One concern, in particular, is this issue of pelvic adhesion from my past ovarian and tube surgery. In doing some research, I came across the information below regarding a condition called "hydrosalpinx" that appears could affect the results of IVF. I haven't been told I have this condition, but I do want to bring it up to my doctor and try to either rule this out, or find out how we will deal with this issue.
What is Hydrosalpinx?
A blocked fallopian tube that is filled with fluid, usually a result of previous pelvic infection such as pelvic inflammatory disease, but also can be caused by adhesion formation from surgery, endometriosis, and cancer of the tube, ovary or other surrounding organs.
Hydrosalpinx's affect on IVF success
According to AdvancedFertility.com, if a woman going through IVF has a hydrosalpinx visible by ultrasound, then the average expected IVF success rate is lower as compared that expected in a similar patient without a hydrosalpinx. If there is are bilateral hydrosalpinges (hydros on each side - the plural of hydrosalpinx is hydrosalpinges) visible on ultrasound, studies have shown that the expected IVF success rate is even lower than with a hydro on one side.
What to Do
AdvancedFertility.com states that careful ultrasound examination should be able to detect a significant hydrosalpinx. Studies have shown that if surgery is performed to remove the fallopian tube (or tubes), the expected IVF success rate is then normalized. Another approach that is effective is disconnecting the tube from the uterus and leaving it in the body. This is often done in cases with severe scarring where it is difficult to completely remove the tube. Some IVF doctors insist that women with hydros have laparoscopic surgery to remove or disconnect them from the uterus prior to performing in vitro fertilization.
Other fertility specialists will counsel the patients about the potential risks and benefits of having the surgery before the IVF: Surgery first, then IVF - Higher potential for IVF success, but need to have surgery, with some pain, some risk of a surgical complication, time off work, and delay until IVF. OR, Go straight to IVF, no surgery - Lower potential for IVF success, but avoid surgery, no delay for IVF, etc.
Tubal damage could lead to higher risk of ectopic pregnancy
Wikipedia states (though I'm not sure where they got their info from), that, historically, people with tubal infertility due to hydrosalpinx underwent tubal corrective surgery to open up the distally occluded end of the tubes (salpingostomy) and remove adhesions (adhesiolysis). Unfortunately, pregnancy rates tended to be low as the infection process often had permanently damaged the tubes, and in many cases hydrosalpinges and adhesions formed again. Also, ectcopic pregnancy is a typical complication.