Do I need a laparoscopy? Advice please :)

[closephine85]

Hi ladies

I've posted a few threads on here now and all your advice and support has been so helpful, so here I am with my latest query :)

Long story short, we are experiencing secondary infertility (ttc for 27 months and counting) - we fell pregnant with DS after 6 months of trying. This time round we went to the dr after a year of no success... So far I have had a HSG (all clear), AMH (16.6), FSH (6.5), internal ultrasounds x a million, progesterone levels, thyroid checked... Everything absolutely fine. DH however came back borderline on 2 analyses (14 million with poor motility) and on our first round of IUI his count was just 3 million but with improved motility.

We are now starting our second month of IUI and have been told that after 3 months, if it hasn't worked then I can have a laparoscopy. Now am I mad, but shouldn't it be DH having further investigations and not me?

I'm just wondering whether you ladies think I should have the laparoscopy anyway? I'm not keen on the idea of surgery, stupidly looked up the risks on the NHS website and it says serious complications of 1 in 1000... I feel like the way our luck has been lately I'll be that 1. Just not sure what to do?! I don't have any endometriosis symptoms (maybe the odd twinge in my cervix area but kind of assume that's normal?). Does anyone know if endometriosis shows up on an HSG?

Anyway... Sorry for the waffle. This whole process is frying my brain. Any input would be greatly appreciated.

Thanks

[Persipan]

Why a laparoscopy and not a hysteroscopy, out of curiosity?

[closephine85]

Hi persipan

I have no idea - I hadn't heard of the other until you mentioned it and had to google it.

[sunshineonarainyday1]

I had a laparoscopy for infertility investigations to rule out endometriosis even though had absolutely no symptoms. They found severed endometriosis! I thought a hsg could detect endometriosis but couldn't actually remove it....but I might be wrong.

If your husband is borderline in terms of SA, why have you had iui. I would have thought IVF more appropriate.... But I'm not an expert.

Are you under a gynaecologist for all of this or is the gp managing the referrals? I would see gynaecology consultant and ask them why they suggest lap if iui doesn't work.

If you do decide to have lap ask if you can sign consent for a hysteroscopy too. When they did my first one they found I had a bicornuate uterus but couldn't investigate it fully as I hadn't consented for hysteroscopy. I had to have second lap (with hysteroscopy) a year after the first op and would've been a whole lot better if they'd done this the first time round.

[closephine85]

Thanks for the advice. We would have to pay for ivf (no free IVF where we live and we already have one child anyway) but get 6 rounds of IUI so figured we may as well try it. We probably will end up paying for ivf next year so I guess im just trying to work out whether it makes sense to have a laproscopy in case there is something hidden.

[CanISayOfHerFace]

I had a laparoscopy before starting IUI. The NHS trust here will only do things in a certain order. So you can have an HSG, a laparoscopy, 3 x IUI and 1 x IVF but you have to have them in that order. For example, I couldn't have had an IUI then a lap, then IVF. So I had the lap up front to rule out any issues and potentially wasting time on IUIs.

As it happens everything was fine but glad I had it done as it gave me peace of mind that all was well to start treatment.

[OrangeSquashTallGlass]

A laparoscopy is the only way to guarantee a diagnosis of endometriosis. I didnt have any symptoms really but I had it. 1 in 10 women do.

I would go for the lap, but not just as a diagnosis. I would consent to a lap to diagnose and to treat (within reason). Otherwise, if you do have endo, you'll need a diagnostic lap then a few months later another lap to treat. After a lap to remove endo you have about 6 months of increased fertility, so if you do have it (and you might not) it'll help to treat it.

[AttilaTheMeerkat]

I would be requesting them to examine DH more closely now; there are likely to be male factor issues. I also wonder why they offered you IUI at all (it is likely because it is cheaper).

Have they at all talked to you both about the morphology (forms) of the sperms?.

Did they explain exactly why they thought a lap was necessary?.
Cannot really understand why they are offering the lap op particularly if the lap is purely going to be a diagnostic procedure. You do not want surgery unless it is really warranted.

A HSG does not detect endo if it is there; that is usually determined by having the lap op. A HSG is infact a tubal x-ray.

[closephine85]

Thanks all, I tend to agree with Atilla about not wanting surgery unless necessary.

My DH has an appointment with his GP tonight to find out if he can refer him. The hospital said they do not refer unless the count is under 1 million but we would like to at least try and get to the bottom of this. There is no reason why his count should be so low. They've never really seemed interested in going into detail of his analysis but I think morphology was 4%. I have read. Lot of contradicting things online about what is 'normal' morphology but I guess if his count is low in the first place then just 4% morphology won't be helping either?

Will report back with what his GP says later.

We can only have IUI where we live (there is no free IVF but we have a 4 year old DS anyway so would not be eligible even if we did live somewhere with IVF).

[CanISayOfHerFace]

4% morphology is normal I think.

Problem with IUI is that without the lap you never really know if the egg is getting to where it needs to be and if it is, is there anything stopping it implanting.

How did it go with the GP?

[closephine85]

DH seems to think normal Morphology is 15 but said his dr didn't seem very concerned by any of his results. He did however think he has an infection in one testicle and has prescribed him antibiotics. He didn't think it would do anything major to increase his count though. He has also taken lots of blood tests - testosterone, thyroid etc so we will see what those results are in a week or so I guess.

I probably should admit that I am a little scared of the thought of the laparoscopy. Basically a woman died a few years ago at the hospital I would be having it at due to an error made during the surgery. I know this will have skewed my opinion of it. I've had my wisdom teeth out and I'm sure if I googled I would find out that people have died from having that done.... I know I shouldn't be letting a tragic and rate occurance be affecting my decision but I'm finding it hard to get it out my head!

[CanISayOfHerFace]

I'm not surprised that's in your head. Surgery is scary, even the HSG had me worried!

Kruger standard for sperm analysis state the following levels as normal:
Volume 1.5ml
Count 15 million/ml
Total count 39 million
Motility progressive 32%
Total motility 40%
Morph strict 4%

This forum is excellent and has some very knowledgeable people when it comes to male factor infertility www.fertilityfriend.com/Circles/viewforum.php?f=30

And check out this thread too:
www.fertilityfriend.com/Circles/viewtopic.php?t=2781240

[Happyminimalist]

I had one (secondary infertility) and it showed that my tubes were all over the joint and stuck to my bowels - which they then sorted. It also showed my tubes were clear apart from that

[icy121]

I had a lap with ovarian drilling in July. They found fairly advanced endometriosis and a blocked tube, so I'm glad I had it. If all ok the procedure is about 45 mins. I got a shock when I woke up after 2 hours!

My only regret is I didn't tell work, so I took Friday off "to go to a wedding" and back in on Monday. I wasn't really comfortable until Thursday (I commute into London so the journey is over an hour each way which didn't help)

[Peanutty35]

ah Im booked in for my lap tomorrow and feel pretty much the same as you - I have no symptoms of anything and it feels like a massive big deal on the off chance there is something. A hycosy will only show up severe endometriosis and isn't as reliable as a lap......

has anyone answering this had any tube repair work - Im not sure whether to consent to that or not.....

[closephine85]

Thanks for the replies everyone

CantSay - that's for those links, will take a look. And for the levels. Looking at them he is low to a little low on most things except motility which was at 50%. I just wish someone could say definitively 'this is the issue'.

I probably will end up having the laparoscopy unless we have a miracle between now and then.

Icy and happy, had you had any symptoms before having the lap and them finding problems?

Peanutty good luck for tomorrow I hope all goes well for you. I'm sorry I can't offer any insight on consenting to repair work, but perhaps as others suggest above, consenting in advance would mean you wouldn't have to have another one done down the line if they do find something and can fix it all in one go?

[Peanutty35]

yeah thanks - its so nice to not be alone! Ive actually pulled out of the lap- I think that its just a wee bit too invasive for where I am right now. If you do have one - I really wish you all the best !
Have you had any thoughts about the IC process where they wash the sperm? You might have already done that - I was at a presentation process by CARe on Sunday where they talked about being able to get deeper tests done on both partners - seemed really promising if there were any male fertility factors x

[OrangeSquashTallGlass]

I had my blocked tubes cleared Peanutty. They just had to 'flush them through' though, all very simple.
What repair work are they suggesting?

[OrangeSquashTallGlass]

Ah sorry, xpost.

[icy121]

peanutty they cleared one of my blocked tubes. My surgeon/consultant is v good, been doing gynae surgery for decades so I felt v safe.

closerphine I had severe period pain (which I never mentioned to the doc, until the lap I didn't know what endo was..?!!) I went in with PCOS so he drilled the ovaries and cleared up a load of the mess in there whilst he was at it. Periods pain is 10% of what it was.

I went private as time against us & it cost me £3,850 all in. So srsly, if you can do it on NHS bloody do! And make sure you leave yourself about 6 days to fully recover. Tbh it's not that I couldn't work, I just couldn't walk - so 10 mins to station and then 10 mins from the tube was awful. I think it's what it must be like to be old. Slow and in pain.

So if you drive to work you could have the lap on a Friday and be back at your desk Monday just fine.

In terms of outcomes, I ovulated on my own afterwards but I'm hammering clomid and metformim again now because i need to ensure every cycle ovulates.

[Wifey1990]

Hi, did anyone fall pregnant after they had there tubes unblocked? Xx