QuestionQUESTION: Hello. I'm 27 and from Florida. My OBGYN just found endometriosis at the back of my vagina. How likely is it that it's elsewhere in my body?
Also, he wants me to try Clomid the next few cycles. I'm wary because I've read that Clomid can exacerbate endo and also because I know I ovulate regularly (from charting BBT) and have normal length cycles. Would Clomid help with better quality eggs? Is it something you would suggest for someone with endo?
Thank you!
ANSWER: Hello Jill from the U.S.,
I presume that when you stated "the back of my vagina" you are referring to the culdesac inside your pelvis? And this was found by laparoscopy? Or are you referring to the back of the vagina seen on a pelvic examination (which is highly unusual and would be a reportable case)?
If you have been found to have endometriosis, my approach is to treat the visible lesions at the time of laparoscopy by cauterizing the lesions, then treat my patient for 3 months with Femara or Lupron, if they are an infertility patient, or 6 months if they are not an infertility patient. Then we start trying to get pregnant.
I do not move directly to Clomid ovulation induction or superovulation (increase number of eggs in patients that are already ovulating). The only strategy for using Clomid in your case, is for superovulation to try to get you pregnant as soon as possible. Pregnancy is a very good treatment for endometriosis but it will return within 6 months if left untreated after the laparoscopy. That is why you would want to try to get pregnant as soon as possible after the surgery. Clomid is not a treatment for endometriosis, and definitely NOT a magic fertility drug. Without knowing your whole medical history, I can't determine or advise if this is the best way to go or not. Most of my patients usually elect to try on their own for 3-6 months after laparoscopy and then we proceed with some form of fertility treatment from that point. I presume that no other reason for your infertility has been found because that would change the situation completely.
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
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QUESTION: Thank you for your quick reply! The endo was found during a pelvic exam and my doctor said it was in my vagina. He said he'd heard of it there, but never actually seen it there before. He did blood work that day and everything came back normal, and we're about to do an SA for my husband. He suggested several months of Clomid, and then if that doesn't work he'll refer me to a specialist who may want to do a lap. I have no insurance, so I think he wanted to see if Clomid would work before having to do the costly lap.
Supposing I get pregnant soon, can endo go untreated or will it just get worse with time making a lap necessary at some point? My symptoms aren't that bad right now. They used to be really bad before I was on birth control, but since coming off last year they're tolerable.
Thank you!
ANSWER: Hello Again,
Sorry for the delay as I have been ill this past week.
I doubt that your doc found "endo" unless he biopsied it and it returned as endometriosis. Was that the case? It is very very unusual in the vagina, as I mentioned previously. If in fact he took a biopsy and it returned as endometriosis, then a laparoscopy is warranted because endometriosis is usually in the pelvis and not only will it impede your fertility, but will get progressively worst setting you up for a larger and more expensive procedure, like an open laparotomy or hysterectomy. Also, if the endo is minimal or mild, then it can be treated by laparoscopy and you can try natural treatment menthods, like Clomid, to achieve pregnancy, whereas if it is allowed to progress to moderate or severe, then you will have to do IVF to achieve pregnancy (another very expensive procedure).
Pregnancy is a great treatment for endometriosis, and often will resolve after the pregnancy and not return for years. But, it does eventually return necesitating a laparoscopy at that time.
It sounds like you are seeing a general gynecologist and not a fertility specialist. For that reason, he is limiting your options. Clomid cycles are often prescribed by general docs since they have little else to offer. I know that infertility treatments and surgery are expensive, but as I mentioned above, delay can end up being more expensive. Certainly, if you want to have a go at Clomid cycles, you certainly can. Hopefully it will work for you.
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
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QUESTION: Hello again Dr. Ramirez,
I hope it's okay to ask one more follow up question, even though the original was a while ago. First to answer your last question, yes, my doctor biopsied it and it did return as endometriosis.
Since writing you last, we've had to take a break from trying to get pregnant for financial reasons. My doctor put me on Quasense (generic for Seasonale) birth control. I started it exactly four weeks ago, and I have been having mostly brown spotting the whole time except for three days in the middle. I know that with this type of birth control breakthrough bleeding can be common at first, but I'm wondering if it could be from the endometriosis in the vagina?
Thank you,
Jill
AnswerHello Again,
You are right on both counts. It can be from the BCP (breakthrough bleeding) or from the endometriosis. It is difficult for me to know which is occurring. If it is from the endometriosis, a pelvic examination will show bleeding from the site, and it will probably continue for a long period of time. Whereas, if it is breakthrough bleeding from the pill, it should eventually stop as your body adjusts to it.
Sincerely,
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
