More on Lap

[SCBeach]

Hi Doctor,

Since I too suffer from endometriosis, I wanted to ask a follow-up question to the last post “Lap before IVF”.

For surgically verified endo patients, most doctors would treat with Lupron or Letrozole after the laparoscopy for two to three months to remove any residual endometriosis prior to starting with an IVF treatment. From speaking to other RE’s the problem is that laparoscopy cannot get rid of ALL the endometriosis, only the endometriosis that can be seen. I believe previous studies have shown that there is usually residual microscopic endometriosis that is not seen, and this can continue to prevent pregnancy (implantation issues)

Would you agree that doing a laparoscopy to remove as much as possible of the visible endometriosis and then commencing on a 2 cycle treatment of BCP & Letrozole gives an endometriosis patient a pretty good chance to succeed with IVF (assuming the embryo is of good quality) upfront rather than waiting to get on BCP & Letrozole after a cycle fails?

Thank you.

[Dr. Wisot]

Hi:

I would agree that some sort of pretreatment in a person with known endometriosis is a good idea. I think it has to be individualized; that one size does not necessarily fit all. For some surgery, others medical pretreatment and some both might give a benefit.

Good luck.

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