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Investigative Laparoscopy with Unexplained Infertility?

Has anyone had an Investigative Laparoscopy for unexplained infertility? I have had 1TI cycle with Clomid/Ovidrel and 2 IUIs (one with injectibles) and all BFN. My HSG is clear, and no history of Endo, although I have had my appendix and gallbladder removed, so my RE wonders if there may be scarring/adhesions/damage to an ovary. She has recommended a Lap or moving on to IVF (which would bypass any endo/adhesion/tube issues).  Just curious on other's thoughts and experiences. I don't want to waste time/money with a Lap, when we may end up needing IVF anyways, but I have read that a lot of people become "explained" after a lap procedure. It would be nice if we find the problem and could address since I would like more than 1 child eventually.
History in Spoiler

Age: 32 (same with DH). Together since 2006, Married June 2013 and TTC since August 2015
Diagnosis: Mild Endo, DOR (AMH of 1.5), Poor Quality Eggs/embryos, Displaced Window of Implantation (ERA Post Receptive)
March-May 2016: 1 TI and 2 IUIs- BFN 
June 2016- Laproscopy- found/removed mild endo and confirmed only 1 normal healthy ovary.
August 2016- IVF #1 with Antagonist Protocol- Cancelled (2 lead follies), converted to IUI- BFN
Oct-Nov 2016- IVF #2 with Estrogen Priming Micro Lupron Protocol, 2 eggs retrieved, day 3 transfer of 1- BFN
January 2017- New RE, IVF#3 with Estrogen Priming Antagonist Protocol, 12 eggs, 8 mature, 6 fertilized, 2 day 5 early blasts transferred (none to freeze :(), BFN
May 2017- Sept 2017- Starting Donor Egg process! Waiting for donor to be available... and then she is pregnant at baseline :(
Oct 2017- Donor #2: 25R, 22M,18F, 12 blasts frozen! Fresh transfer cancelled due to thin lining with fluid :(
Nov 2017- Hysterscopy to remove polyp
Dec 2017- DE FET #1 on 12/8 on 2 perfect blasts- BFN and devastated
Jan-Mar 2018- ERA #1- Post receptive by 24 hours, ERA #2 RECEPTIVE with 4 days of Progesterone
Apr 2018- DE FET cancelled for lining issues :(
Jun 2018- DE FET #2 of two 1AA blasts- first BFP ever! Beta 10dp5dt- 378, Beta 14dp5dt- 2840, Beta 16dp5dt- 4035, beta 18dp5dt- 10916. Due on 2/20 with one baby after a vanishing twin
Baby Born born early @ 33.5 weeks due to Pre-e
Back for # 2!

Re: Investigative Laparoscopy with Unexplained Infertility?

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    SanBLSanBL member
    If she find scarring/adhesions/damage to an ovary, will she be able to fix it? It seems like often, even if they find an issue, they can't correct it or not 100%. So most women has to do IVF anyway... 

    I know that sometime they find endo even if you don't have any symptoms. They can remove it, but it come back, so often those women have to do ivf anyway. 

    That's just my opinion, sometime it can work too! I guess it depends how much it is too.
  • Options
    Hello, I just had this done two months ago. And had both gallbladder and appendix removed. There was scar tissue for me and endo. (Which she removed). I am supposed to be "good to go" now but I haven't been able to get a period and am back on hormone theropy. I hope all goes well with you and wish you the best. 
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    I just had one done 3 weeks ago.  I had already had gone through IVF with BFNs. We knew I had blocked tubes from my HSG which is why we tried IVF first.  I'm so glad I had the lap done bc not only were they able to unblock my tubes, they found tons of scar tissue which had closed off my cervix, they found my uterus in a "frozen" state and the I have PCOS.  Ultimately I was not in an optimal state to carry a child even if the IVF had worked.  I may have to end up with IVF again bc of my PCOS and DH MFI but for the next 3 months we get to just try like an average couple!

    Good luck with whatever you decide.  This is such a hard process for all of us.
  • Options
    *BFP mentioned*
    After a few unsuccesful Femara+ TI cycles, my RE felt like something was up with the shape of my uterus, and suspected endo (I had also had my gallbladder removed a few months prior, and according to the surgeon, it was stuck in a lot of 'inflammatory tissue', and many subtle symptoms I had were very cyclical). He did a transvaginal endoscopy to see whether a lap was indicated, and turns out he found a massive amount of endo which in no way correlated with the extent of the symptoms I had. He removed endo from just about everywhere in my abdomen, all the way to my liver and diaphragm. Our plan was to do two injectibles and IUI cycles before moving on to IVF. We were lucky and our first cycle was successful, and our little boy is 4 weeks old today. 
  • Options
    Ladies- thanks for sharing. I really appreciate your thoughts and advice. Glad to know that for each of you having the lap removed some problems and put you in a better position to get pregnant hopefully. I'm trying to talk to my doctor today, as it was just the nursing assistant who called yesterday to give me my options. I appreciate that the RE is letting me decide the path, but I still want to talk to her and she if she has a reco. I'll let you know what path we decide to do!
    History in Spoiler

    Age: 32 (same with DH). Together since 2006, Married June 2013 and TTC since August 2015
    Diagnosis: Mild Endo, DOR (AMH of 1.5), Poor Quality Eggs/embryos, Displaced Window of Implantation (ERA Post Receptive)
    March-May 2016: 1 TI and 2 IUIs- BFN 
    June 2016- Laproscopy- found/removed mild endo and confirmed only 1 normal healthy ovary.
    August 2016- IVF #1 with Antagonist Protocol- Cancelled (2 lead follies), converted to IUI- BFN
    Oct-Nov 2016- IVF #2 with Estrogen Priming Micro Lupron Protocol, 2 eggs retrieved, day 3 transfer of 1- BFN
    January 2017- New RE, IVF#3 with Estrogen Priming Antagonist Protocol, 12 eggs, 8 mature, 6 fertilized, 2 day 5 early blasts transferred (none to freeze :(), BFN
    May 2017- Sept 2017- Starting Donor Egg process! Waiting for donor to be available... and then she is pregnant at baseline :(
    Oct 2017- Donor #2: 25R, 22M,18F, 12 blasts frozen! Fresh transfer cancelled due to thin lining with fluid :(
    Nov 2017- Hysterscopy to remove polyp
    Dec 2017- DE FET #1 on 12/8 on 2 perfect blasts- BFN and devastated
    Jan-Mar 2018- ERA #1- Post receptive by 24 hours, ERA #2 RECEPTIVE with 4 days of Progesterone
    Apr 2018- DE FET cancelled for lining issues :(
    Jun 2018- DE FET #2 of two 1AA blasts- first BFP ever! Beta 10dp5dt- 378, Beta 14dp5dt- 2840, Beta 16dp5dt- 4035, beta 18dp5dt- 10916. Due on 2/20 with one baby after a vanishing twin
    Baby Born born early @ 33.5 weeks due to Pre-e
    Back for # 2!
  • Options
    DH and I are know waiting to start our first IVF cycle, and from my HSG, my RE saw that my uterus was a little heart-shaped, so she had me get an MRI to see if there was any extra tissue or issues, rather than do investigative surgery. MRI came up negative. That might be an option, so you won't waste time with surgery, especially if they find nothing wrong...
  • Options
    @caseyw8784- that's interesting! My RE didn't offer that as an option. Glad yours came back fine!

    my RE actually texted and called me today and we talked for 30 mins about our options. She reco doing the lap, bc if she does find something like endo, removing it will better improve our odds in IVF. She says it's also coded as major medical and I confirmed then it won't go against my life time max for infertility. So we decided to move forward with the lap in the next few weeks. If it comes back all good, then on to IVF. If there's an issue, then hopefully fix it and go from there.

    where my RE does IVF, the labs don't take my insurance. So if we move to IVF I need a new RE, which is a bummer since I like her a lot. Does anyone have a good website or advice for researching IVF clinics? I know you can't just rely on the SART results... So just not sure how to decide which one would be best.
    History in Spoiler

    Age: 32 (same with DH). Together since 2006, Married June 2013 and TTC since August 2015
    Diagnosis: Mild Endo, DOR (AMH of 1.5), Poor Quality Eggs/embryos, Displaced Window of Implantation (ERA Post Receptive)
    March-May 2016: 1 TI and 2 IUIs- BFN 
    June 2016- Laproscopy- found/removed mild endo and confirmed only 1 normal healthy ovary.
    August 2016- IVF #1 with Antagonist Protocol- Cancelled (2 lead follies), converted to IUI- BFN
    Oct-Nov 2016- IVF #2 with Estrogen Priming Micro Lupron Protocol, 2 eggs retrieved, day 3 transfer of 1- BFN
    January 2017- New RE, IVF#3 with Estrogen Priming Antagonist Protocol, 12 eggs, 8 mature, 6 fertilized, 2 day 5 early blasts transferred (none to freeze :(), BFN
    May 2017- Sept 2017- Starting Donor Egg process! Waiting for donor to be available... and then she is pregnant at baseline :(
    Oct 2017- Donor #2: 25R, 22M,18F, 12 blasts frozen! Fresh transfer cancelled due to thin lining with fluid :(
    Nov 2017- Hysterscopy to remove polyp
    Dec 2017- DE FET #1 on 12/8 on 2 perfect blasts- BFN and devastated
    Jan-Mar 2018- ERA #1- Post receptive by 24 hours, ERA #2 RECEPTIVE with 4 days of Progesterone
    Apr 2018- DE FET cancelled for lining issues :(
    Jun 2018- DE FET #2 of two 1AA blasts- first BFP ever! Beta 10dp5dt- 378, Beta 14dp5dt- 2840, Beta 16dp5dt- 4035, beta 18dp5dt- 10916. Due on 2/20 with one baby after a vanishing twin
    Baby Born born early @ 33.5 weeks due to Pre-e
    Back for # 2!
  • Options
    Hi, dear, I'm sorry you're having troubling times. But I really think investigative lapo IS an idea. As far as I know it is normally the standard procedure performed as the final test in the infertility work up before progressing to treatment. Recently there has been a growing tendency to use it. I happened to read many people use it instead to start direct infertility treatment.
    In our clinic (Biotexcom, Ukraine) lapo reveal abnormalities that result in changed treatment decisions in 25% of the patients. The changed treatments mainly concern surgery for minimal/mild endometriosis and adhesions, both performed during the diagnostic laparoscopy. (Sorry for the terms used improperly if there are any..).

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