Brief Answer:
The scarring is from the C-section, tubes might be diseased

Detailed Answer:
Thank you for the question. So to summarize your situation:

1. You had a C-section in 2013 performed as an emergency
2. You now have a diagnosis of endometriosis and a tubal XXXXXXX study that showed that the tubes might be partially blocked.

First of all, endometriosis is a condition where the cells that normally cycle within the uterus get into the pelvis. These cells cycle and cause pelvic pain and in some cases can affect your ability to get pregnant. You had a laparoscopy for pelvic pain and they found endometriosis, all of which makes sense.

Second, they made a comment about scar tissue from the bowel to the belly button. Hopefully they fixed this, but this might described either a hernia at the belly button, or scar tissue related to the prior C-section. These are common findings in the setting of a prior C-section and probably not the cause of cyclic pelvic pain.

Finally, there was the comment that XXXXXXX did not readily spill from both tubes. Well, given that the XXXXXXX DID spill from the tubes means that they are open. It is possible, however, they they have been affected by endometriosis (which can cause some inflammation of the tubes) or the C-section (where they can be injured).

The reason that they are recommending that you go to a fertility clinic is because you have been trying to get pregnant for over a year, you have endometriosis (which is associated with not being able to get pregnant), and there is a concern that your tubes are not working normally.

Does this answer your questions?
Dr. Tim

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Brief Answer:
Yes you can have endometriosis on the bowels

Detailed Answer:
Endometriosis can implant anywhere in the abdomen and I have certainly take care of women with bowel involvement.

With regard to the scar tissue, you need to ask them:
1. Was this a hernia at the belly button?
2. Could the location of the scar tissue be related to my IBS symptoms?
3. Do I need to see a General Surgeon to address this, especially if bowel is involved in the adhesions?

There really seem to be some loose ends and lack in communication going on. I would have you consider taking the operative reports and any pictures taken during the surgery and get a second opinion with another OB/GYN. The fertility clinic could also serve as the second opinion AND address the issues surrounding attempts at conception.

Dr. Tim

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Brief Answer:
I think that the fertility clinic should be your next stop

Detailed Answer:
Because fertility doctors are OB/GYN's with advanced training, and the main goal is pregnancy (as I understand it from your questions), I think that they would be the most relevant next visit. I would do the following:

1. Get copies of all pictures taken during the surgery
2. Get copies of the operative report from the surgery
3. Get copies of any pathology obtained during the case
4. Schedule a consult with the fertility clinic
5. At that visit, you can address fertility, the bowel adhesions, pelvic and abdominal pain and the concerns regarding the fallopian tubes

This is how I would recommend proceeding.
Dr. Tim

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Brief Answer:
Yes, I am able to see a general location identifier

Detailed Answer:
FYI.

A fertility specialist might review the films and still refer you to a general surgeon, but since the primary desired outcome is pregnancy, this seems like the best place to start first.

Dr. Tim

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