Laproscopy

Mrsbabyhopes

My RE wants to do a laproscopy to check for endometriosis while he is removing my uterine polyps or scar tissue with a hysteroscopy. I gather that he wants to just kill two birds with one stone. The only symptoms I have are abnormal spotting which could be caused by polyps and an inability to get pregnant within one year which also may be caused by polyps. He wants to rule out as much as possible and remove obstacles. But, a laproscopy seems like a very invasive surgery and I'm not sure it's really necessary. I'm not sure if I should ttc after the hysteroscopy and resort to the laproscopy only if we can't conceive after the hysteroscopy or if I should follow my doctor's advice. What do you think? Sorry if you read this on TTC over 35

rbtrumpet

I was actually hoping some more knowledgeable people would have answered your question, because I feel like I'm in a similar situation, but came to the opposite conclusion.

I had a shadow in my uterus during my HSG, which I would bet is a polyp (the shape looked like one, and I've had one before and know they can grow back).  My doctor is doing a sonohysterogram next month to determine if it needs to come out or not.

I have a few symptoms, and a family history, of endometriosis, so I'm actually hoping my Dr suggests doing a lap and hysteroscopy.  I'd rather just have one bigger surgery, and get everything cleaned up so we're in the best shape possible to conceive.  Surgery recovery sucks (I've had a small surgery - D&C to remove a polyp, and a larger one - ACL reconstruction with hamstring graft), and I only want to deal with recovery once.  I'm OK with the recovery taking a bit longer knowing I won't have to do it again in a few months.

rox825

I was just in your shoes, I knew I needed surgery to remove a fibroid and my RE suggested a lap at the same time to check for endo. I don't have endo symptoms but I do have a family history. I initially decided to do the lap, but as I did more research I changed my mind about a week before. The surgery comes with some risks that are probably worth it if you're pretty certain that you have endo, but I wasn't willing to take those risks yet since I've only done 2 TI cycles. My main concern was that they would go in and find no or minimal endo, but that I would then develop adhesions from surgery that would cause me to be even worse off. Someone else on the board also informed me that if they have to remove endo from an ovary, it can decrease your ovarian reserve, which impacts IVF down the road if you get to that point.

So, I decided to start by repairing my known problems and see if that makes a difference. If not, then in a few cycles with IUI if I'm still not pregnant I'll consider the lap at that point. I may regret the decision later, but it didn't feel right for me quite yet so I'm OK waiting.

Good luck with whatever you decide!

Mrsbabyhopes

Rbtrumpet: It helps just knowing other people are going through the same thing.  Having a family history of endo and symptoms does make a lap seem more beneficial.  

After my hsg today, RE  says I do not have uterine polyps, but scar tissue.  He wants to remove the scar tissue with a hysteroscopy, just the same.  But, I will have an IUD to hold my uterus together for 4 weeks.  That means no ttc for a month.  He still wants to do the lap at the same time to check for endo.  He can't say whether a lap is necessary, though.  He says he could very well get in there and find nothing. He says some women have no symptoms and extreme endo and vice versa.  I think I was told its a four hour surgery A hysteroscopy is only an hour.  I've never had surgery except for tubes in my ears when I was two and getting my wisdom teeth out.

I started crying after the hsg today.  I asked for the name of a fertility therapist.  My emotions are starting to get the best of me.

 What's strange is my HSG didn't hurt at all. I barely felt a thing.  I didn't feel any discomfort afterward either.  But, the shg did hurt pretty bad for a few seconds when he took the calipers off.  I'm feeling pretty tender and a little crampy now.

 My Mom cried a little after hearing about the laproscopy being a four hour surgery. She asked me if I was sure I wanted to go through all of this.  She started down the road of accepting a happy life with my husband without kids.  She felt it was a lot for my body.

 I'm not ready to throw in the towel, but it does give me pause about what lengths I am willing to go to. 

Mrsbabyhopes

Rox: Yeah, it really concerns me the extent that we have to consent to for a lap.  We have to put our full trust in the RE and say go ahead and take out anything you think you need to without doing any research about what we are consenting to.  Who knows what they will find in there.  I'm afraid I will wake up with a bigger problem than I went in with too.  I hear ya.  I scheduled the hysteroscopy for April 9th.  But, I'm still on the fence about the lap.

Actually, I was all ready for the hysteroscopy when I thought it was a polyp.  But, does scar tissue really do that much harm?  I guess so, if the RE says so.  But, intuitively, it just doesn't seem like it would.  I must need some time to process.

I'm inclined to go the least invasive route possible.  On the other hand, tick tock. 

rox825

That was my fear- that after the lap they would either tell me- you had endo and it was so bad that we had to remove an entire ovary and one of your tubes (extreme worst case scenario, obviously!), or that they would say they found nothing but that the surgery itself would cause adhesions that were not there to begin with.  I was literally having nightmares about the surgery and decided that I want to try IUI a few times before I move to the lap.  Maybe I do have endo or adhesions and maybe it is so bad that it's totally screwed one of my ovaries, but maybe I don't and all of my trouble was due to the fibroid- I'm just not ready to look for more trouble yet.  I might feel differently if I didn't have the fibroid and I had no other reasonable explanation for why my cycles were failing besides endo or adhesions.  Anyway, it's such a personal decision and really depends on how you feel about your situation!

Scar tissue in the uterus, adhesions, polyps, fibroids- pretty much anything that alters the inside of the uterus can prevent implantation.  The hysteroscopy is a pretty easy procedure and recovery.

Mrsbabyhopes

From what I've been reading about hysteroscopies, they cause adhesions too. Great, a surgery to remove adhesions that causes adhesions.  But, they try to prevent scarring with an IUD, stent, and/or estrogen. One resource said scarring recurs in 50% of patients with severe scarring, but only 26% of patients with moderate scarring.  I haven't researched scarring for laps yet.