A specialist shows the right way to determine the truth
In the light of allegations being levelled about ‘crushing’ or ‘clamping’ of the fallopian tubes by a doctor at the Kurunegala Hospital, this Consultant Obstetrician and Gynaecologist recommends the following thorough inquiry to lay bare the truth once and for all. A statistical study –
Pointing out that there is secondary sub-fertility in varying percentages among women who have had a first child through C- section due to adhesions etc., he says a scientific study can be carried out among the women who have been operated on by the said doctor, comparing and contrasting with a different set of women operated on by another doctor.
Secondary sub-fertility has to be established clearly. A woman is deemed to have secondary sub-fertility after she has stopped breastfeeding her baby and has had unprotected coitus for 13 months. Her male partner should also not use any protection method, it is learnt.
According to this Consultant Obstetrician and Gynaecologist: The first step in any investigation should be to choose the women who fit into the diagnosis of secondary sub-fertility from among those who have lodged complaints against the said Kurunegala doctor. Then this cohort of women should be matched with another cohort of women and a statistical analysis carried out. (A cohort is a group of people with a shared characteristic.)
If there is a ‘significant’ statistical difference in the secondary sub-fertility rates, higher of course, in the group operated on by the said doctor, then the allegations will bear some credibility.
He points out that another factor that needs to be taken into consideration is whether any of the women who have made complaints have had a definitive diagnosis of secondary sub-fertility after their previous child and whether they have independently sought treatment for this condition, before this crisis occurred at Kurunegala.
“It is important to ascertain whether during this earlier treatment, a tubal patency test (to find out whether the tubes are open or unobstructed) was carried out and what the findings were. Usually, a tubal patency test will be carried out by a specialist within one year of the woman seeking treatment due to infertility issues,” he said, adding that the presence of tubalblocks during these tests may also point towards wilful harm by the doctor who performed the previous C- section.
However, when looking at the current scenario, the obvious question that arises is why until last month, no such complaints of infertility had been made by any of these women who have now come forward with these complaints.
The patency of the fallopian tubes can be checked in the three following ways, says this specialist, detailing the tests: A laparoscopic examination and dye test–
Laparoscopy enables a direct visual inspection of the entire external length of the fallopian tube for injury. This is a minimally-invasive (keyhole) procedure in which a fibre-optic instrument is inserted through the abdominal wall to view the fallopian tubes.
Meanwhile, a dye (methylene blue) is also injected through the neck of the womb into the womb cavity. This dye will then travel along the fallopian tubes and spill out into the abdominal cavity, if the tubes are not blocked.
This dye can be seen spilling into the abdominal cavity during laparoscopy, if the fallopian tubes are not blocked. Perform a hysterosalpingogram (HSG) –
This procedure uses an X-ray to study the fallopian tubes and involves the injection of a dye which can be
seen by X-ray.
The dye is injected into the womb cavity through the cervix, with the use of a special cannula. The dye will then fill the womb cavity and travel along the fallopian tubes and spill into the abdominal cavity. An X-ray taken at this point will show whether there are any blocks in the fallopian tubes. Perform a falloposcopy –
This is the visual examination of the inside of the fallopian tubes. A thin telescope is inserted through the neck of the womb and womb cavity to the fallopian tubes, which will show whether there is any damage to the tubes. Clincher is symmetrical tubal blocks
“The clincher in all these examinations will be whether a woman who has been determined as having secondary sub-fertility (should fit the right definition), has symmetrical blocks of both the fallopian tubes,” says the Consultant Obstetrician and Gynaecologist, pointing out that this condition cannot be explained as being due to adhesions etc.
If there are symmetrical blocks (similar blocks) in both fallopian tubes, then the answer would be clear – the doctor would have done it, adds this specialist, calling for a scientific and impartial investigation, without letting emotions get in the way.