QuestionDr. Ramirez,
I have been suffering with horrible periods since they began, and now at 36 years old and never been able to conceive, plus the Endometriosis history in my family, I have finally decided to seek treatment. I have been prescribed Lupon and just received my 4th shot today. I was diagnosed by symptom alone at the Cleveland clinic and opted for Lupron over a Larpaoscopy. I am wondering If I have chose the right treatment path, will I need the "lap" anyways, or is there another way to be diagnosed w/o the lap. I read that an MRI can successfully diagnose Endo, and should this be my next step. Furthermore, after the Lupron, what are my chances of conceiving? Thank you for listening.
AnswerHello Colleen from the U.S.,
It has always been my recommendation to "make" the diagnosis rather than "assume" it as your doctors have. The only way to make the diagnosis is to do a laparoscopy. It has two benefits: it will make a definitive diagnosis and tell you what level of endometriosis you have (there are four stages) and it will remove any "bulky" implants of the endometriosis that lupron will not. I also don't like to treat with Lupron first because it can help to mask the endometriosis if a subsequent laparoscopy is done. Also, simply treating with Lupron is not sufficient to help your fertility if you have stage III or stage IV endometriosis. The only situation where I will treat with Lupron empirically (without laparoscopy) is if my patient is planning to go straight to IVF. In that case, because IVF bypasses the endometriosis, it is of some benefit to pretreat with Lupron for three months prior to the IVF cycle.
Because of your age, I would recommend that you consider going directly to IVF, rather than undergo a laparoscopy. That is the choice my wife and I made when she was your age with the same problem. Having the surgery does not guarantee that all the endometriosis will be removed, nor that you will subsequently get pregnant, whereas IVF will give you the very best chances of pregnancy with each try (it worked on the first try with my wife). At 36 years old, you have a roughly 5-7% chance of pregnancy per month (20% per year) if everything were completely normal, which is based solely on egg quality at this age. With IVF, in our clinic, we have a 60% pregnancy rate per try.
I hope this helps.
Good Luck,
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
