Laparoscopy or IVF?

[Beebsy]

Hello,

This is my first time on mumsnet so hope I'm doing this right!

I am looking for some advice...

DH and I been TTC for >2yrs. Have been under private clinic for 1 yr. Had all standard checks done including HyCoSy and no obvious reason, just 'unexplained'. IVF recommended but some other factors have led to delay after delay so not yet started.

Recently seen NHS consultant and told we could go straight to IVF but recommended to undergo laparoscopy first to check for endometriosis. Only reason for suggesting was because I said I sometimes have painful periods. This is the first time this has been mentioned and now I'm really unsure what to do.

I have read lots of threads where ppl had endo treated but were symptomatic so had the benefit of alleviating the symptoms.

I am 33 and have above average ovarian reserve. I am slightly wary of the procedure/recovery and have read that it can affect ovarian reserve but also know IVF is not without risk (I've been told I'm at high risk of OHSS). Have also read of it helping many ppl conceive naturally albeit more so for symptomatic individuals.

Has anybody else been in this situation? Would you recommend laparoscopy or go straight to IVF?

Thanks in advance for your advice x

Unexplained is actually no diagnosis at all; all this means is that they have failed to find out what is wrong. Sometimes it is a "diagnosis" given to couples when they as a couple have not been adequately investigated.

Do either of you have a diagnosis of the underlying problems?. It seems not and I would be asking them why.

What tests have been done on both of you to date and particularly within the last six months?. Any test result done over 6 months ago should be discounted.
Your man should have certainly had detailed semen analyses (so not just one test) by now. He should also have up to date test results; subfertility is not the sole preserve of the woman.

How have you found this private clinic?. I ask only as some private treatment clinics can be poor as well as expensive. Did this clinic ever consider the possibility of endometriosis?. I would further consider what this NHS consultant said. BTW the endometriosis that was found in me was mainly located in the uterine cavity. I would not get too hung up over this whole ovarian reserve issue either way.

The following tend to be omitted in the course of fertility investigations:-

Adequate x-rays of the uterus which may show abnormalities not seen at laparoscopy in either the tubes or uterine cavity.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not otherwise seen.

Carefully timed post coital testing to see if sperms are surviving in the cervix

Repeated sperm counts over several weeks and months to make certain there is no subtle abnormality

Testing the sperm in special media - such as swim tests or velocity testing. When this is done it can sometimes uncover a hidden cause for the supposed "unexplained" problem.

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone.

Scanning of the ovaries to see if follicles really are developing and there is no sign of polycystic ovaries.

Hi,
I found the NHS route likes to go down the laparoscopy route first before IVF. I started to go down this route as I have had many symptoms of endo since 15. I was on a waiting list for a lap for many many months. They said I had to have lap first before IVF. However, in the meantime waiting for this we found out we were ineligible for IVF on NHS anyway so we decided to go private.

Even though I’ve had many scans with NHS which conveniently found nothing, the private ultra sound scan found I had endo (right ovary adhered to uterus, signs of endo in my bowel) also had a HyCosy and found right tube blocked, so my private consultant diagnosed me with stage 3/4 endo. My private consultant recommended I don’t have a laparoscopy as I have a good, above average AMH level and with endo causing my right ovary to be adhered to my uterus, the lap could cause damage and reduce my AMH. So I’ve followed my private consultants advice and gone ahead with IVF without lap, just had my egg transfer today so my fingers are crossed it sticks!

From my own research and experience I’d recommend going for IVF without the laparoscopy.

HI @Beebsy I was TTC for four years and was referred for a lap and dye test on the NHS in 2019, like yourself they wanted to rule out endo due to some painful periods. Due to the long waiting list, I went private on the 2nd Dec 2019. I tested positive on 5th January 2020 and have a 2.5 year old boy and another boy due in October. In my case, I was very lucky and obviously glad I went for the laparoscopy before IVF so I would always recommend that! Good luck!

Hi all,
Thank you so much for your comments and sorry it has taken me so long to get back to you. We've had some unexpected personal things happen over the last week or so.

@Amyjones86 I'm so glad to hear it worked out for you, that's such lovely news :)

@CAA121 Yes, we felt that was definitely the preference of the consultant but he did say he would recommend us for IVF if that was our preference. Unfortunately we have also just found out that we are not yet eligible for NHS IVF as the criteria is 3 years unexplained infertility where we live, so we'd have to wait another year. After posting this I actually spoke to a friend's sister who is a fertility specialist and she also said what you said - go straight to IVF and not laparoscopy. So we have another consultation with the private fertility clinic tomorrow to see what they say. At present they haven't approved IVF because of a genetic condition in my family. I had genetic testing last year but it is taking forever. We've had genetic counselling and the condition is very mild in my family so the NHS were happy for us to go ahead without requiring the results. So it's frustrating but if the private clinic won't offer IVF yet then we may be able to self fund through the NHS clinic. Keeping everything crossed that your egg transfer went well and you'll have good news soon.

@AttilaTheMeerkat Thanks for all of your advice. I've had AMH/FSH, thyroid and AFC, HyCoSy, course of Clomid (caused thin endometrium) with monitoring & timed intercourse and monitoring cycle without drugs. No sign of polycystic ovaries. DH had detailed semen analysis, most recently a month or so ago. Found first clinic to be very poor but changed about 3 months ago and had a much better experience at the new one. Neither of the consultants we've seen privately suggested lap/hysteroscopy but will still ask about this tomorrow to get their take on it. Will ask about the other tests you mentioned. Thank you for all of the info!

Hey Op,

I had a very similar situation to you.

I wanted a LAP first to try and establish a “root cause” and potentially fix because I saw IVF as the last resort and in all honesty I wanted to find something I could “fix” before I ended up down that path.

However my consultant made a valid point to me. He told me that due to my age ( which really annoyed me at the time as it made me feel as if I was ancient) 33 at the time , that he would recommend IVF instead of the LAP and the reason was …. If I had the LAP and they found endo or something else and it was extensive/ untreatable for example, IVF may still be my course of action for having children. so why not do it sooner rather than later.

I was looking at 12-18 month wait for a LAP by which point I would have been 34/35 and then up to another 6-12 months for an IVF referral and for lots and of people IVF at 35 and beyond has great results but given I didn’t really know what my issue was I didn’t want to delay , in case my egg quality was dire or something like that.

Putting it bluntly If I had been 25 at the time I probably would have had the LAP but at 33 after years of trying and with no real explanation as to what the issue was I figured IVF was the right choice.

I don’t think anyone that’s had IVF would recommend it lightly without exploring as many other options as you can but in my case I don’t regret my choice.

Whatever you decide will be the right choice for you and that’s all that matters, best of luck.

Hi @Loulou2202 thanks for sharing your experience. We discussed everything with the private consultant last week and he pointed out that if they found anything on lap we would become eligible for NHS IVF but pointed out that it was an invasive procedure and there's nothing really to suggest I have endo. I am the same age as you, 34 later this year so we have decided to go straight to IVF (self funded for now). We still have the genetics hurdle to cross but we seem to be edging closer!

Sounds like a sensible approach with the information you have at the moment :) best of luck to you on your IVF journey x

Hello,
I’m so pleased I found this board as I’m grappling with a similar question!
I’ve been trying to concieve for about a year - diagnosed already with a short Luteal phase and PCO. Other tests (hycosy, sperm, day 3 bloods) were fine.

I’m lucky to have private healthcare and am having a fibroid removed via hysteroscopy. The Doctor suggested also performing a laparoscopy while I was sedated to check for other issues. Other than very occasional pain during certain sexual positions, I don’t have any other signs of endometriosis.

So at first I was keen to have another diagnostic operations (especially as the cost of covered), but I have read up on laparoscopy and it does sound relatively invasive and poses some risks. I also plan to start IVF in the new year so it may be of little benefit anyway.

I was wondering how others got on with their choices or if they had any words of wisdom? It all feels quite scary and big right now having to make these choices! X

@Carlotta27
I completely understand your dilemma, such a difficult decision to make and hard to know which is the right route.

Can the laparoscopy been done purely for diagnostic purposes e.g to see if endo is present etc but not to take action at that moment in time, as the risks are then lower? It’s when they start having to remove/ drain cysts, unblock tubes, remove endometriosis and especially if the ovaries are affected by endo (my right ovary is adhered to the back of my uterus and Hycosy showed that right tube was blocked) this can have risks and an impact on AMH after. So the risks really depend on what they find and the actions they take, if purely to see the status quo it carries less risk but also depends if you want it just treated there and then rather than having to go under again (again depends on extent of endo). My private consultant recommended I try IVF first, and if that’s unsuccessful then go down the surgery route as the benefits then start to outweigh the risks.

I’m currently 11 weeks pregnant after a successful first round of IVF (I didn’t opt for a laparoscopy prior) so for me that was the right choice ☺️

Good luck with your journey x

Hello @CAA121 Thank you for your response and massive congratulations on your pregnancy - wishing you a healthy and uneventful next couple of months :)

Great to know that going straight to IVF worked for you as that’s what I’m leaning towards. I’m not sure how much benefit the laparoscopy will be if we plan to do IVF anyway and my husband is very worried about the risks as he thinks it’s more invasive than necessary at this stage x

@Carlotta27

I replied to original op earlier on the thread. Appreciate it’s not everyone’s experience but I am 22 weeks pregnant also from 1st round of IVF.

being honest. I would have liked to have a proper diagnosis and potential treatment to get pregnant naturally and had I been mid / late 20s I might have decided differently but I have no regrets.

@Loulou2202 Thank you for sharing that and congratulations on your pregnancy - looks like lots of women on here have had success with IVF without the Lap.
I’m coming up 34 so thinking that in the interests of time going straight to IVF May be the best option too x

Hi @Carlotta27 I'm not sure about the medical side of things but for me, I decided not to undergo laparoscopy and am having first round of IVF in a few weeks. My private consultant said that the laparoscopy would really only be beneficial if there was severe endo and like others, coming up to 34 I also did not want to lose anymore time.
My consultant did tell me though that if I did opt for the lap and they found endo, no matter how mild, it would make me automatically eligible for NHS IVF. Not sure if you want to go down that route but I wonder if you would be eligible based on your fibroid?
Good luck with the hysteroscopy! x

Hi @Beebsy Thank you so much for sharing that, especially the note about how endo / other findings on a laparoscopy could help to get the NHS funding. I am leaning against the laparoscopy as I may well go ahead and pay privately if our meeting with the NHS consultant makes us think we may not be approved. I’m an odd case as I have a 5 day Luteal phase and PCO, so little chance of conception in a natural cycle, but don’t fit into a clear box for someone who qualifies for NHS funding (eg male factor, endo, etc!)

This journey seems so unfair and like a series of obstacles for some us, whilst others seem to concieve so easily and have no clue how lucky they are.

Best of luck for your IVF treatment - fingers crossed that the high ovarian reserve means you’ll get a good number of eggs! X

@Carlotta27 yes the funding is such a postcode lottery. Sadly for our local CCG the criteria is 3 years for unexplained infertility, so after 2 years (and having already been under the clinic for over a year) we have decided to go private, for now at least. Thank you! Good luck with whatever you decide x

@Beebsy Oh gosh, waiting three years to concieve is tough, i don't blame you for pushing ahead with private treatment! Thank you for sharing your experiences and advice x