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Dr. Mayur Dass

Senior Residency, Senior Residencty, DNB, DGO, MBBS

Gynaecologist, New Delhi

14 Years Experience  ·  300 at clinic  ·  ₹200 online
Dr. Mayur Dass Senior Residency, Senior Residencty, DNB, DGO, MBBS Gynaecologist, New Delhi
14 Years Experience  ·  300 at clinic  ·  ₹200 online
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Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; a......more
Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; as a health provider being ethical is not just a remembered value, but a strongly observed one.
More about Dr. Mayur Dass
Dr. Mayur Dass is one of the best Gynaecologists in Vasundhara Enclave, Delhi. She has been a practicing Gynaecologist for 14 years. She has done Senior Residency, Senior Residencty, DNB, DGO, MBBS . You can visit her at Varshney's Uro-Gynaec Clinic in Vasundhara Enclave, Delhi. You can book an instant appointment online with Dr. Mayur Dass on Lybrate.com.

Lybrate.com has a number of highly qualified Gynaecologists in India. You will find Gynaecologists with more than 26 years of experience on Lybrate.com. Find the best Gynaecologists online in Delhi. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Specialty
Education
Senior Residency - LBS Hospital, Delhi - 2012
Senior Residencty - LTMMC & LTMMH, Mumbai - 2011
DNB - National Board of Examination, Delhi - 2008
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DGO - AMU, Aligarh - 2006
MBBS - AMU, Aligarh - 2003
Languages spoken
English
Hindi

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Varshney's Uro-Gynaec Clinic

Shop No-112, 1st Floor, Vardhman Sunrise Plaza, Vasundhara EnclaveNew Delhi Get Directions
300 at clinic
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Please advice if I will do ivi so it can possible with thyroid and reports are normals.

MBBS, CCEBDM, Diploma in Diabetology
Endocrinologist, Hubli-Dharwad
Please advice if I will do ivi so it can possible with thyroid and reports are normals.
lybrate-user, If thyroid reports are normal, and if TSH levels are <2 mU/L, then you can go ahead. Plus through out the three trimester TSH should be maintained around the same level. Thanks.
1 person found this helpful
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I gave my gf unwanted 72 on 12 december her date of periods is 16 but till now she have not got her periods .till what date she will get her periods? We had dry humping few hours ago .and after 8 hours I gave her unwanted 72 .how many days will it take to have her periods please tell me fast I worried plz.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Raipur
I gave my gf unwanted 72 on 12 december her date of periods is 16 but till now she have not got her periods .till wha...
Usually unwanted 72 doesn't alter the preiods. U can wait for few more days if she doenot get periods get a pregnancy test done.
4 people found this helpful
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I had sex on 26 Dec and uske baad check bhi kiya but report negative aayi hai and ab tak period bhi nai hai actually meri date koi fix nahi hai last year se mere date ke din kam hote ja rahe hai and abhi aaye bhi nahi please help me koi medicine bataye jis se ki normal Ho jaye.

DNB, DGO, MBBS
Gynaecologist, Ghaziabad
I had sex on 26 Dec and uske baad check bhi  kiya but report negative aayi hai and ab tak  period bhi  nai hai actual...
Do a blood test called serum beta hcg to rule out pregnancy. If negative, then there are many other reasons for a missed period, such as hormonal imbalance, hypothyroidism, cysts in ovaries etc. You will need to get an ultrasound of pelvic organs along with few blood tests to find out the cause of this. Please meet a gynaecologist for further evaluation.
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What test for infections of mine and my husband should we go for before conceiving. Please suggest.

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
Are any one of you suffering from any infections? otherwise, no routine testing except the tests needed as pre-conceptional check up.
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I m Priti my age is 29. I have thyroid (tsh) I have menses problem late menses and no bleeding what can I do and my weight is 120 kg my height is 5'3.

Doctor of Naturopathy & Natural Medicines, DM - Clinical Haematology
Dietitian/Nutritionist, Agra
I m Priti my age is 29. I have thyroid (tsh) I have menses problem late menses and no bleeding what can I do and my w...
Lybrate-user your body's proportion is not good: start taking something natural and have a will to improve your health without medicines, for thyroid start drinking coriander juice (50 gram), make a paste and boil in water, then when its bit colder drink it regularly in morning empty stomach, after 45 minutes eat" triphla" chooran with luke warm water than 45 minutes later have breakfast, triphla will help you reduce your weight. For menses problem start drinking cow milk and put 1 table spoon cow ghee in it, you will never have any ladies problem in you life. Bleeding might not be coming due to lack of blood, get your hemoglobin check, drink fresh juices, eat lots of green vegetables, avoid fast food.
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My first delivery on 7 Nov. After date my first period arrive on 10 Dec. Thereafter till now no periods. Pregnancy test is negative. Breastfeed my 5 mnth old baby but not exclusively. Please suggest is this nrml or I need to check up.

MBBS, MD - Obstetrtics & Gynaecology
Gynaecologist, Gurgaon
My first delivery on 7 Nov. After date my first period arrive on 10 Dec. Thereafter till now no periods. Pregnancy te...
It's normal, lot of women during breast feed do not get their periods for three to six months ,as the prolactin levels are high, but however it's not mandatory that it happens in all cases ,suggest you wait for few months.
1 person found this helpful
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I have irregular periods. I have done all the treatments but still having same problem. Please advise me for this.

M.D (HOMEOPATHY), MBA (Healthcare)
Homeopath, Gulbarga
Dear, cause for irregular menses may be many. Get checked your thyroid profile and abdominal scan. And let me know the medications you took these days. Homeopathy helps you to get rid of your problems. Take care.
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I am married from 2 years and still did not conceive. I tried many medicines and the all the advised tests are normal. Please how can I conceive as I am much worried.

MBBS, MD - Obstetrtics & Gynaecology, Fellowship in Laparoscopy, DNB (Obstetrics and Gynecology)
Gynaecologist, Delhi
I am married from 2 years and still did not conceive. I tried many medicines and the all the advised tests are normal...
Stop isotretinoin and go for hysterolaparoscopy. If everything is normal then you ll b directed for iui.
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I am 39 years woman and suffering from fibroid in uterus size 18.7 mm. What shoud I do?

FRAS, MD - Ayurveda, Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Alternative Medicine Specialist, Ernakulam
Uterine fibroids can effectively be treated with ayurveda med some of the medicines are kanchanara guggulu tab, nityananda ras tab, sukumara kwatha, guggulutikta grutam or khwata, dasamoolapanchakola kwatha, chandraprabha vati.
1 person found this helpful
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BHMS
Homeopath, Solan

I am five months pregnant my hair falls to much why? What is the home remedy for it.

Ayurveda, Delhi
I am five months pregnant my hair falls to much why? What is the home remedy for it.
Dear First check your​ vitaminD Fenugreek seeds Soak fenugreek seeds in water overnight. Massage the strained liquid into the scalp next morning. Wrap a towel around your head and leave for 4 hours. Shampoo and condition. Lemon juice Prepare a mixture of olive oil, rosemary, egg yolk and lemon juice. Apply all over head, paying special attention to hair roots. Leave for an hour and wash off. Rosemary leaves Boil some rosemary leaves in water for about 5 minutes. Cool, strain and use for your hair wash. Egg yolk Massage a raw egg yolk onto scalp and leave for 15 minutes. Wash and shampoo hair and comb gently with a wide toothed comb. Leave to dry naturally. Do this once a week to strengthen hair roots. Castor oil Mix an equal amount of warm castor oil and almond oil and massage on scalp once a week. Almond oil Massaging just almond oil on scalp 2 -3 times a day will help to stop further hair loss. Aloe vera Coconut milk and aloe vera gel are also very good for hair growth. Massage onto scalp, leave for ½ hour and rinse with warm water. You can repeat this three times a week. Apart from these home remedies for pregnancy related hair loss, make a habit of the following for improved hair health:  Do not use water which is too hot for washing your hair. Use good quality brushes and combs and don’t brush hair too vigorously or too often. Use a mild shampoo suitable for your hair type and wash every third day. Condition regularly.
2 people found this helpful
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My friend is suffering from, polycystic ovarian disease, some doctors said this is incurable and remains for life long and she can not become pregnant and some said she can become pregnant but with some complications. Is that true that she can not become pregnant? Does this disease remains for life long?

MBBS
General Physician, Cuttack
My friend is suffering from, polycystic ovarian disease, some doctors said this is incurable and remains for life lon...
1.In PCOS (polycystic ovarian syndrome )many small cysts appear in ovary-causing hormonal imbalance.there is production of excess Testosterone.Omega 3 Fatty acid reducece excess Testosterone and can be used in the treatment 2.They secrete more androgen 3.The symptoms are weight gain,acne, decreased ovulation, irregular period, infertility, depression, extra facial and body hair, hair loss from scalp, insulin resistance causing Diabetes. 4.it is genetically inherited,runs in families 5.it can be diagnosed by pelvic laparoscopy/vaginal ultrasound. 6.Treatment-surgery/anti androgen therapy 7.consult gynecologist for advice and treatment
1 person found this helpful
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Hi my question is I am still not pregnant and what is my health problem, my marriage life is completed 2years only please reply me your suggestion.

MD - Obstetrtics & Gynaecology
Gynaecologist, Mumbai
Hi  my question is I am still not pregnant and what is my health problem, my marriage life is completed 2years only p...
To get pregnant you need to have fallopian tubes patent which is checked by hsg test and semen should be adequate quality which is checked by semen analysis. These both tests are done before the treatment of any infertile couple. Once the above tests are normal, then treatment with clomiphene citrate is started with monitoring of egg. You need to consult a good gynecologist who would start proper treatment for u.
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I am married for 1 year 6 months now and we're thinking of getting pregnant. My friends are suggesting me to take folic acid tablet from now only. But folic acid is making me feel bloated all day. Is this normal? Should I discontinue? What else do I need to know other than folic acid. Please help.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Zirakpur
I am married for 1 year 6 months now and we're thinking of getting pregnant. My friends are suggesting me to take fol...
Best way to play safe with Ayurveda for potential pregnancy. Start with Sitopaladi+ prawal pishti and mandoor bhasm. Its nost safe and side effects less combo. Also phala ghrit to be used with milk (not vey tasty but high class uterus strength enhancer and conception). After you conceive, garbhchintamani rasa should be added. U will get fair, properly developed and intelligent child. This is Ayurveda 's wisdom. Better meet some Ayurvedic doctor near you or consult us privately for full guidance.
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I want my vagina tighten again .Give me suggestions how it is possible? My vaginal wall loose due to rough sex and wet my vagina soon Nd my partner not satisfied from me.

PDDM, MHA, MBBS
General Physician, Nashik
Vaginal tightening can be achieved by- 1.Vaginal tightening creams. These act by strengthening the muscles. 2.Kegel's excercises-consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. 3.Vaginoplasty operations.
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Hi, My wife age is 25, Period getting delay from last 18th dec, We had tested in test device. Result is positive. So please advise how we can handle this situation, which is the right food now.

DGO, MD, MRCOG, CCST, Accredation in Colposcopy
Gynaecologist, Kolkata
Hi, My wife age is 25, Period getting delay from last 18th dec, We had tested in test device. Result is positive. So ...
Please read my health tip on Healthy eating in pregnancy. A diet well balanced in proteins and vitamins/minerals- like milk, egg, dal, fruits and green vegetables and if non-veg then fish and chicken is good. Also take enough carbohydrates like cereals, chapatti, brown bread and moderate rice
1 person found this helpful
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Having PCOS plus my prolactin level is higher. Trying to conceive from 2 years but no luck at all. Dr. suggested weight loss but that is also not happening. Having few doubt as I heard dairy product is not allowed can I have curd. N spices like only green chilly It become difficult to eat without this both. Even I have to avoid sugars? As prolactin level is high I am confused. please reply as my Dr. is out of country And thanks in advance.

C.S.C, D.C.H, M.B.B.S
General Physician,
Having PCOS plus my prolactin level is higher.
Trying to conceive from 2 years but no luck at all. Dr. suggested weig...
On a weight loss programme, you want your body to get most of its energy from fat rather than carbohydrates. In fact, what you want your body to do is to feed on its fat stores. In order for your body to start doing this, your carbohydrate intake will have to be restricted, however, still leaving enough to form glucose for your brain. In terms of your carbohydrates, you can either reduce or eliminate some foods from your diet, for example, flour, biscuit, rice, soda and pastries. These can be substituted with either ground provisions, steamed vegetables, vegetable juices or fruits, although it's always best to eat the fruits rather than drink the fruit juices. Try to reduce the amount of fatty and oily foods in your diet. Your overall aim is to be healthy and reduce your calorie intake. As such, you need to start or increase your exercise programme. If you are just starting your exercise programme, it is best to start slowly at first and then gradually increase as you go along.
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I'm 33 years female. Trying to conceive from 1 year but didn't get success. I started treatment from last month and take letroz only. In ultrasound it founded that my egg size is 15 mm only. But this month I am missing my period. Today I checked pregnancy and its negative. please help me.

MBBS, MD - Obstetrtics & Gynaecology
Gynaecologist, Gurgaon
I'm 33 years female. Trying to conceive from 1 year but didn't get success. I started treatment from last month and t...
I think you should continue to try for atleast two three months more, and take proper medications and still if you are not able to, then you might need a bit more advanced treatment to enhance your fertlity, in case you need any further information or assistance you may get back to us.
2 people found this helpful
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My sister is pregnant for first time aged 33 and 05.12.2017 is the date given by doctor and position of baby is reverse-head upwards since 10 days which was noticed 2 days ago and she is suffering from cold and cough. What further to do?

DNB, DGO, MD
Gynaecologist, Delhi
My sister is pregnant for first time aged 33 and 05.12.2017 is the date given by doctor and position of baby is rever...
Position at this stage of baby will keep changing. Don't worry about that. Position of the baby has to be seen in last month. Secondly for cold and cough she can take steam and if still not relieved some medicines which are safe in pregnancy can be prescribed.
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Fallopian Tube Block In Infertility - What Can You Do?

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
Fallopian Tube Block In Infertility - What Can You Do?

When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.

What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.

In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm.

It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.

Thus, to summarise, pregnancy requires:

1.Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes

2.Transport of these sperms through the sperm conducting ducts from testes to penis

3.Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina

4.Transport of these sperms from vagina through cervix to the uterus and the tubes

5.Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries

6.Pick up of the eggs by the tubes

7.Approximation of eggs and the sperms to form the embryo

8.Transport of embryo from the tubes into the uterus

9.Acceptance of the embryo by the uterus and its growth

What is Infertility?

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor.

It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%.

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage.

What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned.

Thus the common causes may be

1.Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.

2.Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examples include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.

3.Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.

In general, what are the treatment options for infertility?

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress.

In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.

What is Fallopian Tube(s)?

Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus, as mentioned above. Each tube is of 10 cm length. The part attached to the uterus is called the “cornu” and the part remaining free is called the “fimbria”. It’s the fimbria, that is present near the ovary and picks up the ovum and transports it inside the tube. The cornu received the sperms from the uterus and passes it inside. Inside the tube, the sperms and the egg meet to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts.

What happens if tubes are blocked?

If both the tubes are blocked completely, anywhere along the length (cornu, fimbria or the middle), pregnancy is not possible. This is quite obvious, because either the sperm cannot enter or the egg is not picked up or they cannot meet.

However, if any of the tubes are partially blocked, then the sperms and egg can pass and meet but the embryo cannot come down into the uterus. As a result, the pregnancy continues inside the tube, which is called “Ectopic pregnancy” that is life-threatening for the mother. It’s important to remember that ectopic pregnancy can happen even if both the tubes are open.

What are the reasons for tubal blockage?

Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion”. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.

What are the types of tubal blockage?

Tubal block may be one sided or both sided. It may involve only a particular part of a tube or multiple parts of a tube. The site of the block may be the cornu, the fimbria or the middle portion.

Hydrosalpinx, is a thing that you must know. In this condition, the tube is blocked but the mid-portion is dilated and contains some fluid (often infected). This tube is not functional. And the problem is even if there is pregnancy by IVF inside the uterus, this fluid from the tube may trickle down, coming in contact with the embryo and can potentially kill the embryo!

How can I understand that the tubes are blocked?

Unfortunately, very few women have signs or symptoms indicating tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, appendicectomy or other gynaecological surgery, there is chance of tubal block. Patients with fibroid and endometriosis are also at risk of tubal block. If you feel severe pain during periods or during intercourse, there is a chance that the tubes may be blocked.

When the tubes should be tested?

As mentioned earlier, the routine investigation of infertility includes testing for the ‘open-ness’ of the tubes- “Tubal patency tests”. That means if pregnancy does not come within 12 months of regular intercourse, then we usually advise the tests. Sometimes, tests are needed, after 6 months of trying (see above). However, in some women, with low risk of tubal block (no risk factors as mentioned above), it may be appropriate to start treatment and continue it for few cycles and if no response, then tubes should be tested.

How the tubes are tested?

The method of tubal patency test depends on your risk of having blocked tubes and also your wishes, availability of resources, other fertility factors and of course the affordability.

Routine ultrasound (like TVS) cannot detect tubal patency. However, it can detect the hydrosalpinx in most of the cases.

If you do not have any risk factors (like pain during periods, endometriosis, previous infections or surgery), you can choose either HSG or SIS. These are done in out-door basis, without any need of anesthesia.

HSG (Hystero-salingogram) is a method by which, your tubes will be seen under Xray. After visualizing your cervix (mouth of the uterus) by a speculum (instrument inserted in the vagina) a small screw will be inserted inside the cervix and a contrast material (which can be seen by the X ray) will be given through it. If tubes are open, the Xray will show that the contrast material will be going through the tubes into the abdomen.

The advantage of HSG is that, a test showing open tube has good correlation with tubal patency (if HSG shows the tubes are open, it’s likely that tubes are open). It is widely available and also cheaper.

However, the problem is that most of the women feel it painful, although they are given pain-killers for it. In addition, there is small risk of infection, for which antibiotics are prescribed. The contrast material can rarely give rise to allergy in some sensitive women and it may be life-threatening in very rare cases. Another problem is the false positive result. That means if tubes are found to be blocked in HSG, in 50% cases, they will be found to be open subsequently in laparoscopy. This is mainly because of some spasm of the muscles of the tube during the test.

SIS (Saline infusion sonography) or HyCoSy (Hystero-Contrast-Sonography) is the method by which tubal patency is checked by ultrasound (TVS) along with water like material inserted inside the uterus through a small tube. If tubes are open, the passage of water can be seen going into the abdomen through the tubes, in the ultrasound.

The advantage of HyCoSy is that it’s much less painful than HSG, although mild discomfort may be there. Pain-killers and antibiotics are prescribed usually. Additionally, problems inside the uterus can be better visualized, even better than normal TVS. In addition, the false positive result is much lower, only 7%. That means if HyCoSy suggests that the tubes are blocked, in most cases, the tubes will be found to be blocked at laparoscopy.

The problem with HyCoSy is mainly the cost and it’s not available everywhere.

An important merit of doing the tubal test is that, sometimes the water or the contrast material used in these tests can open the “mild” block. That’s why we often find patients who conceive spontaneously with pregnancy inside the uterus, after apparently “blocked” tubes in HSG or HyCoSy.

Now, laparoscopy is reserved for those, who are at high risk of tubal block. This includes women with risk factors (pain, surgery, infection etc) o women having “blocked” tube in HSG or HyCoSy. Clearly, it’s done after hospitalization under general anaesthesia inside the OT. Two or three small opening (key-hole surgery) will be put inside the abdomen and through vagina a coloured material (“dye”) will be given inside the uterus. If the tubes are open, the laparoscopic camera will show that dyes coming out of the tubes inside the abdomen.

The advantage is that it’s a definitive test, can help you to make final decision. It also provides the options of treatment. If there is corneal block in HSG, we can make attempt to open the tubes using laparoscopy (see below). In addition, if there is hydrosalpinx, where the tube serves no function, the tubes can be removed (salpingectomy) or clipped (we put clips to block the tubes) to improve the chance of pregnancy if IVF is the only option left for you. In addition, laparoscopy helps us to see whether there is any other diseases that have been missed by routine tests and that may account for infertility. We can treat the cysts of PCOS (by applying current to destroy some cysts), remove any large cysts, remove any adhesion, treat endometriosis etc.

The disadvantage of laparoscopy is of course, the need of anaesthesia and associated surgical and anaesthetic risks, although in modern era, the serious complications are uncommon.

What are my options if tubes are found to be blocked in HSG?

There are simply two options. It depends on your age, fertility factors and affordability. Number one is directly, you can go for IVF. In that case, you can save time and cost. It may be a preferred option, if you are aged or have some other fertility factors (low sperm count, endometriosis etc). The chance of pregnancy per cycle of IVF is usually 40%.

Another option is that you can confirm the block by other tests, keeping in mind that you may need IVF if the tubes are found blocked ultimately. We usually advise to have laparoscopy. However, some women want to give a trial with HyCoSy, because if HyCoSy shows the tubes are open, then you can avoid laparoscopy and you can try different fertility treatment options.

In laparoscopy, first we see if tubes are open or not. If open, there is no need of further treatment in laparoscopy. However, if tubes are found blocked, especially if the block is in cornu, we can try “hysteroscopic tubal cannulation”, where we put a small catheter through hysteroscope (a telescope, like endoscope, put inside the uterus through vagina so that we can see inside the uterus using a camera) to open the tubes. If tubes can be opened, you have all options for fertility treatment open. However, if we fail to open the tubes, the only option left is IVF. In addition, if there is fimbrial block, it can be released and new opening in the fimbria can be made. The treatment of hydrosalpinx by laparoscopy has already been discussed (see above).

Having said that, there are some group of women, who conceive while waiting for IVF or laparoscopy after a blocked tube found in HSG.

What can I do if tubes are blocked in Hycosy?

In this case also, there is choice between the two- laparoscopy first and IVF directly.

What can I do if laparoscopy suggests tubal block?

Unfortunately, in that case, the only option left is IVF. As mentioned before, if hydrosalpinx is found it must be treated before IVF. However, sometimes we find hydrosalpinx in laparoscopy but cannot cut the tube of clip it, simply because you did not give consent to us for doing so. In that case, we can suck out (“aspirate”) the fluid from the hydrosalpinx under ultrasound guidance (no need of further laparoscopy) using the needle.

How tubal block is dealt in your particular centre?

We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.

We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.

We prefer to have SIS or Hycosy, rather than HSG, to reduce the pain to the women. We discuss all the options if tubes are found blocked.

Conclusion:

Tubal factor can account for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier- whatever be the fate of the pregnancy). Tubal test is a part of infertility investigation. The choice between HSG and HyCoCy is open to you. If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy.​

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