I am currently doing IVF and have jumped through all the test hoops, well most of them anyway. I haven't had a lap because the only reason for me to have one would be to check for endo and if I do have endo it is not severe enough to prevent IVF from working, I am doing IVF anyway so there is no point. A lap is the ONLY way they can be sure about endometriosis so if they suspect she has endo then that is the test yes. Severe endo can often be seen on a high level ultrasound but not always and less severe endo probably would not be seen by ultrasound. There is a blood test for endo but my understanding is that it is so unreliable as to be not worth the time.
They often also check tubal patency during a lap but this can by done without the lap by having a HSG (dye/xray) or HyCoSy (sugar solution/ultrasound) instead, both of these tests can be painful but they are quick and do not involve any more sedation or painkillers than a couple of panadol. Is her Gyno a fertility specialist practicing as part of an IVF clinic? If not then she should change Drs, general gynos are not known in the infertile community for giving the best fertility advice. If she is in Sydney I can recommend two excellent Drs. Whether she changes Drs or not she should take all of her test results to someone else for a second opinion, you would be amazed how differently two fertility specialists can interpret the same results. I don't know what other tests she has had but fertility workups usually start with a semen analysis, cycle day 21 blood tests to check progesterone levels and confirm ovulation, probably a bunch of other blood tests too to look for things like PCOS and a tubal patency test. Depending on what is wrong then possibly some cycle tracking with regular blood work and ultrasounds. If the problem is PCOS then she would most likely be put on metformin, which seems to be quite helpful and will most likely also help with the weight problem. If tubes are clear and SA is ok then the the medical approach for unexplained or ovulatory infertility is usually 2-4 months of chlomid. If Chlomid doesn't work in 4 months it won't work. Chlomid has a number of drawbacks but it is cheap and simple (taken orally monitoring not really required) and it does often work. Then maybe FSH ovulation induction with or without IUI, FSH ovulation induction works better than chlomid, has less side effects but i! s more expensive, involves injecting yourself daily and extensive monitoring. If neither of those work then she would be encouraged to move on to IVF. Fertility treatment often provides more answers as you go along, though sometimes you continue to be told there is no apparent reason for your infertility and you just have bad luck... that was probably way more than you were looking for but hopefully it will help a little. cheers Jo At 10:19 PM +1000 29/7/05, Madelaine Akras wrote: >I have a patient that I am treating for infertility. Her gyno has recommended >she have a laparoscopy to investigate possible causes. She is feeling >uncomfortable with this procedure due to the risks. She has also been told >that being overweight may also increase these. Can anyone advise or assist >me please. Are there any other safe procedures avaiable to determine the same?? > >Madelaine Akras >Naturopath -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
