The trend now is not to be perform tubal reconstructive surgery if infertility is due to tubal disease. Assisted reproduction is recommended in better off countries. However the cost of the assisted reproduction is exorbitant and many poor women do not afford it. We still perform tuboplasties in such cases. I thought there would be no confusion in the management of these patients after they recovered totally from their operations. I was wrong.
One patient had undergone reversal of tubal ligation at the hands of my Assistant Professor in June. She came yesterday with a report of a hysterosalpingography. I looked at the report. It showed normal findings.
“Who advised her to undergo a hysterosalpingography?” I asked.
“The Assistant Professor who had operated on her” my Registrar answered after going through her case paper. So I called that person and asked, “why did you advise her to undergo a hysterosalpingography?”
He looked confused for some time. Then he answered, “that was the practice in the medical college hospital where I worked when I was studying for my MD.”
I thought for awhile, wondering if I should say it. Finally I said “that could be the case. But you studied the subject from different books and journals. Did you find any such recommendation anywhere?”
He considered the question gravely (at least he made a grave face while he waited) and answered “no!”
“Then you should not do it. You have not given her sufficient time to conceive after the operation. The hysterosalpingography was unwarranted. Not only that, but it was dangerous too. If she developed pelvic infection due to that procedure, the fallopian tubes could get blocked, turning all efforts into waste.
He made a face suggesting sudden comprehension and a desire to do as I told him to. I hope he sticks to that decision, whether he was convinced or not. That reminded me of another extreme. My Registrar at that time has advised oral combination contraceptive pills for three months to a patient who had undergone a reversal of tubal ligation. When the patient came for a follow-up examination, I found this out and was duly aghast.
“This is criminal” I told the Registrar. “The months following recovery from the operation are the best time for the patient to conceive. If you wait, the tubes may get blocked again due to slow inflammatory process, like chronic infection. Why did you deny her the best chances to conceive?”
“Um… ar… I thought she required that much time to heal the tubes” she said.
Most of our residents who do such things pass in their MD examination. I was afraid she would too. Somehow she goofed so much that they failed her. But I think she is unlikely to change all of her dangerous concepts before she passes. In the meantime, all those who have already passed and are yet to pass continue to do weird things after such procedures, despite which life seems to go on. God is really great.
