After the age of about 45 years the ovaries stop making some of the female hormones. Eggs are not released each month. The endometrium is no longer shed. The periods stop. This is called the change or the menopause. The changes in hormones often cause hot flushes and dizzy spells. Sometimes the periods become very heavy during this time.
What has gone wrong?
Your Fallopian tubes may be blocked because of a past infection or by scarring, called adhesions, inside your pelvis. You may have a different condition inside your pelvis that is making it difficult for you to become pregnant.
We use this test to find out if your Fallopian tubes are blocked and, if so, why. As part of the test we do a diagnostic operation with keyhole instruments, called a laparoscopy. This lets us examine inside your pelvis with a telescope, called a laparoscope. We pass this through a small cut in your abdomen. This may reveal a different cause for your pregnancy difficulties. The dye test part of the operation is called hydrotubation.
If we find a clear cause for your pregnancy difficulties, such as blocked tubes, you can start the best treatment. If there are other causes, a laparoscopy is a very good way of detecting them.
It may be possible to unblock your tubes using keyhole instruments during this operation. This may be just dividing a few adhesions that are causing the blockage.
Using keyhole techniques is less painful than doing open operations, recovery is quicker and you avoid having a large scar.
Are there any alternatives?
Ultrasound scans or x-rays may also give us some information about your tubes, but they are not usually as informative as a laparoscopy. A laparoscopy is usually better for finding the cause of any blockage and for seeing the condition of your pelvic organs.
Some specialists use culdoscopy. For this, instead of passing a telescope through your abdomen and into your pelvis we pass it through the wall of your vagina. It lets us see the outside of your uterus, Fallopian tubes and ovaries, and with the dye test we can see if your Fallopian tubes are blocked. The advantages of culdoscopy are that it leaves no visible scars on your abdomen and can be done using local anaesthetic. The disadvantages are that the view is not usually as good as from a laparoscopy and it gives a higher risk of infection. Also we cannot usually operate to remove a blockage during a culdoscopy. With a laparoscopy under general anaesthesia, if you require treatment, we may be able to do it straight away using the laparoscope. You may have a culdoscopy first then a laparoscopy at a later date if you need treatment.
Discuss the options with your gynaecologist.
What if you do nothing?
If you do nothing, your difficulties in becoming pregnant will probably continue. If we do not know the cause of your problems we cannot treat you.
Author: Dr David Hutchon F.R.C.O.G. Consultant Gynaecologist.
© Dumas Ltd 2006