Could there be another reason why I'm not pregnant?

Hello,

My HSG was normal and I did 1 round of Clomid + IUI but it failed. Now I'm on Clomid + Ovidrel + IUI. So far on day 10, everything is looking hopeful.

right ovary--11cm follicle
left ovary--15.5cm and 10cm
(total of 8 follicles)

Lining 8.2
Estrogen 332
LH 8.6

They scheduled me for a followup blood/ultrasound on day 12 and are hoping to trigger the same day and IUI the next or the day after.

However, before I saw the RE, I had an ultrasound to check for a follicular cyst and that ultrasound said I had my left ovary stuck to my uterus due to possible endo adhesions. My OB said "you better go right to IVF". My RE, however, said that he didn't see anything on the ultrasound or HSG so he isn't worried. He said that he would have had to have seen the original ultrasound that showed these 'adhesions'. So he said "If you do have endo, we can't tell unless a lap and right now, I don't see a need to do a lap."

And while that's all fine and dandy and it seems that the CCT is doing good so far, my question is should this RE take the possibility of endo more seriously? Or if CCT and HSG were good, then no need.

I want the best chances possible and I am second guessing the ignoring of possible endo. But I also know many women get pregant with endo so I don't know if this matters for me.

Suggestions? The doc has a good reputation and I'm going through the hospital infertility section so it's not like some clinic.

[Shayne Plosker, MD]

Dear maybebaby29 - I agree with your REI. Unless ultrasound shows a large endometriosis cyst (endometrioma) on the ovaries, it is not at all very sensitive at diagnosing endometriosis. As your RE says, the only way to diagnose endometriosis is to do a laparoscopy. The problem is, even if endometriosis is found at laparoscopy, in your case it would be minimal or mild (since to have moderate or severe endometriosis you would have to have an endometrioma). Surgery is only minimally beneficial in improving fertility due to minimal or mild endometriosis - we estimage that between 8 and 12 women need to be laparoscoped and their endometriosis treated surgically to achieve one additional pregnancy. Thus, even if surgery were to make the diagnosis, the benefit is very small. You are more likely to reach your goal of pregnancy by trying 3-4 clomid-IUI cycles if needed, and then consider moving on to IVF if clomid-IUI has not worked.

[Hope4Baby24]

Umm, I would NOT ignore the endo factor.  I also would not do a lap unless the endo is severe...it doesn't sound like you have a severe case of endometriosis.  The doctor can usually predict the severity of endometriosis by doing blood work.  I have endo, I don't know how severe it is.  I had a "blood cyst" that was removed from my right ovary in 2006.  I had a HSG in 2007 that showed my right fallopian tube is blocked, and the doctor thinks it is a result of the scar tissue from the surgery.  So unless the endo is severe, I would not do a lap or any kind of surgery because sometimes that can do more damage.

Do you have diminished ovarian reserve? the doctor can usually tell by looking at your FSH levels.  My FSH level was pretty high for a 25 year old, so the doctor concluded that it was a result of the endo.  But going in and removing any lesions isn't going to help me at this stage, so I went straight to IVF.  The first 2 cycles failed and I will try a third time next month.

If I were you, I would continue to try naturally. I would also repeat the ultrasound to check for lesions, and have more blood work to check ovarian reserve.  Many women have endo and still get pregnant.  The fact that the HSG looked good is a positive thing for you, so don't give up!

[maybebaby29]

Thanks. My levels from a 3 day FSH were FSH 9.5. My progesterone on day 21 is a 3.3. He didn't say I have diminished ovarian reserve, but then again, I never get to see him!

I did one round of clomid + IUI and it didn't work. This time I'm on a monitored cycle and have 8 follicles. 3 of which are looking good. I have to do an Ovidrel shot. For some reason this clomid cycle is really hurting. They said so far my blood levels and lining are looking great.

I hate to be all TMI but today I had to go to the bathroom and as I drove in to the doc so I can use their bathroom and it felt like someone was tearing me apart. I don't know if that was an adhesion ripping or what but felt the pain in the front of my uterus and left ovary. I had to squeeze the steering wheel so tight I thought I was going to rip it out of the car.

Not pushing for a lap if it's not necessary. I just don't want to go through all of these infertility treatments and then find out that I should have had surgery.

[maybebaby29]

Thank you for your comments. I'm sure you're used to all of us wanting to know an answer as to why when we're trying everything possible with science. Sometimes we think first time is a charm when it comes to medical intervention.

Round 2 IUI was yesterday (Thurs). The doc said everything looked great by the time trigger of Ovidrel was to be scheduled (Wed).

Out of 8 follicles---3 were mature, 19, 11, 11
LH 61.1
Lining 8.6
Sperm count 60 million (and day before IUI trying)

Here's hoping. This time around I actualy "felt" the Clomid work--very, very, very sore ovaries and about midnight after the IUI, I could feel an egg burst through. I know it sounds crazy but it was a pain of something pushing out of the ovary instead of usual sore/twisty pain. Not sure if I'm just crazy but that's what I felt.