Can there be "remants" from a miscarriage 2 years ago?

They can look in the uterus using U/S during a sonohystogram. That's how they can discover polyps. Simple outpatient procedure.

Did the do an HSG before starting meds?

A miscarriage can cause scar tissue and I don't know if it will shed during a period.

J-

Metformin does not just help women who are overweight, I was put on it because my periods were so irregular & my ovaries appeared polycystic even though my blood work was always normal. I am not overweight either & it regulated my periods & we ended up being able to conceive. There would not be any remnants left over from the miscarriage but there is a very small possibility of scar tissue (as JTB suggested) although this is very unlikely given that you did not have a D&C. Hopefully you have had an HSG & this would have detected any scarring inside your uterus. The main point of exploratory surgery is to look at the outside of the uterus for endometriosis because there is no other way of checking for this. I had scar tissue but it was after multiple miscarriages & 2 D&C's. Mine was very aparent on the HSG & then I ended up having a hysteroscopy to resect the scar tissue. Scar tissue will not shead during your normal cycle, the only way to remove it is via hysteroscopy, but I think this is very unlikely to be your situation. Do you ovulate & have regular cycles? As well as going through infertility myself, I am also an RN in an OBGYN office so I would be happy to answer any of the questions you may have about the surgery. I am sure you have had a thorough work up done but if you want to let me know what they have done thus far I can tell you if there are any other tests that might be helpful prior to surgery. Different Re's can do things differently so sometimes it is helpful to compare notes. Please let me know if I can help, we thought that IVF was our only option but then we took a little "break" & wound up pregnant! It's amazing how that happens!

Thanks for your responses! I haven't had irregular periods - they always have been 25-31 days and I always have had a period. My hubby's sperm is on the low side 18mil instead of 20mil, but we did AI twice as I mentioned. I want to do it again, but want to make sure I have the surgery first and have been on the Metafornin to regulate my blood sugar. Its seems to me you wnat to be cleaned out and ready to go - so to speak. I've heard the HSG can "clean you out" - is that the case with surgery? I have not had the dye test/HCG done. I have not had a work up and only had the blood levels done for PCOS b/c I told my Dr. that I suspected I have a blood sugar issue (b/c my sis never could get pregnant again and she is now pre-diabetic). I'm frustrated b/c I feel like things were done backwards...shouldn't I test to see if I am ovualting before continuing on Chlomid? It may not be working. I did have a progesterone level taken ONCE but that was well before I even started the Chlomid and fertility - it was normal...makes we wonder if I even need Chlomid....anyway, just venting...and looking for advice. Also, isn't there a technical test to run to see if I am ovulating other than just taking a progesterone level/blood test?

J-

It does seem as if things were done a bit backwards, so I don't blame you for being frustrated. It suprises me that you have not even had an HSG done after that long of a period of time! The HSG or dye test we sometimes says "blows out the cobwebs" & there is a higher chance of pregnancy directly following the procedure. The procedure is not meant to clean out the uterus but sometimes if there is a small amount of scarring in the uterus or tubes, it can dislodge it, clearing the area. The surgery that your doc was talking about is a laparoscopy & will not clean anything out or even evaluate the inside of the uterus (unless he told you that he was going to do a hysteroscopy along with.) I think the place to start would be with the HSG before you move on to more invasive procedures. The only ways to detect ovulation or efficacy of Clomid are either through day 21 progesterone levels or through US monitoring. Progesterone levels are a fairly acurate way of determining if one is ovulating adequately or not, so this probably needs to be rechecked during a Clomid cycle. They can also do Follicle US's starting around CD 12 & repeating the US every few days to follow the follicle development to see if they develop to maturity & release. This can obviously be expensive & is usually not necessary unless you are on injectable meds. There is really no need to "clean out" the uterus, it does it on it's own with your monthly cycles. The only way to clear out the uterus is through a D&C, which you certainly do not want to do if it is not necessary. If the HSG reveals any issues with scarring then a hysteroscopy can be done to clear out the scarring. Doing a D&C when not needed can cause scarring of the uterus & is never recommended just because someone is not getting pregnant. I would certainly hold off on any surgery until you have at least has the HSG done. Is the doc you are seeing an RE or just your OBGYN?

thanks again for your great response. Funny, b/c my RE is very quick to just do things and I alway like to know why, get all the facts, etc. He thinks I should do the surgery (I think laparoscopy and hysteroscopy-am confirming) He said the HSG test is a waste of time b/c he can go in and if there is any blockage, fix it while he is in there. I didn't want to do invasive and expensive surgery, so I had backed off from seeing him and went back to by OB....My OB is the one who administered Cholmid and Metafornin. Now, that we're still not getting pregnant, I have call back into the RE - but this time to his partner...who I've heard explains things a little better and has a bit of a better bedside manner. I'm confused a bit as what to try next but once I talk to him maybe things will get clearer. I hate to keep going back and forth between my OB and RE.

I would definitely try to push for the HSG first. It may help you to avoid an expensive surgery. If they see a small amount of scarring or something then they can JUST do a hysteroscopy to resect that area & avoid the Laparoscopy altogether. The hysteroscopy alone can be done just under sedation & usually in the office whereas the Laparoscopy must be done under general anesthesia & the recovery is much longer, not to even mention the cost. I just think it makes sense to do that first befor jumping into surgery. It sounds frustrating, I hope the other RE will be better at not only explaining things but also doing things more conservatively. Good Luck!

Thanks once again! I think I've learned more through you than my OB or RE! We are in the middle of another cycle of Metafornin and Chlomid, but then I think I am going to schedule an HSG. I believe both the OB and RE can do this...guess I should go with the RE - but I'm sure their cost is higher. Actually its 1600 vs. $1900 for laparascopy and hysteroscopy....which makes me think that is why the RE said just do the surgery? Once I hear back from the other RE- his partner than I can decide/schedule. I'll let ya know what happens. Good Luck with your pregnancy! Is this your first?

Make sure you are being quoted the TOTAL cost. Your RE might be giving you their cost and not including the anethesia and hospital or facility cost.

HSG is just take a pill, lay on the table, while doing the equivalent of an IUI with an x-ray. The laparascopy is knocking you out surgery.

J-

I am sure that is just the cost from the doctor & if they do a laparoscopy there will be huge expenses for anesthesia, hospital fees & then the docs fee as well. I had to have my hysteroscopy in the hospital because of how complex it was going to be & I think the total was around $8,500 & that was JUST for the hyst. Luckily for me, my insurance covered 80% of everything because I fell into the category of habitual pregnancy loss & not infertility. Since your would be billed under infertility (unless you have coverage for infertility) your insurance may not pay any of those costs. I would just make sure you get the HSG before doing anything else, I am still really shocked that they never ordered one before this. If you do it through your OB, they will send you to a radiology clinic to have it done whereas your RE will do it at their office. I would just see what the price difference is cause it really doesn't matter who does it. Remember, the HSG has do be done between CD 7-12 so it will need to be scheduled if your next period starts. Good Luck!

My doc refused to put me on any meds before doing a HSG. She didn't want to stimulate me if my tubes were blocked.