Did an Exploratory Lap. explain your infertility issues?

[blueyezz4]

I'm pretty much about to throw in the towel w/ all this infertility stuff after unsuccessful pregnancy's, IUI's, and IVF/ FET.  I'm just thinking back to all the tests we have been through and how everything seems to come back fine, but I've never had an exploratory lap done to actually see inside there.  I'm not sure if that would be something I'd want to do or not and would only be able to do it if insurance would cover it.  Anyways, I was just wondering if anyone out there might have been in the same situation "Unexplained Infertility" and ended up getting their answer w/ a lap type procedure??

[Skyler]

Hi!

Well, I don't have any helpful stories, but I wanted to say that if you are thinking of throwing in the towel, it may be worth it to do the exploratory lap even if it doesn't find anything, if you feel that would help you move on without regrets.  If you think you would always wonder if that surgery would have discovered something, I mean.  I have unexplained infertility, and it is so frustrating!  I guess all infertility is frustrating, but something about the not knowing makes it especially hard.  Good luck!  I hope you get some good info from ladies on here who have had the procedure.

[Skyler]

I just remembered a helpful story - My friend had been trying for a while and had surgery to remove the endometriosis and she got pregnant pretty quickly after that.  But I'm not sure that the lap discovered she had it or if she already knew.  

[lesliesara63]

Unfortunately no for most people I know with unexplained IF. My sister and another friend both had endo removed but the doc in both cases said it wasn't enough to be the cause of their IF. For me it showed that my tubes were open which was questionable with an HSG. But when the doc saw that the outside of my uterus looked slightly heartshaped he didn't investigate further. I really wish he had taken the time to look inside and tell me for sure if I have a septate uterus or not. Either way it didn't really clear things up. That was early in our IF testing though. Did you end up having your follow up appt?

[babygirlie]

No, but i guess i knew at least my tubes were open. 1 thing down? I only did the HSG

Edited by babygirlie - 4/19/11 at 11:31pm

[Laurucha]

Originally Posted by lesliesara63 

Unfortunately no for most people I know with unexplained IF. My sister and another friend both had endo removed but the doc in both cases said it wasn't enough to be the cause of their IF. For me it showed that my tubes were open which was questionable with an HSG. But when the doc saw that the outside of my uterus looked slightly heartshaped he didn't investigate further. I really wish he had taken the time to look inside and tell me for sure if I have a septate uterus or not. Either way it didn't really clear things up. That was early in our IF testing though. Did you end up having your follow up appt?

You didn't have a hysteroscopy done? It is much less invasive than a laparoscopy and allows the doctor to look inside your uterus. It sounds like maybe you have resolved your infertility problems though.

[blueyezz4]

Thanks ladies!!! I kinda thought no one was going to comment on this and forgot about it.  LOL  I think we may actually attempt another IVF in the summer.  DH and I talked more and we think we might give it one more shot.  I'll have to see what my RE says when we have our phone conference w/ him next week.  I've never had a hysteroscopy done either.  Funny b/c the ladies on the IVF Forum were talking about that test too and I had totally thought I had gone through every test in the book over the last 5 yrs, but I guess not.  It kinda sounds like a HSG but w/ a camera instead.  I wonder if they consider that (HSG) good enough and that is why they don't do the hysteroscopy instead.  My HSG was fine so who knows... they saw the shape of the uterus and made sure the tubes were open.  Thanks again for your comments!!!

[Tear78]

I think that my RE has a policy not to go forward with IVF until their patients have had a laparoscopy and HSG. Their reasoning is that there could be endometriosis or fibroids or polyps that could interfere with implantation and make the costly/emotional IVF process less effective. I agree with whoever said that if you'll always wonder, then it's a good idea. I had one last year and it wasn't so bad: sure, it was surgery, and I was sore, but for surgery it was pretty routine. I'd be happy to share whatever you want to know!

[blueyezz4]

Tear - thanks girl, I'll keep that in mind.  So good to see 25wks on  your ticker!!!!!!!  Gave me a warm feeling in my heart!!!

[Laurucha]

Originally Posted by blueyezz4 

Thanks ladies!!! I kinda thought no one was going to comment on this and forgot about it.  LOL  I think we may actually attempt another IVF in the summer.  DH and I talked more and we think we might give it one more shot.  I'll have to see what my RE says when we have our phone conference w/ him next week.  I've never had a hysteroscopy done either.  Funny b/c the ladies on the IVF Forum were talking about that test too and I had totally thought I had gone through every test in the book over the last 5 yrs, but I guess not.  It kinda sounds like a HSG but w/ a camera instead.  I wonder if they consider that (HSG) good enough and that is why they don't do the hysteroscopy instead.  My HSG was fine so who knows... they saw the shape of the uterus and made sure the tubes were open.  Thanks again for your comments!!!

Yeah, it's weird. I am pretty new to the infertility world, but I don't hear a lot about hysteroscopies. However, in the books I have read, two different fertility doctors talk about how useful and relatively non-invasive it is. For example, from If at first you don't conceive by Dr. Schoolcraft of the Colorado Center for Reproductive Medicine:

It is very important to thoroughly evaluate the uterine cavity prior to in vitro fertilization even for women who have no abnormal bleeding. One study showed a very high incidence of uterine cavity abnormalities when hysteroscopy was performed after a failed IVF cycle. Even women whose HSG results are normal should consider having hysteroscopy. Even when the HSG indicates that the tubes are open, a hysteroscopy may show a problem in the uterus that the HSG did not show. An earlier study of IVF candidates who had previously had a normal HSG exam showed that pregnancy rates were decreased by two-thirds in those patients with abnormal findings with hysteroscopy.

 

The most common problems discovered with hysteroscopy are fibroids, polyps (usually benign overgrowths of glandular cells), scar tissue, and congenital abnormalities, many of which can be surgically repaired.

[LostMyMonkeys]

For me, I ended up having a lap to remove a cyst on my ovary that the initial u/s and MRI showed as being an issue, so that's why they went in to remove it. Once they got in there, they found a metric ton of endometriosis that we didn't know was there and they found a ton of scar tissue from my appendectomy I had when I was 8. Like so much attached to the outside of my uterus that they couldn't see everything they needed to until they removed it.  They don't know for sure yet, but they believe that was the cause of my IF, or rather, sub-fertility as they called it...multiple recurrent (early) miscarriages.  They also did an HSG while they were in there. They think that because I had an IUD for so long, that kept the endo symptoms at bay for a long time and it was now surfacing, which would explain why I didn't really feel any symptoms of the endo (short period of time between IUD removal and cyst discovery). 

So the bottom line is that while my cyst ended up being a big nothing, the result of the surgery was that I had all that endo discovered and removed as well as the scar tissue. Not a terribly helpful post, I realize but just throwing it out there that as in my case, there WAS something going on that we didn't know about and could have been a problem in all the TTC stuff. We dont know yet as we are in the trying for several cycles after the surgery to see if we are successful route right now

[Skyler]

I also want to know if a hysteroscopy can see more than the HSG.  I didn't want to do the HSG initially because of the radiation forn the x-ray, and asked for the hysterscopy instead and the Dr told me that the HSG is the only one that can see if your tubes are open, so I assumed that the HSG can also see fibroids and polyps.  But when I was having the procedure done, I asked the woman administering it if they would be able to see polyps or fibroids and she said "not really, only if it was a really big one."  So, I have wondered ever since then if I need a hysteroscopy too...  Just curious if anyone else has been told anything about the difference between the two tests.

[blueyezz4]

Skyler - good question.  I'll be interested to see if anyone has more info on this. 

[Tear78]

For the HSG, I believe they simply put dye through your cervix and check to see if they find it spilling out at the top of your fallopian tubes. The presence of dye up there proves that the way is clear. It showed a vague shape of my uterus, but nothing specific.

The hysteroscopy was done while I was under for the laparoscopy, but I believe that for this procedure they actually look up in your uterus with a camera and look around. That way they can see if there is any scarring, polyps, etc.

I can imagine that an HSG would be better for proving the tubes are clear because a camera couldn't get up in there (I think), but for seeing the shape and contours of your uterus, as well as any abnormalities, a hysteroscopy is better. Can anybody confirm all this?

[blueyezz4]

Thanks Tear!!!!  Sounds right to me!

[Starr]

I would certainly ask about a laparoscopy. I have had two done and both times the Dr.'s found things they wouldn't have known unless going in. The recovery isn't too bad either. Also it really helps if you have a great Dr. who really takes the time to look around and investigate. This last time my Dr removed a tumor, 3 cysts, endometriosis, and actually seperated my reproduction organs that were starting to attach to my colon. Normally everything down there is sort of free flowing and he said mine was attaching and while it doesn't affect infertility it really has helped my IBS that he took the time to do it.

[blueyezz4]

Just realized I posted about this on the IVF thread, but forgot to update all of you on here.  So here's the scoop....  My RE thinks I should have chromosome testing done to rule out any possible issue there first and then if that is fine, we will probably do a hysteroscopy to take a look at my uterus inside to rule out any kind of issues there.  So I'm working on the whole insurance issues to see if I can get things covered and I hope to have the chromosome test done this week and we will go from there.  Thanks again for sharing and all of your input.

[Tear78]

Oh, good! Yeah, chromosome testing is nerve-wracking but a good one to do. It's so annoying how many tests are out there and there's no clear resource for what else could be done! Somewhere in the infertility board I posted a thread about this, and compiled a list of tests. I think it got linked up at the top under helpful links. I'll go see if I can find it.

eta - here's the link if you're interested. People added some tests I had forgotten, and it was a great resource. Hugs and kisses, blueyezz!!!

[blueyezz4]

Tear - Thanks!! I remember that thread.  I looked at it again and I think I've had pretty much everything on there except for a lap, the killer cells checked and i don't think we have had that specialized sperm analysis test done.  The Chromosomes are to be tested for me hopefully this week and then possibly the hysteroscopy after that.  One thing that kinda makes me wonder, is that I have had these moles in the past where they will get a white ring around them and I asked a dermatologist about it and he said they were called Halo Nevus which is where my body thinks that they are foreign and it is attacking them.  It will actually make the mole disappear and there will just be a little light white circle left, so these chromosome tests scare me a little, but it would be nice to have an answer, i guess.  We will see.  I just hope I don't have to wait too long for the insurance company to fully approve it to get it done.  I think the Dr. said it takes like 2 wks to get the results back, so the sooner the better. It just seem kinda weird that I was able to carry our boys until 22.5wks w/ no problems until then if it is a chromosome issue. Hope you are doing well.  I love watching your ticker and haven't been over to stalk you on the BSL area lately, but should.  's to you my friend and thanks for the input!!!!