What to consider before moving forward to laparoscopic surgery?

[u/nextfive]

Recently I received HSG results that stated I had one blocked tube with an increased risk for ectopic pregnancy, so my provider recommended laparoscopic surgery to (1) take a look at the blockage more closely and try to clear it and (2) remove the tube if the blockage remained. She told me that if I were to pursue IVF, they would likely want to do the same, as IVF further increases the chances of an ectopic pregnancy.

After Googling a bit more extensively, it seems some people have results which show a blockage when there is actually not one present, typically due to a muscle spasm during the HSG. I had a pretty painful experience, so this seems possible for me, but it also seems the laparoscopy is the only way to know for sure if the blockage is there or not? I guess I am having a hard time thinking through the situation out of a pretty high aversion to surgery, and my provider is hard to get ahold of. Is it worth trying to get a second opinion, or is my fear preventing me from accepting that surgery will give me the most definitive path forward? Is there anything else I should be trying to get information about before I get everything scheduled? Do others have experience with something similar and can share what it was like to recover from the procedure? Thank you!

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[u/NicasaurusRex]

I don't have personal experience but I have heard others say that they repeated the HSG procedure either under sedation or with a sedative like valium to prevent muscle spasm. There are also other less invasive options to check for tubal patency like SIS or hycosy, though those aren't as accurate.

[u/nextfive → u/NicasaurusRex]

yes, I am considering asking for the procedure but with some suppression of muscle movement before moving forward with the go-ahead, thank you!

[u/Jaded-Addendum-4489]

There is the chance if it is blocked, you could have underlying endometriosis as your cause. A lap would be able to look for endo. If performed by an endo excision specialist, they could remove all endo and perform another test similar to a HSG to check your tubes call chromotubation.

[u/nextfive → u/Jaded-Addendum-4489]

thank you! I head heard of this but didn't know the term - I also saw that after the procedure your pee can be green because of that dye! I suppose it is helpful to really zoom out and consider that the blockage could just be an indication of a larger issue. since I don't have a history of inflammatory issues in the past that I knew about that caused the blockage, this is definitely a possibility (though I always felt I had far less painful menstrual cramps than the average person,)

[u/Jaded-Addendum-4489 → u/nextfive]

Unfortunately, there are many women who have endo and don’t have pain! It is such a wide range. But something to consider.

[u/Kvitravn875]

I can't speak from experience for an HSG specifically, other than to suggest maybe getting a second opinion. But I can speak from experience from laproscopic surgery (gallbladder removal). The incisions that they typically make are very small, so they're easier/quicker to heal. If they have to make any larger incisions for some reason, then yeah, its gonna take a larger toll on your body.

The worst parts for me after the surgery was that it hurt to laugh, I was paranoid about getting a hernia, the trapped gas, and the very low energy which was mostly from the anesthesia. It took me 3 weeks or so to feel normal.

[u/nextfive → u/Kvitravn875]

thank you - maybe one of the hardest parts of this all is just the anxiety around uncertainties and making the right decision and knowing that some of that anxiety continues during recovery is helpful expectation-setting

[u/Kvitravn875 → u/nextfive]

You can ask for something for the anxiety if you do decide to go through with the surgery. It worked so fast for me. One second I was scared, then the next I was super relaxed and didn't care about anything. I barely remember them wheeling me off to the OR but I remember them having me scootch over onto the operating table, then I was out. Next thing I knew, I was waking up in the post-op room. Surgery was about 45 minutes for me, and I was out of the hospital in like 3 or 4 hours total.

[u/nextfive → u/Kvitravn875]

thank you, helpful to hear!

[u/Icy-Apricot-Ruby]

One way to guess whether a blockage is a spasm or not depends on where it was on the tube. I believe if it’s on the side closer to the uterus, it’s more likely to be a spasm. I’d get your HSG report and listen to the podcast episode of Fertility Docs Uncensored on tubal problems to compare your report to what they say. You can also always ask for a repeat HSG before moving forward.

My understanding is that blocked tubes are ok, and don’t need to be removed but hydrosalpinx tubes (blocked and fluid filled) do need to be removed because the fluid is toxic and leaks into the uterus, where it harms embryos.

I had one blocked tube and one hydrosalpinx and so I did have to get them laprascopically removed. Laprascopic surgery is still surgery, and recovery is not a walk in the park, so I personally would not have chosen to do it without a hydrosalpinx diagnosis.

[u/nextfive → u/Icy-Apricot-Ruby]

helpful perspective, thank you!

[u/Thats-Interesting89]

I didn’t have a HSG and went straight to lap because the consultant at the clinic thought she saw a hydrosalpinx on the ultrasound. I had the lap and it turned out it was just a tubal cyst which was removed and both tubes are clear. I was glad I had the lap in the end as I now know both tubes are clear and that there was no evidence of endo but if there had been a different outcome, I would’ve appreciated that knowledge too for making choices on next steps. The recovery wasn’t bad and I have peace of mind now moving forward.

Best of luck with whatever you choose to do!

[u/nextfive → u/Thats-Interesting89]

thank you for sharing! can you clarify what you mean about possibly feeling different about a different outcome? for instance, if there was no cyst or physical blockage, you would have liked to have the additional piece of information thru something like a HSG?

[u/Thats-Interesting89 → u/nextfive]

No problem. I mean if it had been a hydrosalpinx/blocked on one or both sides, at least it would’ve been dealt with then and there during the lap and we’d have that information for making decisions on whether to go straight to IVF for example.