Laparascpy or HSG

[jensand]

I am 36 years old and am trying to conceive..we have been trying almost 2 years.  It took only 3 months with our 3 year old and then 3 months with the miscarriage I had almost 2 years ago.  We have done 2 rounds of AI with Chlomid.  My OB found my LH level to be twice as high as my FH level nad put me on Metafornin.  I have been on that for 3 months, but my RE thinks that I don't need to be on that and I am not overweight.  My hubby has a somewhat low sperm count 16-18mil instead of the 20mil they like to see.  We're not sure what our next step should be.  My Rep. End. says to do surgery (laproscopy) over the Dye test - doe the surgery "Clean you out" as I have heard the dye test does?  Can the surgery look at the tubes as well as the utuerus - so then why do an HSG test?  Trying to decide if I should do the HSG or the surgery?  I am guessing that should be done before doing another round of insemination or IVF.  Any suggestions?

[Elaine Brown, MD]

Hi!
The reason to do surgery would be if endometriosis is suspected.  If someone has endometriosis, laser surgery can be done to clean up the implants and improve fertility.
I'm not sure why your RE thinks you should have surgery, but maybe he/she has explained that to you.  The HSG is cheaper, and less risky, as it doesn't require any anesthesia while a laparoscopy requires general anesthesia.  Both procedures "clean out" the fallopian tubes and improve conception rates on the following cycle.  It sounds to me like your problem is male factor.  If IUI is going to work, it usually does within the first three tries.  If you were my patient, I would switch you to Femara instead of clomid. If you are tolerating the Metformin OK, I don't think it will do any harm, so I wouldn't have strong feelings about it either way.  I would try maybe one or two more IUI cycles. and then move on to IVF.  By the way, have they done a day 3 FSH and an antral follicle count for you to check your ovarian reserve?  If it is not good, the sooner you move to IVF the better!  If it is good, you have some time on your hands to try the less expensive route.
I hope this helps!
Good luck!
Dr B

[prayingfor3rdblessing]

With my 1st child I tried for 3 years...I had the HSG, took Clomid, and still not getting preggo. I went for a Laporoscopy and my doc loosened the fat up around my tubes and ruptured a cyst I had received from the Comid. I was preggo 2 weeks later, the 1st time we did anything after my surgery! So it can help, plus it will let you know 100% if there is anything else going on in there that the HSG might not catch. The recovery is very fast and your incisions are so small. Go for it! I am now trying for my third in which I am not getting preggo after 2 years of trying. I am 39 and my RE says if this next round of IUI doesn't work, I will go in for my 2nd Lap. before going to IVF. Hope this helps.