thanks Jo, I will certainly pass on this information.
- Original Message -
From: Jo Bourne [EMAIL PROTECTED]
To: ozmidwifery@acegraphics.com.au
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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