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Dr. Lawrence
Dr. Lawrence, OB/GYN
Category: OB GYN
Satisfied Customers: 853
Experience:  Board Certified OB/GYN and accomplished educator
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Several years ago I had an ovary and fallopian tube removed

Resolved Question:

Several years ago I had an ovary and fallopian tube removed as they had been badly affected by an unknown infection. I am now experiencing the same pain as then but on my other side. 3 weeks ago I had surgery for a missed miscarriage. I am frightened that this pain is an infection secondary to that surgery and that it will result in infertility. I saw my GP on Tuesday who took a high vaginal swab and she put me on amoxycillin as a precautionary measure. The results aren't back yet and I am worried silly that my fertility is in danger. Should I get a private pelvic ultrasound? How fast could an infection cause problems with fertility and why has it only surfaced some three weeks post op? Thanks
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. Lawrence replied 2 years ago.
Dr. Lawrence :

Hello, and thank you for your question. I will be happy to assist you. Answers are for educational purposes only.

Dr. Lawrence :

Hi.

Dr. Lawrence :

I am sorry that you are experiencing this.

Dr. Lawrence :

A pelvic ultrasound would give you insight to an infection in the tube or ovary.

Dr. Lawrence :

If there is a concern about fertility, then an HSG can be done to see if the fallopian tube is open.

Customer:

I want to prevent concerns about fertility

Dr. Lawrence :

It would be unusual to get an ascending infection in the tube infection from the D&C done for the miscarriage,

Dr. Lawrence :

The fact that you were just recently able to get pregnant is reassuring.

Customer:

What then would cause this very specific pain?

Dr. Lawrence :

Hard to say. But amoxicillin is not going to cover a possible infection if it is related to the recent D&C. It isn't the right antibiotic to be used alone for a potential uterine infection. I would recommend asking your GP for a pelvic Ultrasound and a referral to a gynecologist.

Dr. Lawrence :

Infection can cause pain so looking for an infection is reasonable. But just doing a vaginal swab is not enough. You should have the pelvic Ultrasound, a CBC blood test, and a pelvic exam by a gynecologist to help determine the cause.

Customer:

Can this be done in the UK where you don't really have much influence over the health system unless you go private?

Dr. Lawrence :

If it persists and the ultrasound is not helpful, then a ct scan would be appropriate.

Dr. Lawrence :

I would talk with your GP. Given that you had gynecologic surgery and you are having post operative problems, then they should be able to refer you back to the gynecologist. Once you see the gynecologist, these are routine tests.

Dr. Lawrence :

This is beyond the GP's area of expertise.

Customer:

Could the length of time that I will wait between first seeing the GP and actually having a scan and seeing a specialist influence whether the infection could result in me not being able to get pregnant?

Dr. Lawrence :

No, that should not be a problem.

Customer:

So I should just wait for the NHS to chug along as opposed to trying to find the cash to go private and speed it up? It won't make a difference?

Dr. Lawrence :

I think the timing should be sooner rather than later because you had surgery and now having pain. More concerned about that than this compromising your fertility.

Customer:

Would it be a good thing to try for an appointment tomorrow with the GP? Should I be so very worried about it being the end to my fertility?

Dr. Lawrence :

I just don't want you to get sicker by waiting, but the likelihood is that you can wait. If the pain worsens or you start having fevers or vomiting, then you will know that it is something that can't wait.

Dr. Lawrence :

I know you are focused on losing your fertility, but I really don't think that is the issue here.

Customer:

really? why?

Dr. Lawrence :

The fact that you were just able to get pregnant suggests that your fertility is ok.

Customer:

Yes, I know that. But I only have one tube and ovary and if it is infected I am stuffed

Dr. Lawrence :

You don't just lose fertility in a moment's notice. So having pain doesn't translate.

Dr. Lawrence :

I understand.

Dr. Lawrence :

But if there is a problem, then you already have it.

Customer:

?

Dr. Lawrence :

Having a tuboovarian abscess has the same effect if you diagnose it after a week or three weeks.

Dr. Lawrence :

Also, if you had a serious infection, you would likely be a lot sicker and need to be in the hospital.

Customer:

But could early diagnosis mean it is easier and more succesful to treat?

Dr. Lawrence :

Not necessarily.

Dr. Lawrence :

Are we talking a week, 6 months, a year delay?

Customer:

I wasn't at all sick last time, I just had this dull pain for months. When they eventually had a look inside it had all shriveled up

Dr. Lawrence :

I don't think it is unreasonable to wait for the cultures. Just know that I don't think that a GP can manage this regardless whether it is now or a week from now.

Dr. Lawrence :

The pelvic ultrasound would be able to determine this and then from a fertility standpoint, the HSG.

Dr. Lawrence :

You really need to see a gynecologist, but it is not emergent. I agree waiting months is not ideal but a week or two if you aren't sick is not a problem.

Customer:

OK. I will ask them for more tests if it is not offered. I will talk to them tomorrow face to face. Thank you for putting my mind at rest that waiting a little while is OK. It will save me trying to find a private ultrasound appointment and paying a lot of money for it.

Dr. Lawrence :

I understand. Press them for a gynecologist referral. Use the argument that you had a gynecologic surgery and are having a postoperative problem that needs to be addressed by a gynecologist.

Customer:

Is it possible for a post-op infection to cause infertility?

Dr. Lawrence :

Unlikely.

Customer:

Thank you

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