Laparoscopy or not

sherrimspires · April 2014

I had my first IUI 4/1 and bfn yesterday. Met with RE today who said a few things that I'm having a difficult time processing.
First- I have a cyst. I go back Monday because he's under the assumption it will go away on its on and I could then start my next IUI cycles
Second- he mentioned laparoscopy. He didn't say I needed it and said "I'm just offering it." He mentioned I had a 70% chance that if I had it done, everything would be fine. He said he wouldn't offer it again because he will only do 3 super ovulation IUI cycles with me.
I'm beyond frustrated the IUI didn't work. Now I'm frustrated bc I don't know if I need this surgery or if it's worth it. It appears he is learning more towards thinking my issue is strictly ovulatory and nothing else.
Any feedback or advice would be great

airidh80 · April 2014

*lurker coming out of hiding*

As someone who's had 3 laparoscopies and 1 laparotomy for serious cysts and severe endometriosis, I would NEVER do a laparoscopy "just because." Abdominal surgery almost always causes scar tissue to form, and that could very easily make your situation worse. Now, plenty of people have no ill effects from their scar tissue, but with the odds your surgeon gave you - ie, that there's a 70% chance everything is fine in there - it just doesn't seem worth that risk (in my personal opinion). That said, there have certainly been women who've gone into exploratory laparoscopies having been assured that everything is probably fine, and the surgeon ended up finding asymptomatic Stage IV endo. But personally, I wouldn't do the surgery at this time, unless given MUCH stronger reasons.

Costs: Costs for a laparoscopy will vary wildly from hospital to hospital. Mine were anywhere from 15-25k (covered by insurance). If your RE does the surgery and bills it as fertility-related, then yes, you must have Fertility benefits or it won't be covered. But often they can code it as a basic gynecological procedure. Just make sure you know EXACTLY what you're getting into, code-wise, before you do it.

Just my opinion

Best of luck to you!

EDIT: Oh, and don't fret about the cyst. They suck, but almost all cysts self-resolve and are NBD. They just need to be watched, which your RE is doing.

sherrimspires · April 2014

FINEdoubleLINE said:

We might need a little more information. What would he be looking for? Why does he feel it is indicated in your case?

That's just the problem- the way he talked, he indicated he would find nothing worth $15-25k. My HSG was clear and I have never had any signs of endometriosis. He said my ovaries "look like they've probably had cysts" and that he thinks I an an ovulating issues- and an issue at times with amenorrhea.
My husband asked if it was necessary and he said it was offer and that some people he doesn't give them the option to say no.
ugh- why can't doctors just be more straightforward? and why can't my ovaries just do what they are supposed to do?

Milagros315 · April 2014

I think that's it's really weird that he would offer it "just because". Do you have or have you ever had any symptoms of endometriosis? And I really don't know what he meant about having a 70% chance that everything would be fine. That you would be cured of infertility? If so, I think that's absolute BS. In fact, most of the data that I have seen indicates that surgery doesn't really do much to improve fertility rates, except in more severe endo cases (and even then you are still very far from "fine").

I would absolutely get more information and do your own research regarding laparoscopy because I don't feel like I would trust what your doctor is telling you.

@CaterinaC - I do no have any IF coverage, but my surgery was covered by my insurance. My RE coded it as gynecological/diagnostic since it is a surgery that I would have needed whether I was TTC or not.

ky29 · April 2014

I thought about a lap because of a family history. However, my RE foes not like to do surgery just because. In all my ultrasounds and scans he hasn't seen anything that would make him want to do a lap. (If I was having endo symptoms he would do it to help those, but if not there's no enough of a benefit) He said if I was his daughter, he wouldn't do it. But that just my REs opinion and he may be more conservative.

athlete010688 · April 2014

I had a Lap last month because my HSG showed something could be up with one of my tubes. He said the only way to know for sure was to do a lap. He also checked for Endo while in there, which I did have some minor endo and he removed it.

Total cost billed was about $17k (before plan discounts). I was responsible for about $2500. I had already met my deductible and was only responsible for 20% of the charges My insurance covers testing and diagnostic, so I'm not sure what it would have been if I didn't have that on my insurance.

CandaceC1020 · April 2014

I wouldn't do it. I've had two laps for endometriosis. Each time I've had the surgery, the endometriosis has been lasered and burned away. I'm scared to even think about how much scar tissue is in my uterus, on my cervix and on my fallopian tubes. Scar tissue can hinder your efforts to get pregant. I recently had a hysteroscopy to remove an adhesion/scar tissue bundle that was next to my fallopian tube and was the size of a pea.

It makes no sense that your doctor would offer a lap just because ... especially after your first IUI. My doctor flat out told me that it could take 3,4,5 or more IUI's to get pregnant.

sherrimspires · April 2014

Thanks all for the feedback. He mentioned there is a slight possibility that precious cysts might have left a little scar tissue- or something. But that it didn't appear as if I had any issues with that. That's why I was so confused. at this point, I'm wondering if it's bc he wants to be on vacation this next week and doesn't want to deal with me. He's coming in only for a few select clients- me being one. to my knowledge, I have no indications that I have any endometriosis- but from my understanding- you could have it and never know. I don't know if thinks this might be related to my infertility.

I will say, I had a consult with and RE who is a family friend and out of state. He said that by talking to me, he would say I have an ovulatory issue related to my hypothalamus- especially since I didn't respond well to clomid, provera, or oral prometrium. My RE was able to get me to ovulate, however I ended up with only 1 mature after high doses of follistim. (20mm, 14mm, 9mm, 9mm, 8mm, 7mm and numerous small). My RE said once the cyst goes down, we will start the next round, if I don't select surgery, and he will use higher doses initially because he wants 3-4 mature.

I guess I will wait to see how the cyst is on Monday and try to get more answers out of him. He believes I won't even begin to develop any follicles bc in the past, I don't ovulate on my own... Hoping that remains true so that I won't have to wait another month or more to start the injections.

Sami14vb · April 2014

I had 1 laparoscopy a couple of years ago before TTC. I had been having a lot of pain and menstruation issues. Basically I was on my period for like 2 months straight. The other reason I wanted to do it is because I wanted to see what was going on with my reproductive system, and give my husband a heads up to any issues before we got married. I wanted him to fully know what he was getting in to and give him a way out. Well, the procedure itself was very simple, and I have a small little scar on my stomach. The doctor said he found a tiny piece of scar tissue but that it was normal and every thing was fine. I specifically asked him if I had endometriosis, and he said that I didn't. Fast forward a couple of years to my first RE appointment, and my RE says well I see you had a laparoscopy which shows you have mild endometriosis. What?! The doctor never told me that! I specifically asked if I had it and he said no! I asked my RE if I could have another laparoscopy to get rid of any other scar tissue that built up, and I was told that they wouldn't do it because research shows that a laparoscopy is only effective one time. Who knows? So for me, the laparoscopy was basically point less. At first I was happy that it gave me the piece of mind that everything was ok, but nope, that wasn't even true. The only thing that did come out of it is that now I know I have endometriosis.

BunnyBerry · April 2014

Ugh sounds like your dr just doesn't want to take responsibility for his advice to you and is leaving it on you, giving himself an out either way. Do you think it's possible to ask him for more detailed information on his reasoning and get his advice?

sherrimspires · April 2014

I think I've decided not to go with the surgery after reading and asking a nurse friend (who had the lap and went on to conceive with IUI). My plan is to try again and hope for better follicle result. If it doesn't work this time, I will reconsider. I would definitely have the lap before I ever went to IVF.
from what I understand, even having the lap and removing any scar tissue- if I had any- could just lead to more scar tissue? Is that accurate?
thanks for the overwhelming feedback on this. I am slight irritated with RE for not being more direct. Did talk with DH who asked the RE directly about it- apparently RE said that if he really thought I needed it then he wouldn't give me an option not to. Well- then why bring it up? Can't you tell I'm a hormonal mess?

airidh80 · April 2014

sherrimspires said:

I would definitely have the lap before I ever went to IVF.
from what I understand, even having the lap and removing any scar tissue- if I had any- could just lead to more scar tissue? Is that accurate?

***Stuck in quote box***

Yes, this is exactly how scar tissue in the abdominal cavity works. You take it out, and more forms. The first surgery I ever did was exploratory, and honestly, if I could go back in time, I'd refuse the procedure. Scar tissue has made my life miserable, and blocked my tubes.

kdchrisman20 · April 2014

I would talk to your regular gynecologist and get a second RE opinion. I had a fibroid blocking my left tube (found during HSG) and it was easily removed without a lap. Lap is serious surgery and unless you really need it I would not pursue.

sherrimspires · April 2014

thanks, Ladies. I have an appointment with RE in the morning to see if the cyst has gone down. If it has and follicles haven't started, we will begin injections.

Question: He said if follicles have begun, then he wouldn't start the injections. Does this sound right? I have been under the assumption that my follicles do not grow like they should- i.e. on clomid 100mg at day 14 they were only 9mm. I assumed even if I had a tiny few, they should be able to start the injections to get some to grow faster? I'm kind of confused about this.

I feel silly because when I'm sitting there with RE, I have a difficult time asking any questions, and when I do, I don't completely understand what the doctor is saying.

I plan to also ask him about the laparoscopy & ask what he would suggest if I were his wife or daughter.

Also- has anyone else's RE said only 3 IUI? I was under the assumption when we started that he would do more- now I'm concerned.

Either way, I'm just praying for a better appointment all together- with no tears or bad news.

Want a personalized experience?

Laparoscopy or not

Re: Laparoscopy or not

Choose Another Board

Search Boards