I've been trying to conceive for the last two years. Last week I went for an HSG, and the results show my uterus and left fallopian tube are fine, but there is blockage on my right fallopian tube. My GYN says there is no way they can do any surgery on the blocked tube. Now I have only one good tube and my chances of conceiving are naturally very low. He suggested that I go for IVF. I'm not ready for that. It is costly, and I'm only 27. Is there other alternative beside IVF for me, or am I left with no other choices?

N.

If the one remaining tube is normal, your ultimate chances of conception are not lowered, although it may take you a bit longer to conceive. There are a few exceptions. If you have had a bad pelvic infection, you may have scarring in the remaining tube that went undetected by ultrasound. Or, if the bad tube is blocked and remains filled with fluid (a condition called hydrosalpinx) you may have a reduced chance of conception and a higher risk of miscarriage. Studies looking at IVF patients suggest that surgical removal of a fluid-filled blocked fallopian tube can improve IVF outcome.

If I were treating you, I would need to see the HSG films to determine why your doctor states that the tube is irreparable and whether the open tube is also damaged. But with one "good tube," your chances should remain normal on the months you ovulate from that side. In fact, many of my patients have benefited from a few months of therapy with clomiphene (Clomid, Serophene) to promote the development of eggs from both ovaries each month.

Common causes of a blocked tube include infection, endometriosis or prior pelvic surgery. Unfortunately, most cases where infection was the culprit are diagnosed after the fact. A blood test for chlamydia IgG antibody will determine whether you have been exposed to this sexually transmitted infection.