Dear Bridie,
I am so sorry to hear of your ectopic pregnancies and losses. To experience one loss is difficult to deal with multiple losses is heartbreaking and my heart truly goes out to you.
Sadly, there are no tests or investigations that can be done to assure you that you will not experience an ectopic pregnancy again. Ectopic pregnancy occurs because of some underlying damage to a fallopian tube and the cause of this damage may never be established. Doctors would usually want you to wait to try again for three months, after which, your doctor will probably encourage you to try again for 12 months if you are less than 35 or 6 months if you are over 35. Only if you do not conceive within those times would they then consider further tests and investigations. Having said this, as the nurse has already suggested as you have sadly experienced three losses, Dr’s may well investigate sooner for you.
You do not have to have further testing but tests you maybe offered could include Chlamydia testing, if you feel that you may have ongoing problems of pelvic infection. Chlamydia is usually symptomless. Testing for this and taking antibiotic treatment if required might help to reduce the risk of a future ectopic pregnancy.
A Hysterosalpingography (HIS-tur-oh-sal-ping-GOG-ru-fee) HSG is a very safe procedure to investigate the shape of the uterine cavity and the shape and patency (the state of not being blocked or obstructed) of the fallopian tubes. The test is an x-ray of the uterus and the fallopian tubes. The doctors inject a special radiographic dye into the uterine cavity through the vagina and cervix which shows up on the x-ray. They then watch to see if the dye moves freely through the uterus and fallopian tubes to look for a block that may be causing fertility problems.
If the fallopian tubes are open, the special dye will fill the tubes and spill out into the abdominal cavity. If the fallopian tubes are full or partially blocked the dye will not flow freely and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal) can also be determined. The test is not 100% accurate as the fallopian tubes can go into spasm during the test and can appear blocked even though this isn’t the case. The test can also not determine what the internal villi of the tube look like.
The HSG can be painful, so analgesics (pain relief) may be administered before and/or after the procedure to reduce pain. Many doctors will also prescribe an antibiotic, such as Azithromycin, prior to the procedure to reduce the small risk of an infection. The medical professionals prescribe the antibiotics taking the viewpoint that prevention is better than cure and it is better to prevent an infection in your fallopian tubes rather than cure it.
Many women feel emotionally conflicted between wanting the peace of mind of answers versus the fear of catching an infection that could potentially do harm when they have a HSG test.
There is only a 1% chance of getting an infection from a HSG test and, of that 1% chance of infection, only 20% of the 1% who get an infection would need hospitalisation… This means that you have a 99.8% chance of not damaging your fallopian tube and a 0.2% chance of damage.
It would be likely that you would know if you got an infection through symptoms like abnormal vaginal discharge, painful menstrual periods, painful or uncomfortable sexual intercourse, abdominal pain affecting both sides, frequent urination, spotting between periods, pain during ovulation, fever, and/or lower back pain.
People are able to try to conceive again during their next menstrual cycle after a HSG test, unless medical professionals suggest a longer wait time. It has been claimed that pregnancy rates are increased in a cycle when an HSG has been performed.
If you feel these are tests you would like to pursue, please talk to your GP who can refer you.
In the meantime, please be kind to yourself during this difficult time. Allow time to grieve, to heal both physically and emotionally. We will be here for you for as long as you need,
Sending much love and warm hugs,
Karen x
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Further information is available at www.ectopic.org.uk
Email us at ept@ectopic.org.uk.
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