Follow up HSG results and question: To lap or not to lap? (OPP mentioned)

BandM14

Hi ladies. Crappy day here so far. A little background- my first HSG showed no dye spilling out of my right tube. I just went for the repeat (it's been about 3 months) and the same thing happened, so the RE said we are most likely dealing with a blockage. He suggests continuing with Femara (I am on my first medicated cycle right now) for a few months and then proceeding to IUI's before considering laparoscopic surgery.

Of course, no part of me wants to go through any surgical procedure, but the thought of not knowing WHAT the cause of the blocked tube is is bothering me. From what I've read, tubes just don't block themselves for no reason. I have no history of STI's (other than HPV) or any other cause for scarring, so part of me is really wondering if I have endometriosis. If I do, I'm worried that even if I ovulate on the "good" side the endo will make it difficult to conceive... obviously we have been trying for over a year and I'm sure I've O'd on my left at least a few times.

I'm feeling unsure of what to do. Is it worth going through medicated cycles and IUI's with potential endo or other cause for blocked tubes? On the other hand, is it worth going through surgery to determine the cause (and potentially remove endo) if I might be able to get pregnant without doing that?

Would love to hear from any of you who have had a laparoscopy, or who have blocked tube(s), or who have decided to hold off on a lap while doing some medicated cycles. Or anyone who just wants to throw in their $.02!

Also, I just got home from work to find an invitation for a friend's baby shower in the mailbox. Sigh.

ronniesgirl1981

Do you have any insurance for IF? Not all REs agree on this, but mine isn't a fan of the lap unless there is pain. He feels that it doesn't increase the IVF success rates if IUIs don't work. However, if the IUIs don't work (which I'd be willing to try...they are easy) and your insurance covers the lap but not IVF, then I'd be more inclined to try the lap. Good luck with whatever you choice!

dancerspose

My HSG showed a blocked right tube as well.  I have no history of STIs nor do I have any traditional symptoms of endometriosis (although I do know it's possible to have it without symptoms).  I have no insurance coverage for IF treatment, but my insurance covers all diagnostics.  The lap would be considered diagnostic since they don't know what's causing the blockage.  My RE told me it was up to me if I wanted to go ahead and try a few medicated cycles without doing the surgery.  Since we're 100% out of pocket for that, DH and I decided I would go ahead with surgery.  We figure if we're going to pay for treatment we might as well give ourselves the best possible chances.  Especially since a little dye did go into my right tube, just didn't spill out, there would be possibility of an ectopic pregnancy if I did ovulate on that side.

My sono also showed a polyp and slightly abnormal lining in my uterus as well.  So again, the thought process was might as well do everything my insurance does cover, hopefully come out with squeaky clean reproductive organs, and have better chances when we go to medicated cycles.

Now, all that being said, I haven't actually had my surgery yet.  It's scheduled for 11/6.

So, in a nutshell I'd say if the procedure is covered but you're OOP for treatment I'd consider doing it.  That's just my 2 cents.

Good luck!

BunnyBerry

I can only speak from my own experience - I was so happy the RE postponed treatment so I could have a lap because he found and treated endo and adhesions, and he said it makes a big difference in success rates. He said that until recently, all IF women got exploratory laps as a matter of course. Now, they've found it's only worth it on average if there is an extra risk factor for endo. I guess I would ask your RE how much of a risk factor a blocked tube is for endo? I would want the best chances possible even for IUIs, so you know if they fail that you really do need IVF. My lap was not bad, pain and nausea for a few days and then tenderness/pain for a few weeks.

BookishMomma

My 2 cents: I have a 1cm cyst on one of my ovaries that my RE suspects as endo. He advises "wait and watch" instead of surgery. I'm 35 and he is concerned about messing around with the ovary, in terms of ovarian reserve. I am scheduled to do IUI with Femara & trigger next month & my RE isn't too concerned about the cyst. Sorry you're dealing with this.

Eta: one of my Dx's is recurrent pregnancy loss, so I'm not sure how much that plays into my RE's advice.

molly84

Hey there! I actually had a lap done in August to remove stage 2 endo and some polyps. I'm still not prego, but to me, the surgery was worth it because my periods aren't as heavy or painful. I hope this isn't tmi, but my periods were awful as far as huge clots and just ridiculously heavy. Now they aren't bad at all. The recovery was fairly easy too. So I guess I would do it again just to make those issues better, but that's just me. That's just me 2 cents!

BandM14

Thanks so much for all of the responses, ladies. Like @shafwilson, I don't have any traditional symptoms of endo... I have pain the first day of my period that I have to take Advil for or it's pretty bad, but I don't think that qualifies based on all of the horror stories I've read. But, I can't help thinking that must be the cause. It just sucks knowing that something is wrong but not being able to know what it is without going through surgery.

Like @ronniesgirl1981, my RE doesn't seem to be a big fan of the procedure. After the first HSG showed a potential blockage he wanted to wait a few months before repeating it and said that he wouldn't feel comfortable operating on me until we had tried a few medicated cycles. I'm sure if I pushed for it, he would agree sooner, but his resistance makes me question whether it's necessary. What he told me over the phone was that success rates after the procedure vary immensely, and that it's pointless to do the surgery if there is still a chance of me getting pregnant without it.

I'm 27, so there isn't a big concern with my age at this point. My insurance covers all testing and treatment up to IUI's, but will not cover IVF. So money isn't an issue between the lap and continued treatment/IUI's, but what IS an issue is my sanity. I'm not sure if I can deal with a bunch of pointless IUI's to then find out that I have severe endo and IVF is the best bet.

I do also think there's part of me that is scared of the surgery part. I've never gone under general anesthesia for anything, and the whole thing freaks me out a bit. But I'm trying not to let that be a factor in my decision.

As you can probably tell, I'm still undecided about what to do. But I so appreciate the feedback. I'm going to keep reading up on it, reading your responses, and talk to MH about what he thinks is best. Maybe the Femara and TI will work this cycle and we won't have to worry about it, but I'm not feeling very hopeful about that.

BandM14

Thanks @rainbowbridge14! I actually just messaged a good friend of mine who lives out of state, her boyfriend is an RE and she has told me before if I have any questions I can run them by him. A counselor is a good idea. That's my job, but it's hard to be a therapist when you're going through your own stuff!! Maybe seeing someone myself would help me to process all of this. I see some signs of depression in myself lately, which is scary but understandable I think given the new IF diagnosis and starting the treatment process. Thanks for your hugs

ETA: Also, I just youtubed laparoscopy for endometriosis. Turns out that was a bad idea. 

mshandlebar

Your situation sounds pretty similar to mine, well sort of. My HSG also showed that my right tube is blocked. My dr. isn't very concerned about it, she actually never even brought up surgery to clear the blockage. I'm on my second IUI now, and because I am a worrier, I constantly obsess over whether my tube is going to turn out to be a issue. Despite, persistent pestering, my dr. assures me that there is no reason at the moment to think that it is. Most everything is OOP for us, so all tests and procedures have to be juggled based on finances, which totally sucks.

If it is going to drive you crazy, it might not be a bad idea to get things cleared up before proceeding, especially if it is covered. On the other hand, if it isn't endo my impression is that a blocked tube isn't an insurmountable obstacle to pregnancy. Good luck!

vlevitt

i was diagnosed with "unexplained infertility" after an HSG and about a million blood tests showed absolutely nothing wrong with me or DH.  I chose to do the lap before trying any fertility treatments because i wanted to have all the information in front of me before trying treatments.  If it makes you feel any better, they did use general anaesthetic, but the entire procedure takes about 15 minutes plus about 1.5 hours of recovery in hospital, max.  the recovery from the surgery was pretty quick, and, as invasive procedures go, this one was pretty low-key.  my lap showed nothing, btw, but i was still glad i had it done.  i live in Canada so didn't have to worry about insurance or payment concerns, so i can't speak to that part of the decision making.

BandM14

@mshandlebar It does sound like our situations are similar, and I can totally relate to the worrying about it. There is something unsettling about not knowing *what* is blocking it. My RE told me that one blocked tube only reduces your yearly pregnancy rates by 7%, which I find shocking TBH. I wonder if that is referring to a blocked tube NOT caused by endo. It's the possibility of having endo all over that is stressing me out, because that might mean that even if I ovulate on the left the endo could interfere with conception. But I guess I need to either suck it up and get the lap surgery, or accept the "not knowing" part and move forward with treatments. I hope this IUI is it for you!!

mshandlebar

@BandM14 I don't know that much about endo, but is there another way to DX it. That way you could answer the endo question before having to do the surgery. If it isn't endo (which I hope it isn't) then it might be easier for you to move forward. Sending all sorts of happy thoughts your way.

BandM14

@mshandlebar Unfortunately lap surgery is the only way to accurately assess for/diagnose endometriosis (correct me if I'm wrong, ladies). Thanks for the happy thoughts, I really appreciate it!

Radiantly

Loving this thread! I'm in a similar boat. No symptoms of typical endo (Periods aren't too bad, usually day 1 I take Advil to relieve mild cramping & lower back uncomfort and general body aching.)  

I have Right side full blockage (HSG) and also 1.8cm endometrioma on R ovary.  The HSG technician said the blockage was close to the uterus rather than the ovary which is a good thing. 

Since my HSG in July I've been using pads and only tampon overnight on day 1 or 2 when I worry about bleeding off the edge since I sleep in weird positions.  I've heard using pads b/c it's better to help flow... (and about to buy organic b/c the plastic coating on the non-organic ones can actually leech plastic dioxins into our soft tissue down there. Novel idea but makes sense!) 

I'm 37 as of 2 weeks ago. My RE said that a)I have good eggs/lots of them, and b) he recommends doing the lap since the endometrioma is likely meaning there is endometriosis in the whole system.  He said after lap he would go to IVF and skip IUI, better chances and I have a 15K max for procedures so IVF is a higher chance of success than spending $ on IUIs.

I want to wait on the surgery until I'm through another couple months of busy season for work, and also to try some natural ways to change my flora and hormone levels... I've posted a few times on other threads but in case you haven't read my posts, I've been seeing acupuncturist and chiropractor. The acu is working on blood flow, and the chiro did further testing - blood showed very low vitamin D, and chronic inflammation.  

I also did a cortisol test (involving paying $116 OOP for a little kit that had 4 vials where I had to spit into them at waking, lunch, mid-afternoon and bedtime) showing I was running low on cortisol. That is created by adrenal gland, which also is involves/affects ALL hormones.  I believe in funtional medicine, in treating the SOURCE of the problem. From what I have read on the googs, there is no consensus among medical community on what causes endometriosis.  I worry that if I had the lap, it will kick my stress levels up for healing from the surgery trauma, and the endo will just pop back in.  

So I'm on a regimen of: mulitvitamin, vitamin D, calcium, magnesium, "adrenal blend" (various roots & herbs), fish oil (both a pill and in refrigerated fermented cod liver & skate liver oil by Green Pastures.  Plus drops on my tongue 3xday of DHEA and prognenalone.  The way my chiro put it was that it will set a cast around my hormonal dance system, and I'll be able to strengthen from within.

My plan: In early December I'll go back to RE and request another HSG and a look at my endometrioma. With luck it will be clear (or I'll be pregnant by then) and we'll go from there. But I'm mentally prepared to do lap in late Dec/Jan.