Endometriosis and IVF

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Endometriosis and IVF

Post by atomicgirl » Wed Oct 07, 2015 4:09 pm

I wanted to get some insight into my situation and would appreciate your help in determining what the best route might be. I’m a 28 year old female who has been trying to get pregnant with my male partner since mid 2013 and was not successful. In mid 2014, I resumed my birth control pills since my periods were too heavy and painful. My thinking was to give myself a break and thought that perhaps the pain would discontinue after a course of OCPs. I went off the pill at the beginning of 2015 and have attempted to conceive for another 6 months with no success, and strangely enough, started to experience increased frequency of UTIs and dysuria, especially during my period. In July 2015 I reported this to my family physician who ordered an ultrasound and MRI which showed deep infiltrating endometriosis which appears to have originated from the vesicouterine pouch and has invaded through the muscle layer of my bladder. MRI also noted “adhesions in the mid-pelvis” which my obgyn has acknowledged was a vague finding. I am now scheduled for da Vinci robotic surgery - partial cystectomy to remove the endometriosis tumor from my bladder and laparoscopy. Obgyn is aware I intended to conceive and ordered an AMH level which turned out to be .91 on continuous OCPs. Obgyn has warned that endometriosis recurrence rates are high and is concerned about endometriosis recurring after surgery while I attempt to conceive naturally. He has discussed fertility treatments to help me to get pregnant faster with the implication that those with endometriosis commonly suffer from infertility.

My question is…in your professional opinion, what do you think would be the best course of action after surgery? From the research I’ve done, it seems that Clomid+IUI or even stimulated IUI would only provide modest rates of success. Should I move directly to IVF or should I give Clomid+IUI a try first? I’m worried about my endometriosis recurring when off OCPs if I’m not successful. Given my history, what do you believe are my chances of success with Clomid+IUI and IVF? What would you advise?

Dr. Wisot
Site Admin
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Re: Endometriosis and IVF

Post by Dr. Wisot » Wed Oct 07, 2015 4:36 pm

It depends somewhat on the location and extent of the endometriosis and the success in restoring your pelvis to normal.

If the pelvis is normal with no remaining visible endometriosis, then your could try conservative treatment (Clomid with IUI)for a very limited time. But you will probably IVF. If so I usually recommend waiting for three months for the pelvis to heal to get the best response and then an IVF cycle with frozen embryo transfer.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

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