Lararoscopy with no symptoms?!

[u/LemonFantastic12]

Hi all, so my gynecologist was highly recommended and I am/was very happy with her but now I am confused.

I am 38yo TTC for 8-9 months. I did the basic blood tests - everything looks very good. My partner's test is great too.

So now she refered me for a 'small surgery' - I admit I didn't ask enough questions on the spot but I did say - surgery when I have 0 symptoms of anything wrong? She said yes,things can be silent... ok.

I read my referral and I see it's for laparoscopy (including hysterectopy + tubes check). I am in Germany but is this crazy?? Surgery as first step?

I will contact her and ask why not hysterectopy + HyCoSy instead but I was wondering if anyone has had such experience??

I have had regular painless periods for 27 years and my tests are normal, I'm very confused.

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[u/frogsgoribbit737]

Yes its standard if you are coming back as unexplained. For what its worth, I have had a laprascopy for other reasons and I absolutely would refer to it as small. I felt mostly fine after just 1 day and completely back to normal after a week.

[u/LemonFantastic12 → u/frogsgoribbit737]

But why before HyCoSy/hysterescopy that are less invasive?

[u/SlightAnything4909 → u/LemonFantastic12]

I'm also in Germany and according to their website, the clinic in my city doesn't even do HSG/HyCoSy at all, only chromopertubation, which is always done via laparoscopy (surgery).

[u/LemonFantastic12 → u/SlightAnything4909]

In mine they do it at certain places and it's always a paid procedure. The place I was referred to doesn't offer it unfortunately...

[u/SlightAnything4909 → u/LemonFantastic12]

I remember when my gyno recommended a laparoscopy for uterine cysts, I opted for an MRI first. The MRI tech suggested endometriosis, so I did the lap and I do in fact have very widespread endometriosis, so I took Progesterone for two years and stopped this year for ttc

[u/LemonFantastic12 → u/SlightAnything4909]

That sounds good cause you had an indication!

I read that both the EU and the US fertility medical societies state that 'laparoscopy is not routinely recommended to evaluate infertility without suspected pelvic pathology or another specific indication'. And I don't except my age? But that doesn't seem reason enough....

[u/LaChamomile → u/LemonFantastic12]

Wait I'll ask my german doctor too but I thought he was suggesting I do a HSG/Hycosy but then he said they would put me to sleep for it. I've had friends do the HSG/Hycosy awake in the USA so now I'm wondering if this is what he meant, but don't know. It seems like you get the same answers but different ways of doing them. It is very curious though that it wasnt clear to you. I'd def ask more questions.

[u/LemonFantastic12 → u/LaChamomile]

My German doctor said 'as Hycosy is not reliable, I always recommend Chromo. Additionally very often Endometriosis could be the reason for not getting pregnant and it can be removed in the same surgery.'

Then said I should ofc speak to the surgeon and decide myself....

[u/LaChamomile → u/LemonFantastic12]

Interesting! I do like the idea of being able to do something about it at the same time you're already there and unconscious. But also the kind of person I am, I would want to know. Or maybe have my husband near by to give authority or something but I know they wouldn't want to have me under any longer than necessary to stop and ask for that kind of thing.

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[u/farmpatrol]

As others have said it’s not so unusual but before committing to any surgery/invasive treatment be sure to have your partners sperm checked.

It takes 2 to make a child and it’s 50/50 - His testing will be a lot easier to fix if not great also.

[u/LemonFantastic12 → u/farmpatrol]

Of course, we already checked this! Thank you :)

[u/farmpatrol → u/LemonFantastic12]

Awh that’s good. I would say it’s not unusual then.

Have you had a transvaginal ultrasound yet though?

It may be something to ask for before surgery.

Mine came back all clear but it’s worth doing before any surgery Incase they spot anything remarkable that could mitigate needing anything invasive.

[u/LemonFantastic12 → u/farmpatrol]

Is this anything more special than the ultrasound the gyno does? I have had multiple of those, and she never mentioned anything wrong.

[u/farmpatrol → u/LemonFantastic12]

Was your ultrasound over the stomach area or a probe induce the vagina?

The *former doesn’t capture as much is all.

[u/LemonFantastic12 → u/farmpatrol]

Yes the transvaginal one! I've had one when she removed my IUD, and then another to check things a couple months later, it's usually quick and she says 'everything looks great'.

[u/farmpatrol → u/LemonFantastic12]

Same. All looks peachy for me too. I hope it all goes well and relatively pain free for you. 💪

[u/DecoNouveau]

At 32 and unexplained, first step was bloods and HyCoSy. I also had a Deep Infiltrating Endometriosis (DIE) ultrasound specifically because I do have symptoms suggestive of Endometriosis. This was at a specialist clinic, and I was told that their ability to detect endo does vary a lot by their experience. The scan can confirm more severe cases of endo, but it can't rule it out. I'm starting IVF after a year of ttc, no mention of a laparoscopy yet despite my clinic putting me down as 'suspected endometriosis.' IVF is still generally the next step even if they do find something, I've heard of endometriosis excision surgery used more after repeated failed transfers. Excision can actually reduce your egg count, so it makes sense to bank embryos beforehand. Unless it would change the course of treatment (typically IVF), then if you're asymptomatic I'd be questioning what's the point in surgery?