Has anyone had an HSG as part of tests for recurrent miscarriage?

[teaandchocolate]

Ive just seen a new consultant privately in relation to my 3 mcs and he wants me to have an hsg to check for uterine abnormalities - specifically a heart shaped womb & also adhesions from various procedures.

I'm booked in for Wednesday but am feeling increasingly concerned about it. Firstly theres the cost (nearly £500) and I just don't know if I need it. I've had numerous scans before many when I wasn't pregnant by experienced sonographers so I would have thought that if my uterus was an unusual shape it would have been spotted? I'm concerned about the actual procedure as my cervix is very damaged already from surgery and I don't want to cause any more problems. If they do find adhesions won't more poking and prodding make it worse? Can adhesions even cause mc? Wouldn't they just stop me getting pregnant?

Just wondered whether anyone else who had rmc testing had this procedure carried out routinely? Thanks for reading and sorry this is long just very suspicious of hcp especially when it's private!!

Hi Tea I'm interested to see the responses to this too. I've recently been seen in an NHS clinic for recurrent miscarriages and the consultant didn't mention this at all. We spent some time going through the various tests and 'treatments' and the idea of performing an HSG didn't come up in our discussion. I've had a c section and an ERPC so I am at risk of having adhesions.

Hi jollyb. I think that's partly what's worrying me - I've also seen an nhs cons who didn't mention an hsg either. I think this new con just does them routinely and I can't work out if there's any point or whether there are any real risks of the procedure (which they assured me is like a smear but there are horror stories on the Internet!).

I keep changing my mind about it. Would be good to know for definite that there are no physical issues but even if they find something I don't know how risky it would be to sort it out.

I had a elcs because dd was breech and that apparently can be a sign of a heart shaped womb. So not sure if that applies to you too? Can I ask what tests your consultant recommended?? There doesn't seem to be any consistency from what I've read!!

Hi Tea - he really didn't recommend very much in the way of tests - apart from blood tests (inc glucose, thyroid and clotting screen). He appeared to think that checking progesterone levels was old hat and karyotyping not that helpful.

I'm a HCP too and so I'd like to think that our discussion was fairly comprehensive (ie we even ended up talking about whether you would ever do IVF in this instance to choose the healthiest looking embryos - apparently not!)

Meant to add DD wasn't breech - just overdue a mind happy to stay put.

Just had a look at the RCOG guidelines again and an HSG is a recommended investigation in women with suspected anatomical abnormalities so maybe he's not being too over enthusiastic.www.rcog.org.uk/files/rcog-corp/GTG17recurrentmiscarriage.pdf

Thanks for the info. Hope I didn't offend you with my comment about hcps!! I just feel that there's not much consistency with mc tests and treatment and each specialist seems to have their own agenda and particular interests so I feel like you always need to keep your wits about you in order to figure out what's right in your own case!

At this precise moment I feel like I might as well go along with the hsg to at least rule things out. But who knows how I'll feel tomorrow!

I've basically had the same tests as you and doesn't look like I'll be getting any more blood tests with the new consultant. Although I did have karyotyping - but there's nothing they can do if it shows something. I also took progesterone with my dd but no other pregnancy so maybe there is something in it?!?! Its so complicated!!!

Yes, I did. It was fine, I had to go in and have a gown on and go into the operating theatre. They injected the special fluid that showed up on the Xray, it was uncomfortable but not painful. I took the day off work but was fine for work the next day. There wasn't any prodding or poking as such, I don't think it risks any adhesions.

No not at all! Only mentioned HCP status to say that I don't think he was fobbing me off or rationing my investigations (though maybe he was according to the guidelines !). Good luck.

Thanks Rosetta that does put my mind at ease.

Jollyb good luck to you too. Hope you get some answers. I feel like i might as well be a hcp the amount of research I'm doing on this subject at the moment!!

i have a heart shaped uterus-biconcave and have carried 2 children full term.

Hi mumtoaandj do you mind if I ask how they diagnosed it? Do you if it's always obvious on a u/s scan? Even if I also have it, as you say, it hasn't stopped me carrying my dd to term

My first pregnancy i had bleeding so too in my 2nd pregnancy. Both scans looked different from other people's scans...with my first son i had never seen another scan picture. With my second son whilst having an early scan they pointed out the heart shape, it was on a normal nhs tummy scan. It was clearly visible, she described it as heart shaped or 2 horns, i then had to have more scans to make sure that the baby settled in a good part and not up at the top of one of the horns?? does that make any sense? Both pregnancies went fullterm and successful but both caesarian. i dont know much about them- but going by both my scan photos the heart ness looks more defined in the second one and i had more bleeds with him..i have since just had a mc-but have no idea why...i never googled biconcave as i thought i would worry.

sorry it is bicornuate not biconcave?

Thanks for the info. That all makes sense!! I've actually cancelled the hsg and booked instead at a different clinic for a sis scan which is similar to hsg but uses saline to fill the uterus and is a 3D scan instead of X-ray so safer, cheaper and more detailed. Still think it will hurt though! But hoping they find nothing and I can cross these worries off my list! Sure I'll be back again if they discover something....

Hi Tea, I recently had an SIS scan as recommended by Dr Raj Rai - I've had 3 erpcs.
You are advised to take painkillers a little while before, I would say it was quite uncomfortable but bearable as it didn't last for very long.

They found scar tissue, most of which was broken up whilst they were in there but I will have to have the thicker scar tissue removed. All other tests I've had are clear too so I'm hoping this will be the last thing I have done! I think it was around £320.
Good luck!

Hi Ostrich! Thanks for letting me know. Apparently the clinic where I'm having it done also carries them out for St Mary's so hoping I'm in good hands. I've had 2 erpcs and a csection so I'm sure they'll find scar tissue although I'm hoping I don't need further surgery.

Do you know how much the surgery will cost to have it removed? Is it covered by the nhs? I'm a bit concerned that if they find something it will be a total pain (& v expensive!) for me to keep going down to London to get it sorted. Did they say that the scarring causes mc as I thought it juu stopped you getting pregnant? Sorry for all the questions - I must remember to write them all down for next week!

Hi Tea
Hopefully any scarring that you have will brake up while they're doing it x
I had it done at CDS in St Johns Wood - I thought they were very professional. Nice building too.
He couldn't say how much the surgery would cost privately though he guessed it could be £1500 upwards but was very vague. I'm waiting for my first NHS appointment at St Marys so they can then schedule a surgery date - we've spent a lot already so we'll have to wait. Very frustrating.
It was explained to me that scar tissue has no blood flow so if the egg implants in it then has minimal to no chance of growing.
No problem with the questions, I'm glad to help.
x

Hi Ostrich thanks for the info! That's where I'm going too - I was previously a patient there anyway before I moved away from London. They are amazing, its such a good clinic!

The cost of removal sounds extortionate so I really hope I don't need that doing. I'd probably risk trying again before spending that money I think. It's annoying as I wasn't really worrying about this before but now feel the more mc you have the more at risk you are from having them again because of the surgery - seems so unfair!

I know how you feel - I would think twice about having another erpc if I have another mc. I'm hoping I wont ever have to face that decision again though!
When they were doing the scan they told me there was scarring they couldn't break down so hopfully you'll know one way or the other next week rather than having to wait for the results- good luck, let us know how you get on xx

I know but if you have an erpc you can send the tissue away for testing and because of that I found out that my 2nd mc the baby had triploidy which is very useful info. Such difficult decisions - like you I really hope I don't have to think about it again but I'm not feeling too hopeful at the moment. Just worrying about every possible cause!!

Thanks for the advice though. I will let you know what they say next week. Now getting worried I'm going on my own incase it's bad news! Since your last post ive already been working out how to afford the hysteroscopy I'm now convinced I'll need! Am such a worrier!!

Hi Tea,
I had a mean sickness bug which wiped me out for a few days - sorry for the late reply.

While I was talking the hospital into letting me have my last erpc I was told an option would be to go home, collect anything in a plastic box and take it back in for testing. Is that something they say but never do?

Good luck with the scan. Fingers crossed it'll be all clear, hope you're not worrying too much x

Hi Ostrich! Thanks for your reply - hope you're feeling better? Tummy bugs are the worst!

Just to update this I had the sis scan yesterday. It was ok apart from being v painful while they messed about with my cervix. But the actual procedure and afterwards didn't hurt more than period pain really. Anyway all was good. Uterus normal shape and no visible scar tissue! So i guess erpc doesnt always mean scarring. Am very relieved. Although my cervix is very short (maybe why it hurt more) which is a bit worry. It's 2.7cm when 3-5cm is optimal. But I guess i need to wait & see if I ever get past 12 weeks before worrying too much about that!!

Oh and I'd also heard about collecting mc 'tissue' yourself for testing but I think it would be quite tricky to do and also not sure if keeping it in a non-sterile environment would mess up testing. Although I've heard of people doing this on other forums, especially in America. I asked my consultant and he said I could do that but he seemed a bit negative about whether accurate results would be found. Although to be honest he seemed surprised that they found a result when they tested my 2nd mc.

Thanks for your advice though. Anymore news on your nhs appointment? Hope you get it sorted soon.

That's great news! So what's next for you now? Can you try again?
NHS appointment is 13th Nov so have accepted that I won't get the surgery until the new year which I guess isn't too far now. It's longer than I want to wait but there's not much I can do apart from getting drunk, eating all kinds of cheeses and getting more drunk whilst I wait!!

Ha I totally agree about getting drunk while we can!! I actually,weirdly, now find waiting much less stressful than trying again or being pregnant waiting for it all to go wrong. I had planned on doing loads of exercise in the meantime but that's not really happened!! 13 nov isn't too far and at least youve got a focus now & things will get moving.

I am so relieved with what they said, although bit stressed with exactly how short my cervix is!! I am now waiting for the results of my thrombophilia tests which are due mid November apparently. And then if theyre ok will try again. I think the only tests I've not had are nk cells but the consultant I saw yesterday said that I didn't really fit the nk cell 'type' as I've had one normal pregnancy and one with chromosomal abnormalities. Also I've not had the detailed clotting tests that st Mary's do but think if the thrombophilia tests are ok I'd just try again and then if it still doesn't work I'll look into more tests.

What about you - is the hysteroscopy the last step before trying again? Have you had all the tests?

Hi tea,
That must have been such a relief for you and yes, waiting is bearable compared to being pregnant or trying!!
Hope you get the result you want - never know if it's better they find something or not.
I've had a few tests - not the NK test though - all of which have come back clear and the last pregnancy was tested (a girl) but no problems were found so Im hoping once I get the scar tissue removed all will be well.
X