I recently saw my gynecologist for abdominal pain. I figured it was another false pregnancy. He told me that my sonogram showed two "abnormalities" that would keep me from becoming pregnant on my own. I have had problems with miscarriage for a long time (six in all), but this is the first mention of abnormalities. He said that, first, there are many small eggs on my ovaries, and second, my tubes are dilated and full of fluid. Can you explain just what these abnormalities are? My doctor did not seem overly concerned about either problem but suggested laparoscopic surgery to investigate. Is this advisable?

S.J.

Many factors may result in miscarriage, including the two you mentioned as well as others. And your physician should evaluate each of these factors before you try to conceive again.

The small cysts around your ovaries may be a sign of a condition called polycystic ovary syndrome (PCOS). Among many other effects, PCOS can cause an increase in a substance called plasminogen activator inhibitor (PAI-1). Elevated levels of this compound in women with PCOS can promote clotting in the placenta and result in miscarriage. Recent studies indicate that treatment with metformin can lower PAI-1 and, continuing the metformin during pregnancy may prevent miscarriage.

Dilated, fluid-filled fallopian tubes can also cause pregnancy loss. This condition, called hydrosalpinx, is associated with pelvic pain, painful sex, miscarriage and infertility. If the finding is confirmed by laparoscopy, it may indicate you are no longer able to conceive by natural means. Surgery to repair hydrosalpinx is rarely successful. Between 10 and 30 percent of women will conceive after the procedure, but many of those pregnancies will implant in the tube, rather than in the uterus. For women with hydrosalpinx, IVF is the most cost-effective option for conception. Unfortunately, the presence of fluid-filled fallopian tubes may result in lower success rates with IVF, in addition to a risk of miscarriage.

The decision to attempt repair or removal of damaged and painful fallopian tubes is a difficult one. It is best made after consultation with a fellowship-trained infertility specialist who has both the knowledge and concern to help you understand and make the choices necessary to deal with your medical condition.