IVF with endometriosis/adhesions?!

[The_Mrs]

Hello!  My husband & I got married 10 yrs ago.  We have not been able to conceive.  We went to our 1st IVF consult last week & are due back next week for education day & some testing.  I have a history of endometriosis & severe adhesions... I have had a laparotomy (2003) & laparoscopy/hysteroscopy (2005) to remove the endo & adhesions.  My last surgery was 6 years ago!  My RE doesn't think it's necessary for a repeat surgery to "clean up" - despite the face I have TERRIBLE pain with my menstrual cycle.  He thinks we have a great shot of IVF working due to our age (I am in my late 20s).  He said with IVF it will bypass the problems.  We have enough money saved up for ONE cycle.  With that being said - I am very concerned about doing IVF without a "clean up" surgery.  I wanted to know if you believe our chances would be increased if we got a lap done to remove the endo & adhesions before IVF or does it really not matter when you do IVF??  Thanks for your help!

[The_Mrs]

Thank you!  Sorry for the late reply.  We are already on our way to our cycle.  Even tho I have hesitations about it I am trying to relax & put trust in my RE.  I had an HSG done in 2004 which discovered I had one blocked tube.  It didn't help me to conceive.  I also had a couple surgeries years ago - it never helped.  I believe the endo/adhesions prevents an egg being released into my tubes.  I hope all it takes is bypassing it all & going straight to the uterus!   Congrats your your miracle baby!!!  

[maybebaby29]

Honestly? Get a 2nd opinion. I'm sorry your insurance doesn't cover fertility treatments. But yes, anything will help (workup, etc).

I have endo but never surgery. I would be like you wondering if it would help. The theory I was told about simple HSGs is you have 3 cycles after a HSG for a good shot at pregnancy. My tubes were clear but I couldn't get pregnant (unknown reasons). Even though I have an ovary wrapped behind my uterus and stuck to it (thank you endo/adhesions), it only took 2 tries after an IUI/Clomid (and then a trigger was added) to get a beautiful boy. I never, ever thought it was going to happen.

I wish you luck. If you can afford it, get a 2nd opinion.

[The_Mrs]

I just wanted to give you an update.  Our ins will not cover IVF.  However, they will cover office visits, bloodwork & diagnostic testing, so we are at least grateful for that!  Thank you for you help!  

[The_Mrs]

Wow, that would be AWESOME if they cover it!!!  :)  OK... I will do that & let you know what happens.  Thanks a bunch!!!

[Elaine Brown, MD]

Hi!
I don't think that the answer to your question is known for sure.  There is some evidence to suggest that surgery to "clean up" endometriosis increases conception rates and reduces miscarriage rates. There are also some studies that show no benefit.  I don't think that surgery would harm your chances for success, I'm just not sure that it would help.

One question that I have for you is have you looked into the possibility of a "risk sharing" program.  In other words, some clinics offer the possibility of opting for 3 tries with money back if you don't conceive.  I ask this question because, at your age you might very likely qualify, and many programs won't accept you if you have a failed cycle.

I would also recommend that you look into acupuncture as an adjunct, as there are some pretty good studies that show improved success rates with IVF and acupunture.

Good luck!
Dr B

[Relkarmom]

Call your insurance coverage.  My booklet also says they do not cover it, but the phone call and doctor's office says othewise.  CALL CALL CALL.  If the person says no, ask for a supervisor.  IN ADDITION call your doctor's office and provide them with your insurance info and the can call to see if you are covered.  Let me know what happens.  Be more presistent - dont' take what the book says, I didn't.

[The_Mrs]

Mhv - My 1st surgery was for endometriosis.  A couple yrs later I was in bad pain again.  I had a 2nd surgery where they removed lots of adhesions & miminal endometriosis.  I would think he would want to clean it up again b4 IVF, but he doesn't think it's necessary.  I am sooo stressed over it.  I hope it's the right choice.  I will be having a hysterosonogram next week & they will look for cyst.. etc.  If they find cyst, then they will want to do surgery - otherwise, onto IVF.  Adhesions & endo cannot be seen with a hysterosonogram... from my understanding you have to get a lap done to know if you have endo or adhesions (as they are flat against your organs).  He believes IVF bypasses this & is not necessary.  ?!  
Thanks for you help!!!!!  :)


Relkarmom - I do have insurance.  I looked in our policy book & it says they do not cover infertility treatments.  I do have Blue Cross, but each state & each policy is different.  I really wish I had the infertility coverage, but according to our policy book we do not.  Therefore, it will all be out of pocket & we can only do one cycle at this time.  I am pleased with our insurance tho... just wish they would cover IVF... that would be awesome!

[Relkarmom]

Hello, wanted to inform you that if you have insurance they pay for 4 IVF cycles in a lifetime so that may be an option for you and your husband.  A couple of years before doing our 1st cycle, I phoned my insurance company to inquir and the lady on the other end informed me that the insurance company will nto pay for invitro or anything of the sort.  When I asked to speak with her supervisor, she informed me otherwise.  Also the doctor phoned ahead to see if / what / how much my insurance provide paid towards IVF.  it appears Blue Cross pays 100 percent coverabe for 4 cycles in a lifetime.  Hope this info works for you.  Please keep us informed.

[mhv]

If you have adhesions/ endometriosis, it could hender the chances of your embryos implanting and increase the risk of miscarriage.  I would think he would want to start with a "clean slate" so to speak.
Has he ran any test to see how bad the endo is? And to see if the adhesions have came back?  You said adhesions, is that ashermans or is it just endo?
I too had adhesions(ashermans), and just had my 3rd surgery.  I actually ended up going to a doctor that has done over 1,500 surgeries to remove adhesions the third time.  I can tell you this.  I have had NO cycle pain my last 2 cycles since.  This is coming from a person who had severe pain during my cycle.  So bad I threw up.  Now, I have about 3% pain, normal mentrual pain.  I learned that that was a sign for me that my scarring had returned.  And I will know if I start having the severe pain again, that I will have to have things "looked at" again.  

I would think you would want to go into this with the best chance possible of concieving. I myself, wanted to make sure I had everything done to make sure I had every possible advantage.  

I wish you luck in whatever you decided, and if you would like to discuss things further, let me know : )




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[The_Mrs]

Oops - fact - not face!!!  ;)

I also wanted to add - I know of 4 women who used this clinic & all of them got pregnant on 1st or 2nd try.  This clinic is a couple hours away, so it's not like we are just going to any place.  We have thoroughly studied this clinic & feel confident in this clinic. Our main concern is hoping he is correct about doing IVF without a "clean up" surgery 1st - since my last surgery has been so many years ago.

Thanks again for any & all advice!