Laparoscopy/hysteroscopy before FET

[orangecatmum]

Hi all,

I swear all I do right now is ask questions but this is v much where I am right now - really appreciate the guidance and support of this community.

I am in another dilemma - whether or not to have a laparoscopy and hysteroscopy between egg collection and FET.

Background - I have had horrendous, painful and heavy periods my whole adult life and then struggled with TTC. We had one pregnancy that ended in MC at 7 weeks. It has been suspected I may have endometriosis (my left ovary is behind my uterus) and I was put on a long waiting list last June for a lap/hyst specifically for 'subfertility issues'.

However, since then, it was discovered that despite all my hurdles (polycystic ovaries, thyroid issues for which I am now on levothyroxine and a gluten free diet, mild adenomyosis and vaginal microbiome issues) one of the main reasons we struggled is male factor. My partner has poor sperm motility and even worse morphology. We were told to go straight for IVF.

I have just had my first egg collection and am now waiting for our 5 embryos to be PGT-a tested for a hopeful FET in a few months.

But now - I have just heard I have finally got the laparoscopy/hyst booked in for a few weeks' time.

Do I go and get it done or is it not worth the upheaval (recovery, more days off work etc), considering we are already on the IVF path? I don't want another procedure tbh, I found the EC recovery quite tough. But then I don't want to waste the opportunity now it is there.

My IVF clinic said I don't need a lap for fertility issues... but they are happy for me to if I really want to. I think with all the many internal scans I have had maybe they would have spotted some endo if it was bad?

So my qu is - has anyone with suspected endo had a lap/hyst before an FET/IVF cycle and had positive outcomes? Is it worth me still doing it just in case?

This whole fertility game is exhausting, ha. Tired of it all now!

[Backagain987]

I personally would go for it, it took us a looong time and 7 cycles to be lucky enough to have a successful pregnancy. During that time I had a lot of hysteroscopies, miscarriage surgery, 3D SIS, 3D ultrasound and even an MRI.. long story short I found out something new about myself most times, and if all was fine at least I knew. Think of it as an MOT, checking all ok before your transfer x

[Chel91]

I would definitely go for it. So many of on here have had issues and then had to wait months and years for these procedures (and lost embryos along the way). I know a few months seems a lot right now, but it isn't much. Especially if you do have issues later you will probably kick yourself a bit. It's a great opportunity.

Also hopefully the surgery will cure your period pain which might be a nice benefit too. Mine has totally gone since the surgery. Will it be excision surgery at a specialist endo center? x

[Hidden]

personally I would go for it. I wish I had my laparoscopy at the start of treatment but fertility clinics always told me I didn’t need it, now I’m 3 failed cycles along 😞 - I saw an endo specialist yesterday who advised I go ahead, so I’ll be having the lap before my 4th round. I don’t think you have nothing to lose and those blasts will be safely frozen xx good luck with what you decide xx

[TallOne92]

I have had 3 laps and all 3 times my AMH decreased dramatically to a point where we have no choice but to use a donor now.

Of course this may not happen for you but just something else to consider/ look into.

[orangecatmum]

Thanks everyone, appreciate your input!

I'm still very torn over whether to do it - the main reason I wanted a lap was for subfertility. But since then we have found out we need IVF anyway (because of male factor issues). My IVF clinic says I can have it but that I don't need it for fertility reasons.

I'm wondering what they would find and if it would actually have any positive impact on IVF?

What a dilemma!

[Esb27]

100% go for it (in my opinion)- they can get rid of any endo they do find which will only be helpful for IVF going forward, plus if they spot anything else untoward they could sort it or at least know about it / tell you so you can plan for future treatment. The recovery time isn't too bad either, I think 6 weeks and I was back exercising etc, can't remember how long we waited TTC wise but it's really not as long as you would think! Good luck x

[orangecatmum in reply to Esb27]

Oh goodness 6 weeks?! Bless you, that's such a long time. But glad it all worked out for you.

I was upset at the idea of it being a week, ha. I am already out of exercise etc from my egg collection and desperate to get back to normality. The idea of a lap now before FET terrifies me! 😅

How will removing endo help with IVF? I'm a bit unsure about that.

[Esb27 in reply to orangecatmum]

I mean maybe you will be back to it quicker tbf!! I only allowed 6 weeks as I was worried I would push myself back if I went too hard lol.

You should be absolutely fine for your FET if your lap is in a few weeks then your FET is 2 or so months later though.

I'm not overly sure, I guess it depends where your endo is when they find it but I was always told that getting rid of endo can help with your chances with IVF as sometimes it can hinder the experience.

My consultant also gave me a 'scratch' which obvs people pay for when doing IVF to help with implantation. Maybe you could ask if yours will do that so that it helps you as I think the effects of that usually last like 3 months.

I saw you said you had polycystic ovaries, I do too!! Have you put put on anything for them? I was told I have them but then not given any meds or anything, I know you have other things wrong hence the meds but I read that and was like sh*t should I be on something for them?! I do worry that my follicles aren't expelling good eggs due to my polycystic ovaries - i've had 3 chems, 2 missed miscarriages and 2 ectopics - but so far 'everything is coming back fine' 😒

[Fruitandflowers]

Personally I would do it. I had bad endo from as soon as periods began and it took years to get to having a lap - luckily I had been on the pill by a nurse for 3mnths at a time by then as she said it had been known to help and when they got to surgery they confirmed endo, did some minor excisions but said there was no scarring and it had almost gone. I had a hysteroscopy at the same time and I've never had to have that repeated (20 years later) as my consultant said it shows any major defects and anything else like polyps etc can be seen on 3d/aquascans. I did have a lap repeated a few years back when we started TTC but that showed nothing, not even 'micro endometriosis'. It was really useful to have those results for fertility treatment as the doctors knew they could rule these out as issues. Plus it made me more confident I wasn't 'wasting' embryos due to endo or some other physical issue. Then they can also treat the endo during the lap of they find it, which is reassuring.

[orangecatmum]

Thank you - so much to consider. I'm glad it all worked out for you in the end and that it helped with fertility treatments. Really appreciate your reply!

[Batsford]

Hi Orangecatmum, I would go ahead with the laparoscopy if you can do. I had a keyhole laparoscopy last summer to remove 3 fibroids outside the uterus. When the surgeon went in he found 9 fibroids outside the uterus and also found early stage endometriosis that hadn’t shown up on any scan. He said with the amount he found and removed, it would likely make a difference to my next FET and it has done, albeit I am also on an immune protocol for the first time. I appreciate every situation is different, but all I would say is that not everything shows up on a scan and also you want your uterus in the best possible condition prior to pregnancy to maximise implantation and blood flow to the uterus. I was fully recovered within 2 weeks of the keyhole surgery. I totally understand that surgery shouldn’t be undertaken without serious thought to the risks, but all I can say is that I wish I’d done mine sooner. Best of luck.

[Mercury363]

I have a hysteroscopy before every transfer, my clinic views it as cleaning maintenance to make sure everything is ready.I would do it and then at least you won't have anything to be blaming yourself for as you know how this ivf stuff goes, you look for any little thing all the while you will be one embryo down!!

Good luck with it all! X

[orangecatmum in reply to Mercury363]

This is really interesting! Does that work for you, generally? My clinic is so opposite to this - I wish there was a more generalised opinion across all clinics/specialists so we weren't left wondering and having to advocate for ourselves. X

[Mercury363 in reply to orangecatmum]

Do you know I am not sure. If the cynical part of me talks it is that the clinic wants more money. But I have specifically asked for no hysteroscopy this time as they have never found anything and it saves me £1500 quid. They have never provided evidence as to why I need it and I said yes of course but now I am thinking differently as I am on round three of egg collection (1 successful!) but of three eggs transfered and pgta testing I was expecting my two to be complete. Ivf never works that way but I can only ever go by the info I've been given!

[orangecatmum]

Thanks so much everyone for your thoughts - it really does mean a lot, especially as you are all real-life experts in this!

I ended up speaking to one of the doctors at my IVF clinic - she told me that having the lap/hyst won't improve my chances of the FET working and nothing they find in there will mean an adjustment to how we proceed/my FET protocol. She said endo only affects egg quality. They are happy for me to proceed, though.

But I have decided I am still going to go ahead with it. I think I'd kick myself if I passed up after waiting so long and you really don't know, maybe it could end up helping in some way? If I have to do another egg collection, maybe my eggs would be better next time (this time I got 32 eggs, but only 5 embryos and the embryologist said the drop-off was more to do with egg quality than sperm.)

Thanks again for your input! <3