing he has helped bring to our life. We put our trust in him and the Lord and we have been greatly rewarded. My wife is now 2 months pregnant and we are filled with joy and gratitude. Prior to seeing Dr. DR OGBEFI tried IVF.this man is great and trusth worthy. contact him here:ogbefiherbalcenter@outlook.com(pat scoter)

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  12. Dear Dr.OGBEFI and staff, I [recently] had a tubal ligation reversal. I felt a little bloated and uncomfortable for about 2 days, but was back to work [within 3 days] with no restrictions. I am pleased to announce that my husband and I are expecting a baby! I am 8 weeks pregnant (today). The entire experience was very smooth. Dr.OGBEFI and his staff were understanding, very informative, and so wonderful toward us. Thank you SO much Dr.OGBEFI.if you want to get his herbal herbs to get pregnant use his email to reach him:ogbefiherbalcenter@outlook.com

    ReplyDelete
  13. “Hi .Dr.OGBEFI, I just wanted to update you on delivery of baby #2 after using your herbal medicine and herbs. My baby… was born on 09/06/2015. he was 5 lbs 10 oz [and] … was healthy. I’m just very grateful to you that I was able to have 2 more beautiful children… I went ahead and had my tubes tied again. .BABAKULEI if I would have not done that, guess what, with the great job you did and how fertile I am, trust me we would be probably pregnant with another soon because your herbal herbs is good… I will keep referring my friends and relatives as the opportunities arise to you sir so they can use your address that i used :[babakule@outlook.com.
    - marry jane

    ReplyDelete
  14. Dear BABAKULE and staff, I [babakule@outlook.com.
    ] had a tubal ligation reversal. I felt a little bloated and uncomfortable for about 2 days, but was back to work [within 3 days] with no restrictions. I am pleased to announce that my husband and I are expecting a baby! I am 8 weeks pregnant (today) and our baby is due in August. The entire experience was very smooth. and his staff were understanding, very informative, and so wonderful toward us. Thank you SO much Dr. BABAKULE.”
    - edna

    ReplyDelete
  15. ogbefiherbalcenter@outlook.com. performed a GOOd work on me in February of this year through his herbal herbs. I just wanted to let you know that I am now 7 weeks pregnant. Thank you so much. ogbefi is really good at helping family to get children.thank ogbefi

    ReplyDelete

  16. “Hi BABAKULE,babakule@outlook.com you performed my tubal reversal in August 2011 and in September 2011, just after 1 month, I became pregnant. Ultrasound showed a gestational sac with a yolk sac [inside the uterus]. We are very excited! Thank you. Choosing you was the best decision I have ever made. My husband and I are so happy!!!! I never thought it would happen so soon. We will forever be grateful that we came to see you.”
    - CUSOMS

    ReplyDelete


  17. babakule@outlook.com , I just wanted to say that the herbal that you sent to me on march 2015 was a success one and I’m currently 2 1/2 months pregnant. Thank you.you are indeed a real man.
    - SL

    ReplyDelete


  18. babakule@outlook.com , I just wanted to say that the herbal that you sent to me on march 2015 was a success one and I’m currently 2 1/2 months pregnant. Thank you.you are indeed a real man.
    - SL

    ReplyDelete
  19. “I am 40 yrs old and had my tubal reversal when I was 39 in Aug 2010 and in Jan 2011 I became pregnant through the herbal product of babakule. thanks to dr morbabakule@outlook.com and his fabulous staff… We are expecting our third child october 10…yay!… can’t thank babakule@outlook.com enough he is a great professional work with great follow up and bedside manner…thanks again, very much worth it!”
    - JH

    ReplyDelete
  20. ogbefiherbalcenter@outlook.ccom and his staff at the Center for Tubal Reversal were extremely courteous and professional. I am super excited that the tubal reversal procedure resulted in minimal scarring – I can still wear a bikini to the beach! I am looking forward to notifying everyone of our new family member. Thank you,”

    ReplyDelete

  21. On 30th May 2008 Jeff and Cath wrote:BABAKULE THANKS SO MUCH. We've been trying to have a baby for 18 months and about 5 months ago we picked up your HERBAL HERBS PRODUCT "God'HELPED US TO EXPERIENCE Pregnancy THROUGH THE HELP OF YOUR PRODUCT. Praise God! We are now 6 weeks pregnant. Kind Regards Jeff & Cath .babakule@outlook.com.
    kopio vesa

    ReplyDelete

  22. On 30th May 2008 Jeff and Cath wrote:BABAKULE THANKS SO MUCH. We've been trying to have a baby for 18 months and about 5 months ago we picked up your HERBAL HERBS PRODUCT "God'HELPED US TO EXPERIENCE Pregnancy THROUGH THE HELP OF YOUR PRODUCT. Praise God! We are now 6 weeks pregnant. Kind Regards Jeff & Cath .babakule@outlook.com.
    kopio vesa

    ReplyDelete
  23. On 17th March 2015 Sharon wrote: Hi BABAKULE , I'm writing to introduce myself as I'm a new member to this group OF THOSE that has good testimonies about your herbal herbs. My name is Sharon & married to John - I'm 36 & John's 39. I was given a copy of your herbal herbs through my husband who bought it with the ordered cost. So faith building! I also passed a copy onto a friend of mine who is 39 and has been trying for about 8 years. We are now getting together once a week to pray for our pregnancies/babies. to God be the glory both of us got pregnant .and we are preparing to give birth to a child.babakule@outlook.com.desmond hilavs

    ReplyDelete

  24. i am short of words to appreciate this nice man that gave me herbal herbs that made me pregnant. am so excited to share this testimony with everyone that come across with this information.ehi is good and truthful with his work. i feel good and happy to say i used his herbal herbs to make my family happy and alive. now am on my second child just with his help herbal herb.ehilenboajayebabycenter@outlook.com

    ReplyDelete

  25. My Daughter was born on April 22nd, i was able to have this child with the help of EHI the doctor who sent to me the herbal herbs that i ordered for from his country and he actually sent it to me and i made used of it and it worked perfectly well for me. now am blessed with this beauty daughter. (: Thanks)ehilenboajayebabycenter@outlook.com

    ReplyDelete
  26. I just had my third baby (first girl) yesterday (7/29/13) at 33 weeks and 2 days. No complications during any of my pregnancies so this was a shock. I started having painful contractions around noon and started bleeding around 2pm. I labored at home until a little after 5, at the hospital by 6, and she was born at 7:58pm. and will be for the next few weeks as long as she keeps progressing. She can breathe on her own, which is astounding the doctors and nurses, eating, etc. I'm nervous and I have to go home with her tomorrow.dr Ehi has done great for me ,baby has being my wish, and he told me not to worry that i will have baby girl and actually it work out for me.thanks you dr ehi:ehilenboajayebabycenter@outlook.com. She's a big tough girl and I can't wait to take her home. Thanks for giving me a safe place to get this out

    ReplyDelete

  27. My name is Stevie and I’m married to Marjolaine. We were married in 2011 and were both keen on starting a family fairly quickly. However, having children doesn’t always happen when you want it to, and there were also certain problems from the past for both of us, i suffered a miscarriage and was told by the doctors that she might not be able to have children afterwards. and i could not have rest, so i email him for a solution and help me get the joy of a family with a pregnancy.so i made use of the support he gave to me within one month a got pregnant.thank dr EHI.ehilenboajayebabycenter@outlook.com

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  28. dr ehi is different from other that i have wasted my money with.i applied his herbals herbs for my pregnancy and it work out for me.thank dr ehi for a positive change.ehilenboajayebabycenter@outlook.com

    ReplyDelete
  29. it all happend when i found his email address on the internet ,when i was looking for some herbal helps.i was so convience that he is real and good for me to change my situation.glory to God that my bad situation for 15years change for good,now am 8months pregnant. thanks to you for your support.as soon as i have my second child ,please sir i will love to invite you to my country USA for a visit .babakule@outlook.com

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  30. when my tube were tide so i was lucky to have contact with babakule for a help . i got to know with my mother inlaw who gave me the contact. i thought it was spiritual till i applied the herbal herbs for two weeks and on the third week,my tube were open and i found myself pregnant that led to my first child. what i great miracle i got through babakule herbal herbs.if you want him to help you use this:babakule@outlook.com

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  31. it is a thing of joy to say what God use doctor Prince Idialu to do for me,after alot of medical consultation that i can not give birth except i do an operation on fibroid before i can be able to conceive,it was like all hope was lost till i met with my friend and she introduce me to this wonderful man who use roots and herbs with 100% assurance in his work i thought it was like a way to convince me and get my money from me without any result but my friend insisted i do it so i just said let me give a trier even when i was sending the money i never belive it will work i only do it because of my friend so after taking the roots and herb it was not even up to the time he gave to me as 1 month and two week ,to the glory of God i got pregnant just after 1 month and 3 days even when your tube are tied you can still get pregnant with prince idialu roots and herbs with 100% assurance ,i want to say once again thank you prince idialu for help email:princeidialu@outlook.com +2348107996889

    ReplyDelete
  32. I’m Hellen and I’ve lived with unexplained infertility my whole life, never being able to achieve a pregnancy.At age 27, I had some cells frozen off my cervix as a result of having a pre-cancerous condition. Then I went about living my life, traveling, learning, enjoying, loving, never realizing my fertility was dwindling, always confident I could have kids at any age- why hurry?along the line i met with a friend who directed me to Dr Kruma Crumen who help me with fertility herbal supplement which i take and after surprisingly i got pregnant and now i am a motherof two now. If you are in the same situation and you need help Contact Dr Kruma Crumen via Email: drkrumacrumen@gmail.com or website: http://drkrumacrumensolutionhome.tripod.com/

    Yours faithfully,

    Hellen Else

    ReplyDelete
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