QuestionQUESTION: Dear Dr Edward,
I am 40 (DOB 26/04/72) and my husband 37 (10/07/1975). We live in Australia. We already had 4 IVF/ICSF for the past 5 years (8 embryos transfer) with no success (except 1 chemical pregnancy in 2010 but lasted only 6 weeks ). I was diagnosed with moderate endometrosis around 2007 when being investigated via key hole surgery for infertility. I then had my 2nd surgery in 2009 and diagnosed slightly worsen with stage 3/4 endometrosis (wide spread but superficial endometrosis covering abdomen, uterus, anus with normal ovaries but "small" ovary on right side and tube were not block). My fertility specialist (also a surgeon) is keen to have 3rd surgery ASAP due to my re-occur and worsening of severe lower back and pelvic pain with bladder irritation symptom before period (presentation is like UTI but no actual infection) which he thinks is likely endometrosis re-grow. I wonder if you agree 3rd surgery is needed? I am also thinking about IVF/ICSI with egg donor post surgery as I don't think my eggs are any good with so many failed IVF attempt. In your opinion, will this 3rd be helpful for pain symptoms and increase pregnancy rate? Would you agree egg donor is next logic step with my multiple IVF/ICSI failed attempt? Please advise. Thank you
ANSWER: Hello Angela from Australia,
If the symptoms you are having are becoming unbearable, then surgery would be indicated but don't do it to help with fertility. It will do nothing to help your IVF chances. In fact, IVF is the treatment of choice for stage III/IV endometriosis, not surgery (unless endometriomas are present).
In terms of your IVF, you have given yourself a good go with IVF. Without knowing the details of your cycles, I cannot advise if you should stop trying with your own eggs or not, but certainly your age is a problem. Donor eggs would certainly give you a better chance at pregnancy than using your own eggs.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
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QUESTION: Dear Dr Edward,
Thanks for your quick reply.
May I ask why you says "IVF is the treatment of choice for Stage III/IV endometrosis, not surgery"? .. My personal guess is when someone is pregnant follow by breast feeding for another 6-7 moths, she doesn't have period for up to 18 months so endometrosis can't grow and it will decrease in size... I am not sure if this is the reason?
Also my surgeon wants MRI scan in the Pelvix area, what will he be looking for in particular?
As for pain related to endometrosis, I am thinking there may be another option... .
If I have another surgery NOW, surgery may cause further scarring and endometrosis may re-grow on these areas so the surgery will only DELAY but not fixing my pain..... So hopefully in a few years time once I have some babies and completed my family ... I just go for hysterectomy +/- oophorectomy instead which will than "cure" endometrosis.....I guess?
Thank you so much for your expert advise, sincerely yours!
AnswerHello Again,
What I mean is that the standard of care for patients that desire pregnancy and have stage 3 or 4 endometriosis is to us IVF. That is not to say that surgery cannot be done, but it should be limited to patients that are symptomatic and not so that they can achieve pregnancy i.e. not as an infertility treatment.
You are correct that pregnancy and breastfeeding are excellent treatments for endometriosis. Many patients who have endometriosis as the cause of their infertility go on to have normal pregnancies after the first pregnancy. Pregnancy is a hormonal state that not only seems to treat or cure the endometriosis but, as you say, you don't have cycles for almost two years so the endometriosis doesn't grow (possibly it atrophies) and you don't get new endometrial cells into the pelvis.
I think the reason for the MRI is to make sure there is not something else causing pain.
Your final comment sounds like a good strategy.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
