Dear Doctor,
My husband and I have found your forum/site very informative and would like to thank you for all your posts.
Quick introduction: I am 39 years old and recently diagnosed with Moderate to Severe endo (I don’t have Endo on the ovaries or tubes-only on the uterus.) Chromotubation was also performed with prompt spillage of dye through both tubes, which did have good fimbriated ends. My uterus is free of fibroids and polyps and appears normal in width, length and depth. My pain level is mild and usually only on the 1st day of my menstrual period. I usually take 2 advils and the pain is gone.
Based on our research on Endometrisos and speaking with other Endo patients it seems that ovarian suppression with GnRH agonists like LUPRON (3-months) or birth control pills (BCP) with Letrozole for two cycles pre-IVF treatment may help with some of the bad effects (i.e. uterine inflammation/beta 3 integrin) of the endometriosis and improve IVF pregnancy rates.
Below are five (5) questions we have regarding Lupron and BCP and Endometrial biopsy:
1. In your opinion, please advise if you think that 3-month Lupron is more, less or equally effective to BCP with Letrozole pre-IVF treatment for moderate/severe Endo patients. What are the benefits/disadvantages/side effects of going with either one?
2. Does 3-month Lupron or BCP with Letrozole help with beta 3 Integrin and inflammation? Please explain which med is more effective and/or which one you’d recommend and why.
3. How soon after completion of 3-month Lupron or BCP with Letrozole should we start our IVF cycle?
4. There’s been a few times we’ve considered skipping taking Lupron or BCP prior to our IVF treatment due to my age but we think that taking Lupron or the BCP before our IVF treatment will help us increase the our odds of conceiving- Do you agree?
5. Finally, do you recommend doing an endometrial biopsy before moving forward with IVF?
Below are some additional test details/results for your reference:
Age: 39 (6-months away from 40)
Laparoscopy/hysteroscopy surgery in Dec ’11
(note: Endo was not removed) I have never treated my endo with medication or surgery
Diagnosis: Endometriosis (stage: moderate to severe. I don’t have Endo on the ovaries or fallopian tubes only on the Uterus)
Tests:
AMH (anti-mullerian hormone): 1.2 ng/ml
E2 (Estadiol): 43 ( tested on 3rd day of cycle)
FSH: 9 miU/mL (tested on 3rd day of cycle)
My husband’s semen analysis is normal
Thank you so much for your reply.
Best,
Peggy
Lupron vs. Birth Control Pills pre-IVF Treatment
Re: Lupron vs. Birth Control Pills pre-IVF Treatment
Hi:
I can answer general questions on this forum; not give advice. The scope of your questions would really require a consultation.
What I can tell you is that pretreatment before an IVF cycle in patients with endometriosis is the best way we know to bring their IVF results to the level of non-endometriosis patients. Of all your choices I would think the most recent evidence shows that pre-treatment with birth control pills and letrozole leading immediately into an IVF cycle seems to give the best results.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California
I can answer general questions on this forum; not give advice. The scope of your questions would really require a consultation.
What I can tell you is that pretreatment before an IVF cycle in patients with endometriosis is the best way we know to bring their IVF results to the level of non-endometriosis patients. Of all your choices I would think the most recent evidence shows that pre-treatment with birth control pills and letrozole leading immediately into an IVF cycle seems to give the best results.
Good luck.
Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California