Two Years and Counting


Question about laparoscopy
August 12, 2008, 8:58 am
Filed under: Uncategorized

My former college roommate’s father is a well known fertility doctor in my hometown. My family has known him and their family for a long time. Once I got into really thinking about IVF, I decided to shoot the father, Dr. I., an email. My main reason was that I wanted his personal opinion of embryo cryopreservation. I know he’s a Christian and a very gentle man, and I wanted to get his opinion outside of being a doctor, if that makes sense. I wrote him a letter and briefly summarized where M and I were in our journey and told him what tests we’d had. I was expecting him to write a brief summary of his opinion on freezing, if I heard back from him at all (he’s a busy man, and I’m not one of his patients, so I wasn’t even sure he’d get back in touch with me.)

Well, to my surprise, he emailed me back right away and asked if I would get my doctor, Dr H,  to send him M’s and my full records so he could see for himself what’s been going on. I got the feeling he wanted to make sure we weren’t jumping into IVF without having done all the preliminary CD3 bloodwork, a SA for Matt, laparascopy, HSG, etc. I totally understand him wanting to make sure we weren’t heading for the big guns right away, especially since I think my doctor is a big fan of IVF (although I don’t feel like she pushed us to IVF at all.) I was very happy to send him our records, and faxed a medical release to my doctor yesterday to get them sent to him. I feel so blessed to have another doctor who I know and trust (because he knows my parents very well and I know he’d take care and caution in dealing with me) looking at our records. It’s not at all that I don’t trust Dr. H at my clinic or that I’m looking for another doctor (he’s in another city, at any rate) but it would make me feel much better to either have a second doctor agree with what Dr. H has said, or even suggest something else we could try. (I’d still take something else over IVF any day, if possible!) 

I wrote Dr I back and told him we’d had all our blood work and tests done, that everything had come back normal, including an HSG, but that I didn’t have a laparoscopy because nothing yet had pointed to endometriosis and that I was hesitant to have a surgery that may be unnecessary. He wrote back and his reponse to my comment about the laparoscopy was that most patients would have a lap or a hysteroscopy before being given the label of unexplained IF. He said often the only sign of endometriosis or pelvic adhesions is the inability to conceive.

So, this brings me to my question. Those of you with unexplained infertility who have done IVF or are thinking about it, did you have a laparoscopy to rule out endo other other bad things before IVF? I still don’t want to have an unnecessary surgery…but then again, if, just IF, the surgery showed endo or another issue that could be resolved without IVF, I would be a happy girl. Surgery is less expensive than IVF…but then again, it may not show anything. Is it worth it? Do any of you have any thoughts about it?

Thanks!

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9 Comments so far
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Have you had a hysteroscopy?

I ended up having one of those, and nothing else pointed to endo (except that spotting before AF is a common symptom) and thus my RE didn’t think a laparoscopy was necessary.

Comment by Nity

Thanks Nity. What’s the difference between a hysteroscopy and a lap?

Comment by Lauren

My first RE did not order a lap for me before we did IVF. My second RE ordered a lap after an HSG showed a blocked tube; turned out the tube wasn’t blocked, but I did have mild endo adhesions which were removed. (Like Nity, I had nothing pointing to endo.) I’m glad we had the lap done, and I do wish it had been done before our IVF attempts (although what was found really would have had no bearing on our success). That said, I think your dr. will still recommend IVF whether you have a lap or not; a lap may find something that needs to be treated, like endo, but it won’t necessarily clear the way to conceive w/o ART; it will just clear up potential obstacles to the success of ART.

Comment by andrea_jennine

I, like Andrea, didn’t have a lap (internal surgery where they stick a camera inside and look for abnormalities) or an HSG (a dye-based x-ray? test where they inject fluid in through the cervix and watch it expel from the ovaries) before IVF. However, when we moved to donor IUIs, I had an HSG that was all clear and after talking with RE about possibility of endo (only symptoms was a discomfort around left ovary during internal u/s). Mild endo was found and removed and we have continued with donor IUIs. Honestly, if endo is the reason for your infertility, I’ve been told that IVF is the only way around it. Which sucks for us because we can’t afford nor do we want to pursue IVF again.

Good luck, I hope that you find all the answers you need to feel comfortable moving forward.

Leslee
babyattheend.blogspot.com

Comment by Leslee

Laps, from what I understand, are the gold standard in endo diagnosis. However, according to the recent ENDOCAM study (considered the best and biggest of its kind), it required something like 7 procedures to get 1 that actually showed a benefit in terms of fertility and/or symptoms. Most women with endo (>60%) have NO fertility problems and conceive just fine. The connection between mild endo and IF remains a bit of a mystery.

If you do have endo, other recent (much smaller) studies have shown that there is no difference in preg and take-home baby rates btw women with unexplained IF and minimal-mild endo undergoing medicated IUIs or IVF.

I had to do a hysteroscopy for polyps, so we decided we’d throw in a lap, just in case and for my own peace of mind. They did find two tiny patches of endo on the back of my ute. According to Dr. Liccardi’s blog http://infertilityblog.blogspot.com/2006/08/diagnostic-laparoscopy.html, that’s not likely the sole cause of my IF, though my RE thinks it might be involved, as it’s the only abnormal finding we’ve gotten.

If you’re already going ahead with IVF, I don’t think you need a lap.

Comment by shinejil

We’re currently in the middle of IVF. I chose to do a hysteroscopy/laproscopy before we moved forward because I was told that if I had scarring it could stop an embryo from implanting. Plus I needed to know if there was some sort of physical abnomality. I really wanted an answer. The lap showed there is no reason why I haven’t gotten pregnant. I had a little scarring, but it was not in a location that would affect fertility. I’m glad I did it though because I have peace of mind. I know I did all testing before spending a lot of money on IVF. Plus, I won’t be second guessing myself if we aren’t successful.

Comment by Trace

I underwent a lap and hysteroscopy at the same time. I had previously had an HSG and some other tests with no explainable results. As a result of the lap and hysteroscopy, they were able to notice that my ovaries were of poor quality and then recommended IVF. I’m now 21 weeks pregnant. The procedure wasn’t too bad (if you do decide to go through with it). Best of luck on your journey!

Comment by sully

You know, we were a lot like you guys. Unexplained IF, diagnosed around 8 months TTC. I read Taking Charge of Your Fertility at 2-3 months TTC and figured timing MUST be our issue. After 5-6 “perfect” cycles I was convinved something else was wrong. But all the IF workups they did showed nothing. I did finally get a hysteroscopy a few months after my HSG, but ONLY because the REs and the radiologist disagreed on some “bubbles” in my uterus on the HSG. I was convinced it would show some adhesion or something. Nada again. I figured it must be too hard for the sperm to swim through everything, maybe I had hostile cervical fluid. Three IUIs later proved that didn’t work. So we went to IVF. I had wanted to do about 6 IUIs, to rule out those working, but our insurance situation make IUIs about half as expensive as IVF so it made no sense.

I don’t know what to say. I did NOT want a lap just to rule out one of my hypotheses. Yes, I’ve known ladies with Unexplained IF and NO symptoms get one and find endo and then end up pregnant just from sex after it was taken care of. But surgery for just an guess to me isn’t a great option.

We too are committed Christians and struggled through a lof of questions about the ethics of IVF. You still reach your own conclusion in faith. I would really recommend reading “The Infertility Companion” authored by a Christian doctor (ob?) and a woman who dealt with years of IF (and never did get pregnant, for what that’s worth). It goes through a TON of the Biblical implications and thoughts on IF issues.

I have a personal blog, aside from the strictly-infertility one. I talked more on that one about how IF affected my realtionship with Christ, and some of our thoughts leading up to it. I’d be glad to give that to you too, if you want.

Fair warning: I am currently 4 months pregnant. I got pregnant both IVF cycles, although lost the first baby last fall. But to me, it’s been a great advantage having SOMETHING that finally worked with everything else looked perfect and magically did not work.

Comment by Denise

Here from L&F. My doctor recommended a lap before moving on to injectibles with IUI to make sure that made sense. We learned that going that route would not make much sense in our case given the pelvic adhesions. I did not have any symptoms of the adhesions. Unfortunately, they were so bad neither my RE nor the specialist surgeon I saw thought surgery to remove the adhesions made sense. Although the surgery is minor and recovery was easy, if you’ve already decided on IVF, I am not sure its a necessity. Good luck.

Comment by KLTTX




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