Is a laparoscopy necessary before IVF can be done?

[Anonymous]

I had a consult with an RE and despite the fact that I have no symptoms of endrometriosis at all, he said that in order to go forward with IVF, he would require me to first have a laparoscopy. Has this been everyone's experience? I really want to avoid an unnecessary surgery and I have a feeling this is really unnecessary. Thanks.

[Anonymous]

That is crazy!!! There is no need for that surgery just to rule out endo. Even with some endo, the treatment would be the same, so there's really no point (other than to make the RE more $$$).

[Anonymous]

Do you mind me asking what clinic that was?

[Anonymous]

Did this RE recommend any standard baseline testing (HSG, saline sono, etc) before doing a lap? A lap is usually done if there are signs of endo and not just because. Unless you have endo or symptoms of endo, then there is no way I would do a lap. If he is doing it just to get a look, then the other tests I mentioned are non-invasive and are the typical first line tests. I am curious, too, as to which RE is recommending you start with a lap.

[Anonymous]

OP here. I have done all the tests (HSG, Hysteroscopy, saline test). The lap discussion was during our consultation to discuss the results of all the testing. As for the results, the tests show that I have nothing wrong. Probably the only thing working against me is my age: 37. I don't have any symptoms of endo (no heavy periods, no painful periods, etc.) but he said that I could be asymptomatic and he had a patient recently that did not present any symptoms and had it. I just feel really uncomfortable going through surgery "just to see." This surgery is under general anesthesia, so it's not like I am getting a tooth pulled. Honestly, it would really hold me back from going through with IVF and I would probably seek out a second opinion.

[Anonymous]

Get a second opinion!!!! There is no reason for you to go through a lap just because he thinks you might be like some other patient.

[Anonymous]

I have to agree- this (having surgery) seems a like a little much. I actually have potential symptoms of endo and my doctor told me that it was not worth checking out- that even IF I had endo (and it sounds like I likely don't, but even so as you have no symptoms I'm probably more likely to have endo than you do) IVF would likely be the solution anyway AND it wouldn't change anything they would do in the IVF. I see Widra at Shady Grove for what it's worth but my sense from his reaction is that most doctors would have had the same response.

It also seems like, assuming there isn't any miscommunication here, the doctor isn't just being overly cautious, s/he is being irresponsible. I've had lap surgery in my reproductive area and it's NOT fun. Plus, additional pelvic surgery can cause adheadsions and reduce fertility vin some cases.

Sounds like listening to your instincts is the way to go on this!

[Anonymous]

I went through 3 rounds of IVF before I had a lap and then discovered that I had asymptomatic endometriosis (well no symptoms other than IF). The very next cycle we finally got our first BFP (and DC#1). Might be other factors involved as well (and plain ole luck), but I do think it was still critical for our success.

There _ARE_ treatments for endo (removing the endo, depot lupron before an IVF cycle, etc.) and endo can affect your egg quality and implantation.

I wouldn't necessarily do it before a first IVF cycle, but would definitely push to have one sooner than later just in case it's an issue...

I believe there is a related test for endo that tests the endometrial lining - a biopsy to test for beta 9 integrin (something like that - it's been a while). Endometriosis affects that somehow. Might be a less invasive way to see if you have potential issues. Ask your RE about that.

FWIW I do think the hysteroscopy is a much more critical test before IVF. I only know of two other women like me (endo causing IVF failures), but a ton with issues in the ute (polyps, scar tissue, etc.). So that's great you already had that done.

And a second opinion never ever hurts!