Ep. 190: Unblocking Fallopian Tubes for Natural Conception with Dr. Naomi Whittaker

Did you know that blocked fallopian tubes can be UNBLOCKED? Very often, women who discover blocked fallopian tubes during an HSG hear that their only option is to go on to IVF, but that's not the only path forward. There are actually ways to restore the healthy function of blocked tubes through a very simple procedure. Dr. Naomi Whittaker joins us today to talk about this easy approach and give you helpful information as you advocate for your own care! In this episode, she discusses:

·      The limited amount of information available as to why tubes get blocked and how prevalent the problem is

·      pain prevention and management for HSG

·      the procedure that is MORE helpful than a standard HSG

·      why this procedure is so effective

·      how you can talk with your doctor about it and who is trained in this procedure

NOTE: This episode does discuss briefly trauma of medical procedures, but should be appropriate for most audiences.

GUEST BIO:  Dr. Whittaker is a Pennsylvania-based board certified OBGYN and fellowship-trained surgeon who specializes in the Creighton model system and NaPro technology, which works cooperatively with a woman's body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS. She created the Restorative Reproductive Medicine Academy and has dedicated her practice to women's restorative reproductive medicine, compassionate healthcare, and education.

HELPFUL LINKS:

RRM Academy 

@napro_fertility_surgeon on Instagram

Ep. 97: Ovarian Cysts, with Dr. Naomi Whittaker, MD, CFCMC

Ep. 139: Preventing scarring, adhesions, and repeat endometriosis surgery, with Dr. Naomi Whittaker

Transcript

Caitlin (00:25)
Welcome back to the Woven Well podcast. As a certified fertility care practitioner who has worked with many, many couples who are trying to conceive, I know that one of the most common initial evaluations that's done when facing infertility is to check to see whether or not a woman's fallopian tubes are open. They need to be, obviously, in order for an egg and sperm to meet in an embryo to be formed, but what happens if they're not open?

Many women are told that the only option then is IVF. Well, today I've invited back a guest expert, Dr. Naomi Whitaker, to talk about this advice and what women can do to actually address blocked tubes. Dr. Whitaker is a Pennsylvania-based board-certified OB-GYN and fellowship-trained surgeon who specializes in the Creighton model system and NAPR technology.

which works cooperatively with a woman's body to treat the underlying cause of gynecological issues and infertility, such as endometriosis, PCOS, and lots of others. She created the Restorative Reproductive Medicine Academy and has dedicated her practice to women's restorative reproductive medicine, compassionate healthcare, and education. Dr. Whitaker, welcome back to the show.

Naomi Whittaker, MD (01:37)
Thanks for having me again. Such a big fan of yours.

Caitlin (01:40)
⁓ well, you too. I love everything that you put out there. It's so good for women to be knowledgeable and informed and being able to advocate for themselves in the doctor's office is critical. And I think especially when we think about these blocked tubes, so often women are just told, ⁓ well, IVF is now your only option. But maybe we should start back a little bit further, like get a little bit of context for what it really means to have a blocked tube, like

What causes a blockage like that? How common is it? Maybe just a little context there.

Naomi Whittaker, MD (02:15)
Yeah, I mean, there's not a lot of research on this area, unfortunately, because a lot of innovation advancement stopped. Once we had IVF, we thought, well, why should we do much tubal treatment or surgery in the reproductive space if we just have IVF? And so most fertility specialists do IVF and not tubal surgery. Now, tubal surgery did advance after IVF, but more in a little niche corner.

Caitlin (02:17)
you

Hmm.

Naomi Whittaker, MD (02:44)
of gynecology where very few of us were being taught how to do these methods, including tubal cannulation, unblocking tubes in the nineties that.

were was developed and also a robotic surgery really was a game changer for our ability to reconstruct tubes from inside the body from the fimbriated end, from the end that's supposed to capture the egg. So would say I don't know how common it is because I do think there's a lot of false testing and it depends on how you determine tubal factor.

Regular HSG's are something, like if they are normal and open, that's reassuring, but it doesn't rule out a partial obstruction, which can add time to conception. And then just, so the partial occlusion where the tube inserts into the uterus is often missed with regular HSG.

sub fertility from narrow, a narrowed fallopian tube can be missed by a regular HSG. So while I'm reassured by that, I'm not super ecstatic that that's the end of the picture. I'm not satisfied if we don't know what else is going on. I would discuss the option of something called the selective HSG, which is a more objective way instead of just eyeballing, oh, the dye is spilling through the tube. actually tells me objectively with a pressure gauge

if there's a partial occlusion or a complete occlusion, and then I'm able to treat it at the same time and then retest. I don't know the percentage, though it seems quite common by the time women come to me and have multiple issues and we're going to surgery. That's typically when I check at the same time if we're getting to more advanced case, more complicated case. So would say it's very, it feels very common. Some days it's everyone.

Caitlin (04:24)
Mmm.

Mm-hmm.

Naomi Whittaker, MD (04:44)
that comes to the OR that has at least some partial occlusion and I can wide open, make their tube wide open and let as many sperm go through as possible and maybe their cervix could be narrowed too. So multiple channels widening up as many sperm to get to the destination as possible. Now the cause is going to be even more unknown. As we're in this niche of medicine that we're pretending is not important, why would we do much research?

Yes, I open up tubes. could be different theories based on research and based on clinical experience includes ⁓ a narrowing maybe from birth. That's how the uterus was made. Inflammation I think is a huge one related to endometriosis or endometritis, which is an infection or inflammation in the uterus. Let's say this seems to be the two most common. You could have debris inside and maybe just a plug, mucus plug or something. I don't know. We don't really know. ⁓

these blockages, sometimes you can feel it when I'm using a guide wire. can feel kind of the blockage come out. And most of the time, you another thing people are like, well, if it keeps, it'll reblock or, you know, and those cases that reblock like, it'll just keep reblocking. Well, that's not necessarily case, you know, that's an assumption by doctors. So there are cases in women that absolutely want to keep trying naturally.

Caitlin (05:51)
Mm.

Thank

Naomi Whittaker, MD (06:11)
that have wanted repeat multiple unblocking the tubes. And eventually I've had women, these are extremely rare, the ones that keep reblocking I'm talking about. I'm talking about the worst of the worst. I've had them open up later after multiple cannulation. So that's similar to something called Asherman syndrome, scar tissue in the uterus. Sometimes you just have to keep working on it and it will be corrected. You guide the body's inherent healing capacities.

Caitlin (06:22)
Yeah.

Naomi Whittaker, MD (06:41)
and you work with it within the patient's desires, right? And within innovation and individual treatment approach plan and informed consent. So I've had women where I had one complete blocking over and over and over. Eventually we took out one tube because I, well, I tried to re re-anastomose that side. So I took out a segment that kept blocking on the right because it kept re-blocking and that did have endometriosis in it.

actually. And the other side finally opened up. Like we worked so hard on each tube. She absolutely does never want to do IVF. And somehow after multiple, we kept doing things. I think I injected PRP, steroid. We tried all these things. I mean, we were just throwing the kitchen sink at her. Finally we got, I mean, really, I think it was a miracle, but the left tube finally gave way and has stayed open. And the right, I tried to read a very

difficult surgery that this is to resect and re-anastomose again. This is like the hardest case I've ever had of tubal obstruction. And and I are very close now. This is what happens with respiratory medicine. You get to know your hardest cases and you become very close. ⁓ You just like, let's fight it together. Let's try. And we know, she's hard. We're all like realistic. ⁓

Caitlin (08:01)
So.

Naomi Whittaker, MD (08:05)
But that was interesting because I rarely get a segment of the tube to test. And she did have endometriosis. And to us for that case, I think it was really reassuring for me, you know, as a human being, like we did everything and we have an answer for that right tube. And now her left tube is open. But ⁓ yeah, it's a very individualized treatment and difficult because we have little data to work on. But it is a common issue.

overwhelmingly of the time, percent of the time, majority of the time, it is correctable. The worst thing you can do is remove the tube though. Don't remove the tube right away. That's a common thing.

Caitlin (08:40)
Mm hmm. Well, and that's don't move the tooth. Absolutely. That is

really a game changer because I think about women and couples who are trying to conceive and women who go in to have initial evaluations and it's always lab test ultrasound H S G. You know, like those are kind of the standard things that are always done. But then when they find out, you have a blocked tube or you have both tubes that are blocked. It's like

immediately go to IVF. So it's so encouraging for women to hear that there are alternatives, there are things that you can do. I mean, you just told us the one of the most difficult cases you've ever had, and you were able to have success with it, even though you did have to work over and over and over again. That's an example of the hardest scenario. I would imagine a lot of women though are probably it's easier to treat So earlier you mentioned

that you can actually go in there, unblock and immediately retest. Would you tell us just a little bit about what that treatment actually looks like? Like how are you unblocking it?

Naomi Whittaker, MD (09:47)
Yeah, I have a... So first of all, there's two types of tubal issues if we could generalize them. And so one would be a proximal tubal occlusion where the tube inserts into the uterus and at the end, the fimbriated end. So the more common issue is where it inserts into the uterus, the proximal. And so I have a pressure gauge where I...

put the pressure, I actually have one. And so I insert this blue device inside where the tube inserts into the uterus and I measure the pressure of the tube right there. And then I have dye where I turn this knob here and it tells me what the atmospheres of pressure are and if there's even a partial occlusion. And then I look also if it's spilling. And so if it is blocked,

Caitlin (10:31)
Mm-hmm.

Yes.

Naomi Whittaker, MD (10:41)
Then I use a guide wire. It just looks like a little metal. It's really soft, but it's silver and it's very, very delicate. And it's just, I don't know, probably half a millimeter wide. And I snake it through similar to snaking a sink.

Caitlin (10:47)
Mm-hmm.

Mm-hmm. Man, I love, I just think about these general HSGs, which are a great, you know, option out there. I'm certainly glad that they're available, but they seem so elementary in comparison to what you're talking about.

Naomi Whittaker, MD (11:13)
Correct. yeah.

And we're talking about nothing as advanced since I don't know when the HSG was invented, but we really have we stopped all progress with IVF, right? So the regular HSG is a good test if you need IVF. And that's the only thing you care about, right? Like that's your only option. If it's completely blocked, skip IUI and go to IVF. That's the only really it can help natural conception. It can make sure at least let you know that

Caitlin (11:24)
Yeah.

Naomi Whittaker, MD (11:42)
you have a chance of natural conception, but it's not a treatment option and it's not going to be a way to optimize the tubes for natural conception.

Caitlin (11:44)
Yeah.

Right. Irregular HSG. Okay, I'm with you. Yeah, exactly. And women deserve to have access to this treatment, but they also need to know the information.

Naomi Whittaker, MD (11:50)
A regular HS2, I'm sorry.

Super

easy, low risk, minimally invasive, cheap, yeah, not invasive really. mean a little bit more than a pap smear, I mean relative to IVF, I mean it's extremely minimally invasive, no incisions, ⁓ and yeah, very affordable, very easy for a physician to do. The thing is

Physicians don't even know it exists. That's why. No, they never even knew about it. It was developed in the 90s. Who's gonna pick it up? Who's gonna do this? Minimally invasive gyn surgeons have focused on pain. That's kind of their road. REIs have focused on IVF. So who's gonna actually be incentivized to do this?

Caitlin (12:25)
Yeah, physicians aren't trained at it any longer.

Mm, mm, ⁓ mm.

That's where it becomes, you know, the women are making the movement. The women are the ones who need to be knowledgeable and so they can advocate for the care that they deserve and want. And, you know, you're talking about being minimally invasive and I completely agree. But something we've talked about is how HSGs or even selective HSGs can be painful. Can we talk about that for a second? Because ⁓

I'm always looking for what can women do to have a better experience or how can they advocate for themselves. So let's talk about the pain for just a second.

Naomi Whittaker, MD (13:24)
mean as a provider, it's my due diligence to try to make it as little, with as little pain as possible and offer appropriate ⁓ treatments, pre-medications or medications during the procedure to be as comfortable. And if the patient is very uncomfortable, she needs to speak up and say, need to stop and abandon. Please do that. Please speak up. Do not, it should not be extremely painful. Pre-medicate with Cytotec

to dilate the cervix, that's actually the most painful part. If the cervix is open and we pre-medicate, that's great. And if there is a lot of pain, that's probably a sign something's wrong. Either the provider is being really rushed, it could happen, or they haven't done a lot. But mainly I think the cervix not being dilated is the number one obstacle. And that could be a cause of infertility, cervical stenosis. So you might be getting an answer with that.

for yourself. Don't tolerate high pain. They should be working through that with you, pre-medicating or discussing with you ahead of time and during reassuring you to make sure that you're comfortable with every step forward. Obviously, we can't always guarantee there's no discomfort, but it really shouldn't be a traumatic experience.

Caitlin (14:42)
Well, I appreciate you saying that because so many women think, well, I do just have to suffer. I do just have to push through in order to get answers, especially women who are trying to conceive and do whatever they can. So that's a really encouraging word that you do not have to suffer through. You can find a physician medical professional out there who is willing to be very gentle, take their time, walk with you, pre-medicate and it

could be a hassle. You know, some people think to put in the effort to find that physician. But when you're laying on the table and you have someone who really cares and really knows what they're doing. man, we all know the difference that we can have in that sort of experience. So ⁓ would you say anyone napro technology trained like would need to be a fellowship trained surgeon like who can people go to to find someone who knows how to do these selective HSG's?

Naomi Whittaker, MD (15:37)
Anyone could learn how to do them that does procedures in the hospital, technically. So the ones more likely to learn how to do it would be NAPRO fellowship that we've all been trained, It's actually quite simple. Any OB-GYN should be able to do this. That's what's frustrating to me about the lack of access for this.

Caitlin (15:40)
Okay.

Naomi Whittaker, MD (15:56)
call the hospital and ask them if they do this and if they can get someone trained. ⁓ Because again, this should be quite simple to do

Caitlin (16:07)
That's great to know. And by the way, listeners... Yes.

Naomi Whittaker, MD (16:08)
Your REI should really be doing this, technically. You should really be optimizing

tubes first before doing more invasive procedures. And technically, right, with the risk benefit counseling process, you should be offered alternatives before more invasive procedures if they're being ethical.

Caitlin (16:26)
Hmm,

that's a good word. By the way listeners, if you've already gained valuable information from this short episode, we and you want others to have access to information like this as well, would you help us get this education out there by leaving a simple review? Each review helps the algorithm learn that women want this type of content and will recommend it to others. So

If you are also just enjoying the episode, then it lets those who are looking for information like this to see that you liked it, it was helpful, and it was good. We really appreciate it. Well, so much that you're saying, Dr. Whittaker is you're saying how simple it is and how basic it is, but it's so radically different than what we often hear. So it's very encouraging. And especially if someone's been through maybe a painful essay,

been through a painful HSG or they're looking into other health issues as well. Just a reminder that if you do end up seeing a physician or a surgeon for endometriosis, that sort of thing, and you can listen to some previous episodes out there, then you can also have a selective HSG done during that procedure. So you don't have to relive it if that was a traumatic experience originally for you.

But if you're treated with the selective HSG and with the metal wire that you mentioned and able to totally clear things, I know you can't know for every person because it's going to be a little bit different, but in general, is there a timeline that like typically tubes remain clear for a certain amount of time or is it just totally variable?

Naomi Whittaker, MD (18:04)
say statistically 30 % of women with tubal obstruction and get pregnant within three months, quite high, much higher than IUI, for example. ⁓ And I say for what I tell patients with severe bilateral tubal occlusions, I like to recheck at six to nine months. The majority they're open. But, you know, sometimes they still have like a partially narrow, like not as bad as the first time, that's the next most common, and then I open it up maximally again.

Caitlin (18:13)
Mm-hmm.

Okay.

Okay, that's super helpful.

Naomi Whittaker, MD (18:34)
So it kind of depends on the person, what we find, but I would say those are the most common scenarios.

Caitlin (18:40)
Yes, ⁓ this has been so helpful and I hope it's been helpful for all the listeners. But thank you so much for coming back on the podcast and sharing with us about opening up these tubes. I know it gives a lot of hope to women out there.

Naomi Whittaker, MD (18:55)
Thanks so much for getting this information out there. I know everyone's hungry for it, so I appreciate it.

Caitlin (19:01)
Absolutely. Listeners,

I'll also have Dr. Whitaker's previous episodes with us on ovarian cysts and scar and adhesion prevention with endometriosis surgery in the show notes. So make sure to look there. If you're being told that there's nothing left, but IVF after just a blood draw, ultrasound and HSG, I can assure you.

There is more to be explored. There's a different approach to be investigated. And we'd love to help you on that journey and get you connected with some of these medical professionals who want to explore and restore your reproductive health as much as possible. You can find upcoming introductory classes on our website at wovenfertility.com slash appointments. As always, thanks for listening as we continue to explore together what it means to be woven well.