Is a 3D SIS scan enough to check for uterine scarring or adhesions?

[Mudra85]

Hi all,

I'm about to undergo a second IVF cycle and I'm trying to ensure we've covered all bases before doing another transfer. We're doing IVF with PGT-A and PGT-M (to avoid passing on a genetic condition I carry). My first and only FET in 2021 of a good quality euploid blast ended in a chemical pregnancy. I also had a TMFR (baby had the genetic condition we do not want to pass on) of a 20 week natural pregnancy back in 2020. This involved me having a Dilation and Evacuation surgery. I'm now concerned about the possibility of having uterine scarring or adhesions, given that having this surgery puts me at increased risk for this. I had a 3D SIS scan at my old clinic in 2021 which confirmed a normal uterine cavity. However, my new clinic has suggested I have a hysteroscopy, which is very expensive alongside everything else we're having done.

I'm wondering whether it would be enough to have another 3D SIS scan to double check for scarring/ adhesions? Does anyone know whether a 3D SIS scan would accurately and reliably detect these things?

Any advice or experiences anyone could share would be very gratefully received, thank you!

[Hidden]

Hi, I am sorry for your terrible experiences so far.

I am not a medical professional but in my opinion I don't think a 3Dsis would be enough to show adhesions. Really they are just pumping the uterus full of saline to see if any strange lumps or bumps stand out. As I understand it scarring can be quite small and wouldn't necessarily be seen via ultrasound.

The risk of scarring after D&C is low. I have had 4 now and its been confirmed by hysteroscopy that I don't have any scarring.

However if you are really worried I think your best bet would be a hysteroscopy

Good luck x

[Mudra85 in reply to Hidden]

Thanks Hidden , really helpful to hear your opinion and it sounds like you've been through a pretty hard time yourself. I'm mainly worried because I had my surgery quite far into the second trimester and the risk of scarring can apparently be greater when done in the second trimester. I didn't have any complications or issues afterwards, but I'm just worried about doing more transfers without checking again. I'm definitely going to raise it with my doctor when I speak to her next and if she's adamant that a hysteroscopy is the way to go then we'll do it.

[Hidden in reply to Mudra85]

The only other thing I forgot to add was that once I had had my 3Dsis I was then referred for more investigations (in my case it was fibroids) as it wasn't conclusive, I ended up having an MRI.. so again it might just be a sort of delay to a hysterscopy anyway if you see what I mean. Heaps of luck whatever you decide xx

[Mudra85 in reply to Hidden]

Thanks Daisy. Much appreciated and all the very best to you! Xx

[Skittles11]

Hiya. I have been wondering about hysteroscopy myself having also had a TFMR two months ago. I'm so sorry that you too have had one, it is extremely traumatic and such a cruel outcome.

I wasn't sure what the usual advice is in these circumstances. My clinic have said nothing about me having a hysteroscopy, it is only through my own reading that I learnt it may be useful if there was potential scarring.

Sorry that is not much help at all. Xx

[Mudra85 in reply to Skittles11]

Hi Skittles, thanks for your response! I'm so sorry for your recent loss. It's incredibly traumatic and I'm so sorry you had to experience it too!

From what I've read hysteroscopy is the gold standard for checking if there's scarring and adhesions. A 3d SIS scan can also detect scarring in many cases, but appears to be less reliable. If something is seen on a 3d SIS scan that needs further investigation then usually the next step will be to have a hysterocopy. I'd rather avoid a hysterocopy (due to cost) but I may end up biting the bullet as I'd rather have the peace of mind.

I think when you've gone through the trauma of a TMFR, or any loss for that matter, it's difficult to think there won't be more problems along the way.

All the best to you and I hope you have lots of support around you Xx

[Pos1tivelybaby]

Hi Mudra85, I’m so sorry for your loss. I can’t say which of the two is more reliable as I’ve had both with conflicting information with both procedures.

I had a miscarriage in July 2020 and before my first ivf cycle in May 2021, I had a hysteroscopy which showed my uterine cavity was fine. I changed clinics for my next cycle and they recommended having a 3D SIS which showed I had some fresh scarring, most likely from my D&C in July 2020.

We’ve decided to go down the donor egg route in Spain and my clinic would like to have another hysteroscopy. A bit confused about which is reliable but I’d like to get some answers.

I’ll keep you posted on what the outcome is and watch the replies to your question with interest x

[Mudra85 in reply to Pos1tivelybaby]

Hi Pos1tivelybaby thank you and I'm so sorry for your loss too. Your timeline of events sounds very similar to mine.

It's interesting that you had a normal hysteroscopy followed by a 3D SIS which showed scarring. The impression I get is that it depends on the doctor who does the procedure. A doctor with a lot of experience in identifying scarring and adhesions may be able to spot things that another doctor may miss.

We are also preparing to go to Spain for IVF and our clinic in Spain also suggested a hysteroscopy after I told them I wanted to be sure I had no uterine scarring or adhesions. However, the more I read it does seem like scarring can often be seen on a 3D SIS, so what I'm thinking is that it may be worth me looking to have another 3D SIS but this time with an consultant that specialises in this area. I think that would give me the piece of mind I need.

I'd be really interested to hear how things go for you and if you can update on here then that'd be very helpful (although no worries if you can't).

I hope everything goes well for you in Spain! x

[Pos1tivelybaby in reply to Mudra85]

Please let’s keep each other updated. Feel free to PM me if you like. Good luck with Spain, keeping everything crossed for you x

[Mudra85 in reply to Pos1tivelybaby]

Thank you! Please also feel free to PM me. Wishing you all the very best! X

[Eternalwarrior]

Hello lovely.

I am so so sorry for your loss and for your very hard journey. I have had 5 miscarriages but after I lost my baby boy at nearly 18 weeks, I was told that when there is a late pregnancy loss, the uterus can be affected. My experience was also a bit traumatic because there was no heart beat but baby didn't want to come out and they had to induce me, which I found really hard, as it was a long process. I then had retained placenta and needed to have another procedure for that.

I never had a 3D SIS before, so I cannot advise on that, but I had a 3D ultrasound. They couldn't see anything major, but my fertility clinic advised me to do a hysteroscopy, which I am very glad I did. That showed I had a T-shaped uterus and needed to have surgery for that too. I have adenomyosis now and they think it was because of my second trimester loss. I also had an MRI.

I know every test is an extra cost, so it is difficult to decide sometimes. I had my hysteroscopy privately in Spain, which was cheaper than in the UK, but I have got a friend who managed to have her hysteroscopy free on the NHS. I am not sure that is something you could have a look at?

I hope everything goes well for you in Spain! My clinic is there and I am so happy with them. Please feel free to PM too if there is anything I can help you with. xx

[Mudra85 in reply to Eternalwarrior]

Thanks Eternalwarrior it sounds like you've also had a terrible time of it. I'm so sorry for everything you've had to go through. You truly are a warrior.

If you don't mind me asking, did you do your hysteroscopy with your clinic in Spain? Also, how much did it cost you? I have considered having the procedure at my clinic in Spain instead of the UK as I've heard it can be quite a bit cheaper but I've seen varying costs.

Unfortunately I think it'd be quite difficult for me to get a hysteroscopy on the NHS as there's no indication for me to have it other than my own piece of mind. We're having IVF only to avoid to passing on a genetic condition I'm a carrier for, so I don't think I'd be able to use fertility issues as a reason for this. We have also considered having a hysteroscopy with private work insurance, but we'd have the same issue in that it would be deemed unnecessary.

I have now contacted a consultant that specialises in uterine scarring. I know he often uses a 3D SIS scan to diagnose scarring and I think I'd like to at least get a second opinion from someone who specialises in that area.

I wish you every success in Spain. I'm also very happy with my clinic in Spain. It feels like things have moved so much faster for us and we're having more testing done at less cost.

Xx

[Eternalwarrior]

Thank you, lovely! Yes, I did my hysteroscopy in Spain. They had different prices depending on the type of hysteroscopy, whether it was just diagnostic or surgical and the complexity of the surgery as well. We are not allowed to give names of private clinics, but I will send you a PM.

I think you asking for a second opinion is a great idea and I hope this new consultant who is a specialist in uterine scarring can help you!

I feel the same as you, we have had more tests done in Spain and at a less cost, even if we had to fly out and pay for accommodation. Every little helps as IVF is so expensive.

Take care xx

[Pos1tivelybaby in reply to Eternalwarrior]

Hi, sorry to jump in on your reply. Please could you also PM the details of your clinic? Thanks x

[Eternalwarrior in reply to Pos1tivelybaby]

I have just sent you a PM x