Getting put forward for IVF. Consultant says to cancel my HSG?

[isthismummy]

Heard back from my consultant at Guys today and been told that we will be getting put forward for IVF.

I am beyond grateful as we have only been trying since April. I'm nearly 38 however and have low amh. Consultant says she can just about swing it for us as my DP has low motility, so she's putting us forward due to the male factor.

I had a HSG scheduled for next month and she's told me to cancel it. She said my scan didn't show any obvious scarring etc, so just to leave it. However I really want to still have it done. I would like to know 100% if there's a blockage or not. She also told me to not bother with starting the clomid she had prescribed to me.

I now feel like she's thinking there's no point in bothering as there's no chance we can conceive naturally. Whereas I would obviously like to give it every chance I can.

Am I being paranoid? Should I ring the hospital back tomorrow to speak to her? I'm really not sure what to do.

Any thoughts much appreciated :) I'm really stressing about this.

I guess her thoughts are that the results of the hsg won't matter either way if you are going for ivf so felt you didn't need to put yourself through it. I totally get what you mean by holding on to that hope that it could still happen naturally before then. I would definitely ask if I could still have it, explaining your reasoning

I think that's what she meant as well. It's so disheartening basically being told that you won't get pregnant naturally and that the IVF probably won't work either.

I'll definitely ask if I can still get it done. They will probably think I'm being a pita, but I'm too far gone to care now!

Oh I know what you mean, I'm sure my consultant/gp think I'm a total pita too but we have to just push things forward for ourselves. Sometimes I think they're so used to dealing with this stuff every day that hey become a bit immune to how upsetting it can be for us.
Have they said they're not confident about the ivf working?

She said it probably won't work due to my low amh and DP's low motility😢

I know the odds are stacked against us, but it would be nice to hear a medical professional not be relentlessly negative for once.

Ugh I know it just sucks doesn't it. There is nothing fun about any of this. It can feel like we're constantly up against it. The fact that she is putting you forward for it must mean she thinks it's worth giving it a go?

Will the hsg delay your ivf? Maybe she thinks it's best just to get on with it

You don't need the HSG for IVF from a tubes POV but they can be helpful to show up any uterine anomalies that could hinder implantation, so it can be worth having that or a HyCoSy to just give it the once over. I'm sorry the Dr is so desperately unhelpful

And low motility shouldn't affect IVF outcome at all. Natural pregnancy maybe. But the point of ICSI is to overcome male factor by picking one good swimmer for each egg. Couples with male factor are amongst the most successful IVF patients because there's a mechanical reason for infertility that ICSI overcomes. So once you're doing IVF then motility is basically irrelevant

AMH is just a measure of quantity, and it's quality that counts. AMH is an indicator of response to stimulation, but not your ability to make a baby. My consultant said he's had women with 18 eggs and no embryos, and women with one follicle, one egg, one embryo and one baby.

I would be inclined not to cancel the HSG. Although not the most pleasant of infertility investigative procedures (I'm pretty sure I've had them all so this is first hand experience) the HSG will show up any potential blockages which can only be a good thing. Your HSG appointment is next month and your consultant is putting you forwards for IVF...depending on which protocol you are put on (long or short) the wheels will barely be in motion to organise your IVF never mind treatments/medications by then, so i would in your situation, go ahead with the HSG regardless. I would also phone your consultant tomorrow and ask her to explain in more detail why she deems it unnecessary. The information an HSG will provide will only help/rule out other factors that could be affecting your ability to conceive.

Incidentally, I have a friend who had trouble conceiving and had an HSG as part of the initial investigations...there was a blockage in her Fallopian tubes, but undergoing the procedure actually helped dislodge some of the blockage and she was pregnant the following month.

As a PP mentioned, AMH is only an indication of quantity not quality. I had ICSI back in 2009 (husband had low motility and I have a bicornuate uterus). We went private for a number of reasons, and we were lucky enough to find a most wonderful but also realistic consultant. He explained quite early on, that due to both myself and my husband having issues (mostly due to my bicornuate uterus...crudely put, my uterus has a 'divider' which split it into two chambers) that there was only a 5% chance that ICSI would result in a live birth, but that he would do anything and everything he could, to make that possible. On 'egg collection day' a few months later, we were dismayed to find that only 4 eggs could be collected. Only 2 of those eggs were suitable for the ICSI and only one of the two embryos survived the weekend. Funnily enough it was actually 7 years ago today that the embryo was placed in the larger section of my weird womb...and as a result of that single embryo transfer, with all the odds stacked against us, we became parents in 2010.

It is easy for a consultant to dismiss procedures/explanations/information when to them IVF/ICSI is generally black and white and it either will or won't work...this is why I would phone them tomorrow and ask for them to explain why they think an HSG is unnecessary despite the fact it will if anything, shed light on what could be a contributing factor to your infertility.

Sorry for waffling!

I would push to still have it. Surely if it's affecting your chances of conceiving naturally then you should have it. You want to try to make sure it's possible from every angle as you say- and ideally you don't want to place all your hopes on ivf, just in case I would say.

I'd try to speak to her to explain if possible. Just because you're looking at ivf shouldn't then rule out the route for natural conception (unless it definitely isn't possible, in which case it would be useful to know). As I've mentioned before, I have low amh and have conceived both ways.

Thank you for the replies everyone.

I'm going to push to have it done. I'm not looking forward to phoning consultant back though. I feel like she just doesn't like you asking any questions.

She said I didn't need it because my scan showed up no abnormalities; yet before she had my amh and DP motility results she was telling me to get it done. I really do think they've written off any chance of DP and I conceiving naturally. Then on top of that we get told IVF probably won't work either. It's so upsetting😢 We've had nothing really explained to us. Everything I know is from the research I've done myself.

She's now not even interested in helping to regulate my cycles. Temping was showing I wasn't ovulating, although the last three cycles I have! They are just too close together. I've been to a private consultant who gave me some progesterone pessaries.It's the most helpful thing done so far, although he was also really negative about our chances of conceiving.
NHS consultant has basically said it doesn't matter now because we're getting IVF!

It just makes an upsetting situation even more upsetting tbh. I feel so unsupported by the medical staff. The stress is horrendous.

If you are being treated on the NHS, you will not be given comprehensive investigations or a tailored drug regime. That costs time and money and the NHS have neither to spare. If that's the approach you want, the private sector is all geared up for that.

Also, allow yourself enough time and money for at least three cycles. The first cycle in most cases is diagnostic, so they'll learn a lot but probably not get you pregnant. After that there will be tinkering in every subsequent cycle. I had 4 rounds but then had an uncomplicated pregnancy and DD was born when I was 42.

With male AND female factor infertility, and aged 38, you have no time to lose and it sounds like your consultant has taken the same view. You certainly don't have time to be watching and waiting on Clomid.

An HSG is nasty and although it may be useful, it's not essential. IVF and ICSI will bypass the tubes altogether so the state they're in doesn't matter. The only time it's a big deal is if you have a hydrosalpinx; but if you've already had scans and blood tests the consultant will have already ruled it out on the balance of probabilities.

Honestly, just go ahead with the IVF treatment. It sounds like you've built it up into a big and traumatic thing, but it isn't. The injections are easy after the first couple, and the collection is horrible but bearable. The wait and the failure is excruciating of course, especially if you're paying, but easier to cope with if you treat it as a process towards getting your baby and not a last chance.

FWIW, it took me literally years to accept I needed fertility treatment, and that delay has certainly cost me a possible sibling for DD. I'm ecstatic to have just her so there's no sadness at all, but now and then I do wonder what might have been.

Good luck with whatever you decide.

It seems a crying shame of NHS resources when women have a failed cycle or two, and then find out there was something that was never investigated which could well have changed the outcome of the cycle

Women on here post about it all the time

Never had an HSG or HyCoSy (or hysteroscopy or laparoscopy) and discover after 1-2 failed cycles that they have something that didn't show up on regular ultrasound, that can affect implantation. Polyps. Fibroids. Adhesions. Endometriomas. Hydrosalpinx

There seems little point putting an embryo back into a uterine environment that can't (or is less likely to be able to) support a pregnancy

In the majority of cases things are fine. But until you do a simple HSG or HyCoSy you can't know from ultrasound alone there aren't any polyps or blockages or similar. I think it's disgusting to spend valuable resources on cycles without doing basic checks first - I'd have thought the basics were even more important in NHS, because it's public resources being used to pay for the treatment.

Agree with bananafish.
Think the hsg or hycosy important. I had it and it wasn't nice but perfectly bearable. It was reassuring to be able to see, straightaway afterwards, that my tubes were ok.
There's no way the doc would know this.
Please push for it.

Polyps, hydrosalpinx and adhesions - tubal disorders - aren't relevant in IVF because the tubes are bypassed.

An HSG will not diagnose fibroids, uterine adhesions, or endometriosis. That's what ultrasounds (followed by a laparoscopy) are for.

If time and money were limitless, we could all have all the investigations we wanted, but here there seems to be a very time critical and fairly obvious reason to proceed straight to IVF.

Polyps and adhesions are uterine

They prevent implantation

They're nothing to do with the tubes

Hydrosalpinx can prevent implantation due to the spillage of toxic fluid from the tube into the uterine environment.

Why would you want to spend ££££ on a cycle that was always destined to fail - and only then run the simple tests further down the line, to discover that if treated earlier, previous cycles may not have failed

An HSG or HyCoSy may diagnose polyps and adhesions where an ultrasound cannot because the dye shows the outline of the endometrium more clearly than a standard ultrasound

Some polyps or severe adhesions may show up on a pelvic ultrasound

Many, many uterine anomalies do not

If the OP had hydrosalpinx, there would have been other indications.

Very few polyps and adhesions occur in the womb. They are highly unlikely to cause implantation failure given many women have giant fibroids which are only detected during pregnancy.

The most common cause of adhesions is abdominal surgery - if you've never had it, you're very unlikely to have adhesions.

People really need to understand that consultants have a lot of anatomical knowledge than even their most well-informed patients, and are making decisions that need to balance the needs of the patient as well as the financial and skill resources available to them.

If the OP wants an HSG that the consultant does not now think is clinically necessary at this stage, she does have an option of paying for it. It's about £1600 from memory.

Banana, I do agree with you that an HSG would rule certain possibilities out, and if she were being treated privately, she would have it as a matter of course, although obviously at a cost.

The NHS doesn't have that luxury. It's a question of balancing probabilities. It's obvious that the consultant thinks there is a probable reason for the infertility, and therefore doesn't think further investigations are needed at this stage.

Oh, and the OP isn't spending "££££"; the NHS is. That's why the consultant is making the calls about the best way of allocating the money.

Agreed! I just find it astonishing how many women on here and women I know IRL have NHS cycles that cost public funds £££ and only then find out afterwards that the cycles were always destined to fail

Many NHS trusts won't do a cycle without a saline ultrasound for that very reason - they don't want to spend public money on a cycle without knowing there's no major findings that could be setting the cycle up for failure

Postcode lottery, sadly

It is shit, and it's very unfair that NHS policies - the investigations you're 'entitled' to, the rounds of treatment you're allowed - aren't applied the same way everywhere. (Although I have my own counter-argument there: it's to do with the demographic profile of the local population).

Er my hsg spotted my fibroid. Its not huge but it is significant enough that Gaeno thinks it might interfere with implantation & as such if I'm not pregnant by IVF referral time will remove it so I don't 'waste' my nhs cycle.

Isthismummy how did you get on?