Laparoscopy?

[Throwaway_panther]

Well, if you haven't been in the HT board but know who I am, you know I've been put into a wood chipper and spit out.

Husband is due to have an ultrasound to see if his varicoceles are worse/more plentiful than initially expected. If he is deemed needing surgery, husband is more willing to consider it (he was refusing even the urologist appointment if you have followed my story), but then there would be a waiting period for his fresh batch of sperm.

In the meantime -- has anyone had a lap? It's the ONLY procedure I have not had done in this endless series of loss. The REs I see still don't think it's necessarily an egg quality issue for our losses/abnormals, since my numbers are good, eggs were good, embryo quality was good until Day 3 when sperm DNA kicks in, and we have an actual diagnosis of my husband having sperm fragmentation/oxidative stress.

But Dr. Braverman had suggested silent endo as his catch all for "unexplained egg quality issues." My understanding, though, is that endo affects egg quality in terms of infertility -- as in, the shell of the eggs is affect making fertilization difficult. That is not our problem, between IVF and naturally, we fertilize almost too easily it could be argued! I also have had two HSGs, an SIS, two egg retrievals, a million ultrasounds, no endo symptoms except maybe occasionally painful ovulation -- if there was any endometriosis worth anything, wouldn't it have been caught in all of this?

I have read that exploratory laps are not recommended as much anymore because of how invasive they are and because they can potentially cause more issues (including lowering AMH, which is my ONLY possible thing -- normal AMH, but slightly lower than expected for my age, even though my AFC is very good and my LH/FSH are normal now too). I have also read that NAC treats endometriosis better than even Metformin -- and I've been taking NAC for quite awhile now just from reading about its efficacy in preventing miscarriage.

Any thoughts? Would you do a lap as the one last "for sure" sign my eggs aren't contributing a lot here? Our theory that my DD actually was a self correcting embryo grows stronger and stronger to me, especially after getting both abnormal XYS AND an abnormal XX. If there was even a small peice of endometriosis growing somewhere, would it be affecting all of this that much that it'd be worth going in and taking it out? Are the risks of a lap worse than a possible reward here when we DO know DH is bringing something to the table here already?

Thank you for reading!

[ksmom]

I think given that your husband has a known sperm issue, I think that's what the problem is and not something structurally or physically wrong with your uterus. Personally if I were in that situation, I'd skip doing the laparoscopy simply because I think it's the sperm fragmentation that's causing abnormal embryos and recurrent miscarriage. I kinda think the doctor is suggesting it because it's an "I don't know what else we can do" situation so it's basically a hail mary. I could be wrong though but that's just my thoughts on it. If you feel the need to do it, then go ahead with it if you think it will give you peace of mind. I'm so sorry you're having to go through all of this!

[atomic sagebrush]

I'm with you on this one, I find it vanishingly unlikely that you've been through all this and nothing has been detected BUT as you know I'm not so ready to chalk all this up to a single problem and I do think we should keep looking for another. We just know so little about how any of this works.

Dr. B is pretty smart, and if he thinks there's even an outside chance, even though I despise unnecessary procedures I actually think it is worthy of consideration. Doctors miss stuff a shocking percent of the time - they don't "see" anything using their basic technology and are often unwilling to take the next step and take a look with a different piece of technology that may give them more info to work with. Now, do I think they'll find anything, nah, not really, but at the same time so many of us are refused testing by the doctors that it feels weird to me to walk away from a doctor who wants to do more testing. At the very least you will have that marked off your list of possibilities and then if they do see something, the problem can be corrected. But that's my take on it, I probably have a chip on my shoulder over it (in the interest of full disclosure this is after several years of arbitrarily being refused all but the most basic tests by doctors only to find out I did actually have something wrong with me all along).

I don't think it's a terrible thing should you decide to take a pass on it, but I don't think it's the worst idea ever, either. Good luck and I hope you get some answers!