# Should I have a Hysteroscopy?



## KateP1 (Oct 20, 2007)

Dear All

Just wondered if anyone could help me. I am 43 and we have been ttc for three years (took me a while to meet DH!) - started on clomid, then two rounds of ivf with my eggs and most recently a third round with with doner eggs from my lovely sister. Although on the first ivf we got a BFP it was a missed miscarriage and the subsequent 2 ivfs have been negative. We have three frozen blasts and when we went for our consultation the doctor suggested that I might want to have a hysteroscopy before the FET. I am not sure if I can face another op, if its just a waste of money (c£2K) or if it genuinely might help. The consultant said that even if they didn't find anything on the hysteroscopy that the operation itself sometimes "cleaned you up" and meant that the subsequent round of ivf was more successful (all anectodal evidence). Has anyone had one? How bad is it? These three blasts are so precious I wonder if I should be doing everything I can to make it more likely to work but at the same time I am beginning to wonder if they are grasping at straws and we are just unlucky?

Any advice would be gratefully received.

K


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## TwiceBlessed (Nov 8, 2006)

sorry to barge being only 39

I had a mmc in November 06 after my third ICSI. I had an ERPC after this.

I had a hysteroscopy in March 07 and fell pg through ICSI with My DD the next month.  Then in November I found out I was naturally pg....

I really rate having the hysteroscopy. Obviously its only my experience but I really believe it sorted things out nicely.

Wishing you all the very best whatever you decide. x


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## eams (Nov 19, 2006)

I'm wondering about this as well so will be interested to see your replies - is it something that can be done on the NHS with a referral or would it always have to be done privately do you think? My GP is looking into getting an HSG for me on the NHS as well  but I haven't heard about that yet.


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## annacameron (Dec 16, 2008)

yes it is easy- ish to get an HSG.

I have no idea about the hysteroscopy save that ARGC are great proponents of it foir some reason. Kate, how old is your sister and when did she last have a child?

have you ever had your immunes checked? NKs, APA ANA etc

wer eyou on steroids, aspirin heparin?


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## KateP1 (Oct 20, 2007)

Thank you so much for your replies.
My sister is only 29 and has has a 18 month old child so is perfect doner! 
They have also advised I have my thyroid checked - not sure what those other immunes are? And no, not on any other medication.


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## Cotswold Girl (Nov 16, 2006)

Kate - you can have a hysteroscopy done as an outpatient procedure (I did). It's not much fun but more embarrasing than anything. Good thing is that it only takes about 20 mins and there's not always a need for a general anasthetic - so no recovery time. It's worth seeing if you can have it done on the NHS too rather than spend £2K.

Good luck,

CG xxxxx


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## ElleJay (Sep 4, 2005)

Hi - Kate, my heart goes out to you with your miscarriage and subsequent negatives, I am so sorry.

A hysteroscopy is just a camera being introduced into the uterus to take a good look around, and on it's own will not 'clean you up' - it's the D&C surgeons frequently do at the same time that does that.  

It depends on the surgeon's skill as to how useful this is, as I know of two people who have had hysteroscopies done in this country, and supposedly nothing was found, then they had one done by an expert in Athens, and he found and removed uterine septums in both of them (you are born with these), and they are both pregnant now after many multiple treatment failures and miscarriages.  The surgeon also has to be good at doing D&Cs if they are planning on doing one of these, as there is a risk of perforation and scarring.

I have had two done, and since you usually have a general anaesthetic, you know nothing about it and the worst thing is getting over the anaesthetic - the few crampy pains can be controlled by paracetamol.

Good luck with coming to your decision.

Lesleyj xxx


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## ♥JJ1♥ (Feb 11, 2006)

KateP the Homerton offer hysteroscopies as an out pt procedure- if you fit the criteria- I have always had mine (4 under GA at ARGC/Hammersmith) ARGC charge £1100 ish i think, Hammersmith are £2K

L x


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## annacameron (Dec 16, 2008)

interesting debate - what would indicate a need for it medically?

(Ive been ttc for 2 years, had innnumerable bfns from iuis and 3 from ivfs, no chemicals, no mcs)


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## KatieKat (Aug 1, 2007)

I've just had a hysteroscopy and it showed a polyp that wasn't showing on ultrasound, mine was done on the NHS. I may have managed to get this as I've had two miscarriages one of which was at 11.5 weeks, however I think the fact that I had two blastocysts in the freezer helped push them to do it. I'm now really glad I had it.

Good Luck!


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## Skybreeze (Apr 25, 2007)

Hi 

So sorry to here about your tx  

I had a hysteroscopy after having 2 failed IVF's. My new consultant at the Lister recommended it, they were going to charge us £1500 for it. I spoke to my GP after the consultantion and asked to be refered to a gyne for one on the NHS. Which she was reluctant to do but she did it. 

I see my gyne on the 9th of February this year and had my hysteroscopy done on the 24th of February. Which I think it pritty good going on the NHS. A hysteroscopy is usually a day case op. I had GA for mine but I know that sometimes its not needed. 

Is it worth you going to your GP for a referal?? It could save alot of money.

Good luck
Natalie xxx


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## annacameron (Dec 16, 2008)

so to put it non medically, it might show up things that don't appear on the normal scans and which might be preventing implantation?

I wonder if anyone knows what would indicate these "things"?

thanks ANna

xx


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi

I've had 6 hysteroscopies....5 alongside laparoscopies and 1 on it's own....most recent was with lap done a few weeks ago.  The reason  had one done initially was due to painful heavy periods and since I have endo as well, consultant decided to check out my womb for any abnormalities.  It was discovered I had septate uterus so he did corrective surgery to that and also found I had some uterine adhesions which were removed same time.

Subsequent ops have removed polyps and more uterine adhesions.  These aren't generally picked up on scans although may be seen sometimes through HyCoSy.

If there's been recurrent issue with implantation failure and/or miscarriages, or heavy painful periods then having a hysteroscopy may be a good idea to get things checked out.

All mine have been under general anaesthetic, even the one I had on it's own.  I conceived naturally 7mths following one lap & hysteroscopy and then again immediately after the one on it's own, although sadly both those resulted in early mc's.

I didn't have D&C with my hysteroscopies but the reason it can improve chances of conception is because they do flush out the womb which "cleans" things up inside.  I've been lucky that I have private medical insurance so all my ops have been done quickly & privately....my healthcare insurers include clause "disregard all previous medical history" which is good since I've had endo for 28yrs (diagnosed 21 yrs ago) so I manage to get these ops done without any relation to fertility treatment (as my insurance doesn't cover for fertility)

Good luck & take care
Natasha


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## annacameron (Dec 16, 2008)

Thanks Natasha - very helpful. 
I wonder if implantation failure on its own is enough to indicate a need to get one done or whether Im clutching at tiny straws because, tbh, I so want to find a cause to cure....

TRicky. 

thanks ladies

Anna xxx


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## ♥JJ1♥ (Feb 11, 2006)

natasha which medical insurance cover do you have? I have none but it might be worth looking into as I pay up front lal the time


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## Choice4 (Aug 14, 2008)

Katep1
Here are my suggestions
1, Get hysteroscopy done, but it is good to get your FET done within 3months window of hysteroscopy as the womb is still nice and clear of adhesions or scar tissues.

2, Get some immune tests done, It if you find any immune problems, it may be good to get it sorted out before the hysteroscopy

Here are a few of the immune tests you may need, level 1 can be done by your gp, level 2 , has to be sent to USA (P/s note the prices on here have changed

My level 1 tests were:

1. Full blood count, liver function tests, Urea and Electrolytes
2. Thyroid function tests (both free T4 and TSH)
3. Immunoglobulin panel (IgG, IgA and IgM)
4. Autoimmune antibodies (must include anti-nuclear antibodies,
thyroid peroxidase and anti-mitochondrial antibodies)
5. Anticardiolipin antibodies (both IgC and IgM)
6. Thrombophilia (must include lupus anticoagualant, Factor V Leiden
and Panthrombin gene mutation)

My level 2 immune tests aka the 'Chicago Tests' completed at RFU were:
Natural Killer Assay $385
Th1:Th2 intracellular cytokine ratios $333
HLA DQ alpha (male) $52
HLA DQ alpha (female) $52
MRTHR $82
Leukocyte antibody detection $104
total: $1008 = £514.39

To undertake these tests I contacted and paid the RFU lab directly: 
Rosalind Franklin University of Medicine and Science
Clinical Immunology Laboratory
CLIA ID #14D0646416
3333 Green Bay Road
North Chicago
IL 60064
USA

See the immune link here 
http://www.fertilityfriends.co.uk/forum/index.php?topic=82741.0


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

annacameron said:


> Thanks Natasha - very helpful.
> I wonder if implantation failure on its own is enough to indicate a need to get one done or whether Im clutching at tiny straws because, tbh, I so want to find a cause to cure....
> 
> TRicky.
> ...


If you have repeated implantation failure then it may well be worth you requesting a hysteroscopy to get it checked out. If you have polyps or fibroid then it's likely you would have related symptoms such as heavy, painful periods but I suppose there's a chance some women don't get symptoms. Are for septate/bicornuate uterus, this may cause problems with implantation dependant on the extent/severity of the septum.

I'd certainly discuss a hysteroscopy with your consultant as another form of investigation and fingers crossed another thing to rule out.



♥JJ1♥ said:


> natasha which medical insurance cover do you have? I have none but it might be worth looking into as I pay up front lal the time


My medical insurance is corporate so is not standard private healthcare insurance.......here's some info...."Medical History Disregard (MHD) - MHD underwriting is limited to large group schemes with many members (normally over 100). An insurer will accept a scheme and disregard all previous medical conditions"

Are you able to get healthcare insurance through work ?

Take care
Natasha


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## ♥JJ1♥ (Feb 11, 2006)

♥ Minxy ♥ said:


> My medical insurance is corporate so is not standard private healthcare insurance.......here's some info...."Medical History Disregard (MHD) - MHD underwriting is limited to large group schemes with many members (normally over 100). An insurer will accept a scheme and disregard all previous medical conditions"
> 
> Are you able to get healthcare insurance through work ?


Thansk Minxy

No I work for the NHS so not a chance of private/corporate health care! I do sometimes feel bad about using private healthcare but there is no alternative if you are single and wanting to conceive.

Lx


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## annacameron (Dec 16, 2008)

JJ1 - i too feel extremely badly about using private healthcare but my feelings are confined to utter anger that the NHS into which I have contributed a huge amount in NI and from which i have taken nothing at all, continues to provide nothing to me. that makes me VERY ANGRY. why on earth should you feel badly about going privately? You are freeing up NHS precious resources! you are doing them a favour and guess what...we shouldn't have to.


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## london65 (Feb 8, 2008)

Hi! I would - and it's only my opinion! - say be cautious before having a hysteroscopy. It does NOT equate to having a D&C and does not do anything to your womb lining - it just examines, so gives no lining benefit. However, it would obviously tell you if you had any uterine issues.
However again....! I think you said you had tx with your own eggs and then donor with your sister? Those first tries with your own eggs may have been detined not to be viable if, like me, your AMH and FSH and ovarian reserve were really poor. And you have only had one donor egg tx - usually they recommend three to get best chances of pregnancy. We succeeded on our 2nd go, but were going to give it 3 times.
This is such a great site, but bear in mind that when we see all these investigations, it makes us think that we should chase every chance and every test, but the reality is often that we have to try as much tx as poss. Donor egg is your best chance and is likely to work! It is something about being about a 50% chance each time, meaning that 3 times  gives you a really good chance of success.
All very subjective, I know, and everyones opinions on here are as valid as each others.
All the best to you!
Kate x


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