Is HSG/HyCoSy essential prior to IVF

[secondtimelucky87]

Hello,

Bit of background: late 30s f and late 40s male TTC second for over 18mo. First naturally conceived after long time trying. We have some MFI we're investigating properly next month via andrology. I've had internal ultrasounds (zero issues found) and all my bloods fine. Progesterone good and am ovulating. AMH low at 2.6 pmo/l but consistent with my age. If our andrology appointment and subsequent trip to see a fertility specialist indicates only IVF will work for us, I just wondered if anyone happens to know if HSG/Hycosy would be an essential prerequisite? Appreciate only a specialist can give definitive answer so just looking for anecdotal evidence. Tbh I'm very nervous about having those procedures after reading about them here. (I know IVF won't be a walk in the park obviously). I had a planned c section with my first so have wondered about possible scar defect, although I don't seem to have any of the symptoms. Just wondered if HSG is going to be something else I need to tick off the list?

Any information appreciated.

Thank you 😊

From what I understand, it's recommended before ivf and its tell you about potential issues with implantation, such as fibroids, weird womb shape (I have this),hydrosalpinx (if you have this is can create a toxic environment and prevents implantation)

Tbh everyone reacts differently to it, and you'll only really hear the horror stories (a bit like childbirth). I had one earlier this year and it was absolutely fine. A bit uncomfortable when they put the catheter in but that was it. Have you had an internal scan before? For me it wasn't much more uncomfortable than that. I'd also read horrible things on here and from a friend, but it really wasn't that bad for me - I just took paracetamol and ibuprofen about 30 mins before.

I haven't had one but don't know if that's unusual.

Thanks so much for your helpful reply. Yes I had an internal ultrasound in September which was absolutely fine and found no fibroids etc. I do find smears pretty uncomfortable though (feels like my cervix is really tucked away) and tense up despite my best efforts to breathe through it! They are at least over with quickly. But the stories I've read about HSGs here have really freaked me out. I've wondered if I could even ask for sedation of some kind. It makes sense what you said about the kinds of things they can identify that wouldn't have been picked up on my ultrasound. I guess I'll find out for sure come December when I go and see a specialist. Currently researching where would be a good fit for our circumstances. Thanks again 😊

@secondtimelucky87

No problem, I have quite a complex history (though I have a 2.5yo DD conceived naturally within 5-6 cycles), I personally found it really useful, I have regular internal scans due to large cysts but they really talked in quite a bit of depth about what they were seeing.

Thank you. Something I've wondered about is whether I'd be entitled to one if I've already had one naturally conceived child. Do you mind me asking if yours was after having your child? I definitely couldn't afford to have it done privately on top of potentially having IVF.

Thanks for sharing. Yeah it's hard to know if it's essential or not. Guess I won't know for sure until I speak to a specialist but helpful to hear some stories here first.

@secondtimelucky87 I was entitled to one of the NHS but mostly because I'd had a ruptured ectopic. However gynae wanted to me keep trying for another 6 months before having one so I ended up paying for it myself. It was about £500.

I was told HyCoSy was needed to 1) check for any issues within the uterus that could be causing infertility and 2) to make sure that an embryo could be transferred back into your uterus during IVF. I had one and it was absolutely fine, no pain at all. I had one as part of my infertility investigations through the NHS.

Thanks so much for your reply. I already have one naturally conceived child (though it took 3 years and I've been trying half as long for my second) so I'm not sure if i would qualify for one on the NHS sadly. I'll try to find out though. It does make sense it could be necessary, though the many stories I've read here and my own anxiety have worried me a bit! I'm planning to visit a clinic in December once I've decided where to go and will see what I'm told. Really glad yours wasn't painful and I hope it proved to be helpful for you 🙂

I didn't have either before OVF, they tried to do a HSG but due to a pinhole cervix couldn't and advised I needed to be dilated before they could try again. My IVF clinic went ahead with the treatment plan without it.

No problem. For clarity the HyCosy was not part of my IVF NHS funded treatment it was done prior to that, as part of fertility testing. I don't know if there is an NHS criteria (national or via local integrated care board) for having one done pre IVF referral and if already having a child would make a difference. If you search for your local ICB you'll find their criteria/policy on funding. I know my local ICB does not fund IVF if either parent already has a child.

I've had two successful rounds, and never had any procedures prior to IVF. We have very clear MFI though, so other than blood tests I didn't have any other investigations once those came back okay.

Thanks so much for sharing. It's all so expensive isn't it. £650 alone this month on booking some further tests for my DH and a consultation, before we even start exploring going down the IVF route! And even that we could only afford if we were to use something like Gaia or Access. I hope it proved to be helpful for you!

I'm sorry to hear you had this experience! I find smears pretty uncomfortable so can imagine I'd have similar. I'm glad you were able to proceed without if in the end!

That's really helpful thank you. I checked and we definitely don't qualify as we already have a child together, which is fair enough. We do have some known MFI and my AMH is only 2.6pmo/l so it feels like assisted conception or some kind will be needed. The chances of it happening naturally at my age are rapidly dwindling!

Thanks for sharing! Yes we've had two SA's so far which have also shown MFI. 😢 We're checking for DNA Frag too for the first time next month and then (once I've decided where to go!) the plan is to visit a fertility clinic and get some advice. I'm glad you were able to go ahead without a HSG!

Although you may not be entitled to IVF, other investigations and cheaper treatments may be available on the NHS if they would be suitable.

I had HSG during a working day, went to the appointment and came back. It was really fine in terms of pain. In terms of acrobatics so they could see everything that was more complicated for me but they helped me into position! (I do have a retroverted uterus).

If you are looking at payment options I sometimes used 0% credit cards for treatment and paid them off as I went along.