Without knowing about your particular case – there are 3 options:
1. Laparoscopy and attempt to re-open one or both tubes, probably with lysis of adhesions – cutting / burning / lasering any scar tissue around the tubes / ovaries
Sometimes a tube can’t be re-opened, for example if it is covered in too much scar tissue and stuck to your bowels. Sometimes the tube is stretched out and damaged and may not work well even if the surgery successfully re-opens one or both tubes – this is more likely if the hydrosalpinx is large or has been there for a long time (a chronic hydrosalpinx). If you get pregnant after this type of surgery you have a chance of an ectopic (tubal) pregnancy.
If one or both tubes are not fixable”” they can either be removed at the time of laparoscopy of tied or interrupted close to your uterus so that the hydrosalpinges don’t leak fluid into your uterus that lowers your chance of pregnancy with In Vitro. ”
Pregnancy rates after laparoscopic opening of the tubes (neosalpingostomy) are low – about 20 – 32 % of women get a pregnancy in the uterus and 5 – 16% get an ectopic (tubal) pregnancy. See the link below. There are few surgeons offering microsurgical tubal surgery at this point.
2. Block your tubes then do In Vitro fertilization (IVF) – this can be done with laparoscopy and tying your tubes or removing the hydrosalpinges. There are two less invasive surgical options where your MD can do a hysteroscopy (done through the uterus with no incisions on your belly) – these are called the Essure or Adiana procedures. These are quicker surgeries with an easier recovery than with laparoscopy but the Adiana and Essure have a small failure rate.
If both tubes are blocked and you are under 35 with normal ovarian reserve (egg supply) the success rate of IVF can be as high as 60-65% – double to triple that of surgery to open your tubes. If you are a good candidate for IVF this should be your best option for getting pregnant. If you have extra embryos we can freeze them so you may get more than one attempt to get pregnant out of one IVF treatment cycle.
3. Go through IVF without any surgery on your tubes – this can cut the success rate of IVF down by a third to a half maybe down to the 30-45% range.
Your individual case may be different and it is worth testing your ovarian reserve (egg supply) and your partner’s sperm before making a final decision – if he has a very low sperm count IVF with ICSI (where we inject one sperm into each egg) may be the best option preferably after blocking the hydrosalpinges.
Hope this helps. I recommend seeing a Reproductive Endocrinology / Infertility specialist (REI) MD for a more detailed discussion of your options.
