Jo, this might be something you've
already explored, but have you been down the fertile mucous path? If not it's
worth a try before last resort invasive methods. See http://www.billings-ovulation-method.org.au/ .
Cheers Fiona
Regards
Fiona Rumble
----- Original Message -----
Sent: Friday, July 29, 2005 11:05
PM
Subject: Re: [ozmidwifery]
laparoscopy
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
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