# hysteroscopy before donor egg IVF - yes or no?



## eatyourpeas

Hi all,

I have had every test known to man and medecine over my 10 years TTC and 9 IVF cycles (yes 9!!) including all usual bloodwork, HSG, 3D SIS, etc.  My HSG was normal (done a few years ago) even though after acute appendicitis and peritonitis I wondered whether there would be issues. There weren't, all clear.  I have never had though a hysteroscopy or a lap and dye as was always told too risky due to my history of perforated appendix.  Having been to see a new consultant in Quiron Barcelona to begin our egg donation treatment, he is querying why I have not had this done.  I did even go to see a gynae consultant who advised me I didn't need to have it done.  So, views?  Anyone been in a similar position?  Multiple failed cycles and all seemingly normal?  Should I get this done privately?  Part of me feels like I should do it just to tick all the boxes and know that it definitely isn't implantation that is our issue but my duff eggs.  But I also realise that opting for invasive surgery carries its own risks.  

Brief background: 3 fresh cycles and 2 frozen with ex-partner with a known male factor issue (I was tested and all seemed fine so clinics all proceeded on basis infertility was male issue).  No success, never got even a blue line.  Marriage failed.  Now with lovely DP and he has a child so proven fertility.  Have been trying for 3 years, 1 fresh cycle with CRGH and 2 frozen.  10 eggs collected, low fsh, reasonable for my age AMH (I'm not too far off 41), made 6 really good blastocysts.  Had slightly elevated natural killer cells but on last two treatments had prednisolone, intrallipids etc.  Also previously had D&C and also endometrial biopsy to 'aggravate and stimulate' the lining. None worked.  So in summary, totally unexplained as all looks really good for us in producing good blastocysts.  So theory is that my eggs are chromosomally abnormal (due to age, I'm nearly 41).  We have discounted doing another cycle with OE with array testing due to ridiculously low odds of getting normal eggs at my age. 

So, hysteroscopy or not even though other tests suggest all ok?  How long does it take to recover if you have one to be able to have IVF?  Does BUPA cover it? Worth it?  Did anyone have hysteroscopy a while back and all ok and then after D&C or endometrial biopsies through treatment have another hysto which revealed scarring as a result of those interventions?  Can't wait to hear your views and thankyou in advance for reading this and your time in answering.


----------



## Surfergirl

Hi Scooby,

I have had DE treatment in Spain and was advised to have a hysteroscopy by the Clinic (Institut Marques, Barecelona) to check the uterine cavity for abnormalities and to do a biopsy to check for infections. They said they could either do it there or I could ask for it to be carried out in the Uk. I took the email from them to my Gynae Consultant and she did it on the NHS. Also it is done under general anaesthetic in the UK, which I preferred as I am a wimp!! Recovery was quick. It was day surgery and I bled a bit for a few days afterwards. A bit sore but I didn't even need painkillers! 

I think hysteroscopy is advised as its the best way for them to check there is no reason for failed implantation to do with the uterus. I'm glad I had it done as it ruled that out as an issue, although I am aware it carries risks.

Good luck x


----------



## theodora

An exploratory hysteroscopy & endometrial biopsy would not mess up timing for a donor egg (or embryo) cycle at all, you could start right afterwards if nothing shows up wrong. The hysteroscopy itself is the best way to take a look at your uterus (in case of problems which could thus affect implantation for instance) & it is just a tiny camera on a stick kinda! I have had this done many times and it is pretty much painless. An endometrial biopsy should be done during the luteal phase (after ovulation) to ensure that your lining is healthy, that it contains the right mix of hormones & inflammatory cells. In my case I did a biopsy & doc said it was fine, a few years later I found out that in fact I don't have ENOUGH inflammation thus intralipids etc are bad, & I should do an endometrial injury before a transfer. But if you have too much inflammation (such as uterine NK cells), you should not do the endometrial injury as you don't want more of it.

In terms of being tested a few years ago thus not worrying now, this is probably true except if you have endometritis or endometriosis, this scarring could have not been seen before but would be seen now.

Hope this makes sense, I'm a bit rushed...


----------



## eatyourpeas

Thanks ladies.  Reading back through my notes, it looks like whenever I have asked about hysto or lap, consultants have desisted because of the increase risk of bowel injury due to my history of appendicitis and peritonitis.  But they have never quoted percentage liklihood of such injury.  So makes it very difficult to know what to do and how much risk I would be undertaking if I proceeded.  Surfergirl, great that your nhs consultant agreed to do it on the back of an email from your consultant. Did you have to wait long to have it done on the nhs?  Given it was an nhs consultant that told me too risky to do a lap, not sure I'd have quite the same success, but perhaps worth a try if I get a similar opinion from overseas.  Your replies are much appreciated.


----------



## Surfergirl

Hi Scooby,

I only had to wait about three weeks to have mine done on the NHS, which I thought was very quick! I just went in and signed the consent forms and had the MRSA swabs then the op was a week or so later.
Really easy. 

Good luck xx


----------



## eatyourpeas

I really don't know anything about the hysteroscopy and I guess you might not too if your were under general anaesthetic.  But, given I have had 9 embryo transfers with catheters without suffering bowel or other organ injury, how will the hysteroscopy increase this risk?  I am assuming the hysteroscopy is also done by way of catheter?  And even if it is a larger catheter to fit the camera in and no good for someone like me who has a 'convoluted' cervix (consultants' words!) could it not be done keyhole?  I am admittedly entirely ignorant of this whole procedure and I guess wanting to be in a position where I could get it done but knowing I am not subjecting myself to unnecessary risk because of my ealrier surgery.


----------



## theodora

For an "exploratory" hysteroscopy, the doc will insert a speculum, then the hysteroscope. There is a slight risk of perforation of something, & of infection -- like with anything that is inserted anywhere in your body. However those are the only possible (highly unlikely) risks of doing a simple hysteroscopy. A bit of liquid is often inserted as well to check out how it flows, but this is saline & does nothing.

If they do an "operative" hysteroscopy where the doc looks & then decides to cut off a fibroid or some tissue, that is different, & it could cause scarring etc -- & also should be done under general anesthesia. But this is NOT what is being suggested for you.


----------

