"I've had abnormal and painful
periods ever since I went through puberty, "Carrie Y. told the
support group. "To stop bleeding all of the time, I had to go
on the Pill when I was fifteen. The doctor told my mother that I wasn't
ovulating and might never conceive.
"I lost my virginity on the operating table. I can't even
remember how many D&Cs I had before I was twenty-five."
"Did you cramp a lot?" one member asked.
"Yes, but I thought everyone cramped and that having pain
with your periods was normal. The pain eventually got so bad that
when I was in my early twenties, I had to stay home during the first
two days of my period. I learned later that discomfort from normal
periods shouldn't interfere with your daily routines. But since
I never knew any differently, all of those years I didn't question
it." She paused. "Not until that awful day. My husband
and I had decided to try to have a baby. I'd been taking clomiphene
for several months, to get me to ovulate, and my period was a week
late. That wasn't anything unusual, since my periods were frequently
forty to fifty days apart. But I'd been regular since I'd been on
clomiphene. When my basal body temperature stayed up that week,
we both became pretty excited. After two years of trying, I was
sure I was pregnant.
"But that morning at work I had terrible cramps, like I needed
to have a bowel movement. The pain in my side was so bad that I
had to go home. Later that afternoon I did go to the bathroom and
the pain stopped. But not for long. It became so severe that I thought
I was going to pass out. I called the doctor. I cried all the way
to the hospital.
"After running some tests, he told me that I had either appendicitis
or a tubal pregnancy. I'd begun to spot, so I was afraid I was losing
a baby. He had me stay at the hospital overnight.
"The next morning I was weak but I felt better. Since they'd
found some blood in my urine, the doctor thought I was passing a
kidney stone. And he sent me home.
"The pain continued and the bleeding got worse, so I went
back to the hospital and had a D&C. The doctor didn't think
I was pregnant because he couldn't find any tissue in the material
he removed.
"When I returned home, the pain in my right side was gone,
but I was bleeding like a leaky faucet. I knew it wasn't right.
I was a D&C expert by then. Another thing that puzzled me was
that my breasts were still swollen and tender. But when I called
the doctor, he didn't seem very concerned. He just said, 'You can
expect some bleeding after a D&C.'
"Even though the bleeding continued, I returned to work.
In the middle of the morning, searing pain doubled me over. My secretary
rushed me to the hospital. I had an ectopic pregnancy and had lost
a quart of blood. That wasn't all I could have lost. I nearly lost
my right tube and ovary."
The group was quiet.
"What caused it?" a voice asked from the back row.
"When they did my laparoscopy, they found out that I have
endometriosis. That's probably why my
periods were screwed up. 
The
doctor said that my adhesions were so thick he could hardly find
my tubes."
"What did you do?" a woman asked.
"First of all, I changed doctors. After all I'd been through,
I'd lost faith in him. My new doctor is performing a laparoscopy
next week. He believes he can clean out the adhesions and endometriosis
and possibly restore my tubes to normal. We'll know more after the
surgery."
Tubal problems are the leading cause of female fertility problems.
With the tremendous increase in PID and sexually transmitted infections,
and with the increased incidence of endometriosis, tubal problems
account for half of female infertility.
What Causes Tubal Problems?
A number of different problems can impair fallopian tube function:
Abdominal
adhesions and scar tissue that immobilize fallopian tubes
Adhesions
and scar tissue that prevent the egg from entering the tube and traveling toward the uterus
Damage from
an ectopic pregnancy or sterilization surgery
These problems can be caused by a variety of events:
Ruptured appendix
Pelvic inflammatory
disease (PID)
Gynecologic
surgery
Postpartum
infection
In utero DES
exposure
Salpingitis
isthmica nodosa
Endometriosis
Cesarean section
Bowel surgery
Ectopic pregnancy
Tuberculosis
(genital)
When infection and disease attack delicate tubal structures, the
tubes may become deformed and cease to function. Trapped in adhesions
and scar tissue, they can no longer retrieve the egg and coax it
toward the uterus. Infection and damage from ectopic pregnancy may
strip the vital ciliated lining from the inner walls. When this
happens, sperm cannot meet egg, and fertilization cannot
occur. If the tubes are obstructed only partially, sperm may be
able to meet egg, but the developing embryo can become trapped inside
the tube and cause a painful and even life-threatening ectopic pregnancy.
The PID epidemic alone is claiming the fertility of hundreds of
thousands of women each year. Up to 60% of women who have antibodies
to chlamydia are unaware that they ever had an infection will this
stealthy invader that can destroy your fallopian tubes and rob your
fertility without the slightest hint. Fortunately microsurgery,
laser surgery, and in vitro fertilization techniques can restore
fertility to many of those victims.
The
fallopian tube is an active, muscular organ that retrieves the egg
from the ovary and coaxes it toward the oncoming sperm. If adhesions
restrict the tube's mobility or if infection has stripped the tiny
cilia from the tubal lining the tube cannot perform its vital job.
The various tests I use will help me determine if: