QuestionI am 38 years old and recently diagnosed with both diminished ovarian reserve (zero antral follicles and FSH of 39) as well as adenomyosis. The fertility specialist that diagnosed me said that on a scale of one to three, my adeno is a "bad two". MY husband and I were married a year ago and want to have a child of our own. (I have five from a previous marriage, but he has no children) We are perfectly happy to use donor eggs to overcome the ovarian reserve problem and the doctor who diagnosed me said that with donor eggs, I have just as much chance as anyone else of conceiving and that the adeno will not affect our chances. However since that time, I have contacted several doctors in the area where we will be moving about this and get conflicting answers with some saying there is no hope at all with adeno and most saying that is could make it hard to achieve pregnancy even with IVF and donor eggs. I am currently overseas in Morocco with my husband, but we are planning to be in the states for treatment by the beginning of next year. I am hoping for some insight into my situation as this is very hard to deal with, especially having to wait so long to even be able to start. In your experience, will the adeno affect our ability to get pregnant? If so, what treatments may help and will the passing of time while we wait for treatment hurt our chances? How fast will this progress? Any insight at all will be appreciated. It seems that so few doctors are knowledgable about this condition as related to fertility and everyone has a differing opinion. Thank you in advance and I apologize for the length of this question.
AnswerHello Kelly from Morroco (and U.S.?),
There is no data or studies that indicate that adenomyosis can affect pregnancy rates. There is data that shows that endometriosis, a cousin of adenomyosis, can affect pregnancy rates, however, the treatment of choice for the severest forms of endometriosis is IVF. Therefore, I think that even if you have adenomyosis, which I certainly don't know how it could have been diagnosed since the only way to really make the diagnosis is through hysterectomy, it will not affect your ability to become pregnant with donor eggs. IVF would be the treatment of choice.
Now one option you have to minimize any interference from the Adenomyosis (again I'm not sure you have this), is to do a three month course of Lupron depot prior to doing the IVF cycle. This may help to shrink or reduce the function of the adenomyosis. However, I am suggesting this only as an option. I would not recommend it to you if you were my patient as I don't agree with the diagnosis and don't think it will influence your chances.
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
