HSG vs. lap

As nothing has happened in a year, although I seem to be ovulating and the LPD is successfully corrected, my doctor suggested to

  • re-do the SA, as the period of rest before the last one was too short (they did it immediately at the appointment, which we hadn’t expected), and we don’t know if/how this affects the results — maybe my poor husband is worrying about his sperm quality for no good reason. And the guy doesn’t need more stress than he already has.
  • check whether my tubes are clear. And there are two ways to do that, HSG or laparoscopy. The advantages of HSG are that it’s less invasive, no stay in the clinic or general anesthetics needed. However, while it can show that the tubes are clear, it cannot show whether they work correctly, i.e., whether the cilia properly transport the egg towards the uterus* (and, I think, the sperm towards the egg, though that seems contradictory). To evaluate that one needs a lap. And, apparently, clear tubes without the proper movement are about as unhelpful in conceiving naturally or via IUI as blocked tubes. Therefore the doctor I saw in winter recommends a lap. My doc here was less convinced, and said that it depended on what we’d do with the results. A worst-case scenario for me could be that they find the tubes full of endo**, which would make passage almost impossible, or if an egg and sperm meet, it would likely lead to an ectopic, so that we’d need to do IVF for a reasonable chance at (a sustainable) pregnancy.

However, we’ll move next year. Out of the country if not the continent. So we weren’t planning to start any major treatments before that, but keep trying naturally and do tests to make sure conditions are good, we’re not overlooking something “obvious” such as blocked tubes. Based on this, I said we probably wouldn’t do IVF immediately, and then an HSG might be the better choice.

Until I (almost accidentally) read what IVF costs in my home country. About 4k. Insurances even pay 50% for the first 3 rounds, but alas, I don’t have insurance there. I still have to find a good source, but I think costs are similar here… and on the other hand, where we’re likely moving it’s around 10k+. So we could have 2.5 chances at home or here for the price of one chance there…

So, I’m back to considering the lap. Yet somehow, and despite desperately wanting a baby, I don’t feel ready to move to IVF. I’m not even sure why. I think in part I’m afraid of the investment, emotional and financial, with a rather high risk of having nothing to show for it. And if the first round doesn’t work, I’d likely have to stop for the move, although the doctors would just be getting to know me and my body’s reaction to the meds and thus maybe have better protocols for the 2nd round. Maybe I also want to give us a little more time to work this out naturally, but I do want to make sure that everything is in order, so the tubes and the sperm will certainly be checked after the summer. Unless I get pregnant before that… although to be honest, right now I don’t believe I will.

Does anyone have advice on HSG vs. lap, perhaps especially with a history of endo?

* Here’s a video showing lots of information you probably know anyway, but also some cilia movement. I saw someone show videos of functional (coordinated) and non-functional (random) cilia movement in a talk recently, but cannot find it online.
** I have no symptoms though. Yay for that!

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13 thoughts on “HSG vs. lap

  1. I’m going to be no help to you here as I’ve only ever had the HSG. And of all the things wrong with me I’ve managed to dodge the endo bullet. The logistics of this are so hard to iron out. But I also think that you get to things when you’re ready for them, and if you don’t feel ready then that is okay, too. I think starting with the testing and seeing what’s what is a very good next step.

  2. Never done the lap, but it seems so invasive and scary. Isn’t it crazy how much IVF costs vary so much? I hate knowing that my problems are part of such a huge industry, and that I have to pay so freaking much for something that others receive for free – a baby. Seems so simple, doesn’t it?

  3. Hi cc,
    Yes I did read Katie’s post, after I wrote mine, and I found it to be very moving. I guess talk of this sort of thing goes around from time to time! I just am in a position of valuing membership in this community, but also not wanting to be some weird person who is around but doesn’t belong (like the Edward Norton character in Fight Club and all his support groups…:) )
    Anyways, it was good to get it off my chest and I feel better about things now.

    I don’t know anything about hsg vs. lap, but I certainly understand your reluctance to move to IVF. I think it is very unpleasant, so it is good to feel ready when you do start in!

    1. I’m glad you feel better. I guess if I were to get pregnant now, I’d have similar feelings — there were a few cycles when we missed ovulation. Do they count?
      But in the end, as far as our community is concerned, I think Katie makes a great point. This one year mark is just a number (I’m not sure if there’s solid research behind it, and actually I’d be surprised). Dates are probably needed for politicians, insurances etc. — but I think trying for month after month without success (whether that means no ovulation, no BFP, miscarriages or what else could go wrong), we become scarred and heartbroken, no matter what the calendar says.

  4. Ooooh, I am so curioius about where you live and where you are moving to now :)

    I really understand the hesitation about IVF as I experienced that too, and still do. I think I would go for the lap as it is more definitive than an HSG. At least then you will know, and you can make an informed decision.

    Best of luck whatever you decide.

  5. Can you do both? Or, maybe a better way to put it is, do the HSG for sure, then possibly the lap if you don’t get a definitive answer from the HSG. I think it’s always best to start with the less invasive procedure if you can. Now if your doctor really thinks s/he won’t learn enough from the HSG, maybe you will want to do the lap straightaway…but if there’s a good chance the HSG will give you the info you need, that’s what I would suggest.

    The issue of cost and of IVF is a big one–but I still think it depends mostly on what your doctor thinks s/he will learn from an HSG.

    If you do the HSG, don’t forget to take some ibuprofen an hour before.

  6. Andie — if I put all that out here, I’d probably be very easy to identify ;)

    gingerandlime — basically that’s the plan my doc suggested. And thanks for the ibuprofen tip!

    Also, thanks to all who told me that not being ready for IVF is fine. I think I needed some reassurance on this.

  7. I’ve not had a Lap but have had a HSG and agree with the other commenters. Go for the HSG it is quicker and less invasive and see if it indicates there are other things you should be looking for. (And don’t be worried about eh Xrays).

    I totally get the not wanting IVF thing. When I first heard that was my next option I was devastated. Not least because it meant I was ‘properly’ infertile. I couldn’t prentend any more. Now however, bring it on (quickly please).

  8. If it were me (and lets face it, its not so you have every right to ignore my suggestion!) I’d go for the Lap. Its definitely the gold standard and gives you a lot more answers than an hsg would. Yes an hsg is less invasive, but the recovery time for a lap is pretty short and given that it tells you the whole picture (as apposed to part of one that an hsg shows) its worth it in my opinion.
    It’s easy for me to say this though as i’m further thru this journey than you are so looking back i feel that time is of the essence. You don’t know where you’ll be on this journey in a years time… I hope like mad that you dont need IVF and that you get pregnant by a less invasive means but if you DO need IVF then you’ll be grateful that you had a lap done earlier rather than later.
    Its all about information gathering. Drs can hypothesise and give you statistics about which category you fit into, but until you actually dive in and become part of those statistics for yourself you never know how things are going to turn out for you.
    I know its scary to consider IVF right now and you’re right to take it off your radar for now as you have other options to pursue. Good luck!!!

  9. I am at a critical point, trying to decide between a lap and an hsg myself, so your information was very interesting. At this point, I am potentially feeling the lap, but we’ll have to see what doc says next week. Stay tuned.

  10. I know I’m a little late and you may have already decided, but I would definitely go for the lap. An HSG can show if the dye spills through your tubes, but not if you have endo or other blockage (sometimes the dye can flow through a blockage sperm and egg couldn’t.) Why waste time (IMO)? And to be honest, although neither procedure was bad, the HSG hurt more than the lap. I had ZERO pain with the lap, was home in less than 5 hours of arriving at the hospital for surgery and went back to work 2 days later. They can also do other things while in there, for me they drilled one ovary which helps with hormone levels. And according to my Dr., you’re way more fertile after a lap. I hate that you have to make this decision at all, but good luck with which ever you decide!!! :-)

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