Endo and fertility

[maybebaby29]

Hi all,

I'm on round 2 with clomid + ovidrel + IUI (IUI and clomid was last time but it failed). Today I got my follicles measured on day 10.

8 total. 5 on the left w/ 2 good possiblities (size 15, 11, 10) and 3 on the left (<8). So I'm hopeful.

However, I see other women here going for a lap due to endo. My first pre-infertility ultrasound had "ovary adhered to uterus to due adhesions from endo". But my HSG was clear so my RE thinks that if there is endo, as long as eggs are made/released, it doens't matter because it isn't interferring with anything.

I know only being on round 2, me panicing about this is silly. But I want to have the best chances possible and try to avoid IVF.

I know there are lots of women who get pregnant with endo. Should this be a concern at all? I never had a lap to 100% confirm anything and my most recent ultrasound, the tech said that the 'adhesion' thing isn't there.

I'm just confused.

[Shayne Plosker, MD]

Dear maybebaby29 - Ultrasound is not really accurate for diagnosing endometriosis unless the ultrasound shows large endometriosis cysts on the ovary, which yours does not. The only way to make the diagnosis is by laparoscopy. Having said that, I do not recommend laparoscopy routinely for women with infertility, even though I know that probably 20%-30% of women with unexplained infertility would have endometriosis if we looked. The reason is that, if endometriosis is found at laparoscopy, treating it to help improve infertility chances has at best a mild effect - it is estimated that between 8-12 laparoscopies for endometriosis need to be undertaken to achieve one additional pregnancy. Thus, the approach of 2-4 cycles of clomid with IUI, followed by IVF if necessary (or injections with IUI then IVF) is much more likely result in pregnancy than laparoscopy is.

I agree with your REI. My recommendation is to go through 2-4 clomid-IUI cycles, with the expectation of an appox 25% chance of being pregnant. If you are not pregnant after this, then re-evaluate. Medically speaking if you are not pregnant after clomid-IUI, IVF is by far your best bet, but of course the cost of IVF is high.

Laparoscopy is not out of the question if you hare not pregnant if clomid-IUI does not work, but as a second choice if IVF is not an option.

[bny807]

Hello!   I recently got diagnosed with endo (lap about 2 months ago) but it was after finding an endometrioma on my ovary (otherwise i had NO symptoms not even painful periods excpet i did have premenstrual spotting 3-4 days, but have low progesterone so thought that was the case! )    Anyhow one thing that sounds strange and is good, is that if there was an adhesion, esp an endo adhesion then it can't dissappear on its own, so hopefully its not the case! :)    Otherwise I would look into a lap before IVF, since endo can make a "hostile" environment for implantation etc... so you IF You had it it would be best for it to be "cleaned up" as much as possible before the IVF.. as for myself  as soon as I got the diagnosis I went to an RE and we are doing IUI's with femara and ovidrel (He had also mentioned that with endo the tubes a lot of times don't  "pick" up the eggs like they are supposed to) I've only done one cycle, but they did a ultrasound after O time and it turns out that the egg didn't release (follie didn't rupture) so it might be that the endo is obstructing it! ugh!    So if you haven' t had a ultrasound the day after your IUI I recommend it highly!   GOOD LUCK! and keep us updated! : )

[maybebaby29]

Thanks. Same to you. It will happen. The nice thing is that they'll get rid of the endo. At least that's a bonus for you. :)

[nevaeh222]

Yes I am rather mad at my doctor for allowing me to do 6 IUI cycles without checking the endo after the 3rd one when I told him I wanted to get further testing. I have already missed a month of ttc because it took too long to schedule an appointment to see him and now I have to wait another two months because I have to have the surgery. I'm not a very happy camper right now. I would talk to them and see what they say for you though. good luck!!!

[maybebaby29]

That's how I feel. I rather they make one good look before anything. I may just ask them to do so in case round 3 of an IUI doesn't work before we move to IVF. I mean, what's the point if this is the way things are happening due to stupid endo?

[nevaeh222]

well I don't want to worry you but I also had an HSG and everything was clear and everything else was normal and 6 IUI's later with clomid and still haven't gotten pregnant. The doctor decided that we should check for endo with a lap because even if your tubes are clear the endo could prevent the tubes from picking up the egg..I'd really look into it if I were you just to be 100% sure you are ok..

[BabyBlue07]

Make sure your uterus lining is thick while you are on clomid.  I was on 6 cycles of clomid and clomid did my uterus lining thin.  i suppose to do IUI this cycle and becuase of lining doctor won't do IUI on me.  Make sure you ask your doctor check your uterus lining.

Good luck.