I have had two ectopic pregnancies in my right tube -- one treated with surgery and the next with methotrexate. An HSG last month revealed that my right tube is completely blocked at the opening to the uterus. My RE says that the tube should have been removed earlier instead of me being treated with methotrexate, but he cannot recommend I undergo surgery simply to remove the tube now. My left tube is clear. My RE says my overall chance of another ectopic is almost guaranteed if the egg passes down the right tube, and only 20 percent if the egg passes down the left. Would you recommend that I have the blocked tube removed? I feel this would give me much better odds of having a normal pregnancy, instead of taking such a large risk of another ectopic. I know that IVF is often recommended for women with blocked tubes, but I still have one good tube, and I don't happen to have $10,000 lying around.

Cheryl

While your risk of another ectopic is increased, I, too, believe that no surgery is needed at present. I would not normally recommend surgery for removal of the affected fallopian tube unless a large hydrosalpinx was present and you were considering IVF.

When you miss a period, you should take a home pregnancy test; if it is positive, then see your physician one or two weeks after the missed menses to identify the location. If you again suffer ectopic pregnancy, methotrexate can be administered before problems such as bleeding or rupture arise. The use of methotrexate to treat ectopic pregnancy is cost- effective and has limited risk of complication.