To lap or not to lap? Lots of questions about laps
A quick bunch of questions about laparoscopies.
tl;dr context: husband (almost 38) has confirmed high OSA and high normal DFI, as well as borderline MFI. We have continued to get pregnant naturally but miscarry. I had done a full RPL panel, have had two HSGs, an endometrial biopsy, SIS, etc. We do two cycles of IVF with PGS after so many unexplained losses. First cycle -- lots of eggs, lots of high quality embryos -- then only 2 blasts beyond Day 3. Abnormal. Told it's a fluke, do a second cycle -- same amount of eggs, worse fertilization but still all excellent quality embryos until Day 3, then 4 blasts -- again, 75+% abnormals. Took a leap of faith and transferred two mosaics as they were still deemed high quality and our doctor swore by seeing healthy pregnancies despite this. Got pregnant, chemical -- 8 total losses now.
Husband has a confirmed varicocele and is getting an ultrasound in a few weeks to see whether he has more than meets the eye and does in fact need it repaired for any potential success before donor sperm (which two REs had already mentioned after these cycles). I know if he does have surgery recommended, it's still several months until the sperm are ideally better.
In the meantime, the only measure I have not had done is a lap. The only doctor that has mentioned it is Dr. Braverman after my phone consult with him -- but as many in the loss community know, he has his patented 'silent endometriosis' he assumes every woman with unexplained losses has. He said I should do a lap.
My AMH is 2.7, which is normal but low normal for my age, but my LH, FSH, AFC (Often 20+, ER have yielded 16 and 17 eggs respectively), etc. are all fine, my eggs were deemed fine after two ER (though I did have a slightly bigger drop off in mature eggs than expected, though still my total normal of mature eggs put me in 'normal territory,' and the RE wondered if it was a protocol issue since I stim very quickly), we have had one unassisted success at the beginning of all of this, and we do at least have a confirmed issue in all of this unexplained RPL with my husband's OSA/DFI.
Is it worth doing a lap? I have no symptoms of endo, which I know doesn't necessarily mean anything -- but if I continuously get pregnant naturally but lose them, and have had HSGS confirmed my uterus is good, would endo be affecting it? Braverman suggests endo affects egg quality, but then in my research it specifically can affect the shell of the egg affecting fertilization/getting pregnant, which is not our issue.
Would endo in tubes have been noticed at all during egg retrievals at all, too?
I guess I'm asking because there is just nothing else on my end to do, and I guess I'm desperately looking for something to "get a jump" on things. But then I looked into laps being more invasive than I thought, as well as some things showing exploratory laps are no longer recommended. And so far, no one who's been all up in my junk has suggested it. I even read that Metformin has been used to treat endo, and that NAC is even more effective than Metformin -- and I've been on that for ages just for its miscarriage reduction effects. So I feel like I've already been treating any hypothetical endo in this method, too? But again, would endo not have been seen between a SIS, two HSGS, two egg retrievals, a million ultrasounds, etc.? Do I still need that last step of a lap before we can decidedly say egg quality isn't an issue, despite all of the things showing us otherwise?