QuestionI am 28 years old with two children. I conceived both of these after being off birth control for only 1 month with each pregnancy. After 2 years we decided to try again, and i got off my birth control pills for 3 months before trying. I conceived and found out it was an ectopic pregnancy. I tried taking the methotrexate shots, but the pregnancy kept growing and i ended up having several ovarian cysts, 1 large one. So my obgyn took me in to remove the ectopic pregnancy and ovarian cystectomies. She told me to wait 3 months then i could try again. After the first few unsuccessful months of trying, I went back to see my obgyn. I had been having lots of pain and had another small ovarian cyst. She said she would do an exploratory laprascopy and ovarian cystectomy. She found a mild amount of endometriosis. After several more months of trying to conceive with no success i was put on Clomid. Since being on clomid i have had progesterone levels of 9.6, 6.5, 1.5. The 1.5 was with my clomid increased to 100mg on days 3 to 10. Since then she has increased my clomid to 150mg days 3 to 10 and put me on metformin. I am just wondering if my infertility could be related to the ovarian cystectemies, my doctor seemed to think it was more stress related than due to surgery. Any suggestions??
AnswerHello Kristi from the U.S.,
Your problem could actually be due to several factors, the least of which would be stress.
The fact that you had an ectopic pregnancy means that the fallopian tube or tubes were compromised. That is something caused scar tissue formation within the fallopian tube. The most common source is inflammation/infection from a bacteria that may not have caused symptoms. If one of the tubes was affected, then the other could have been affected too and now they are not functional, hence the difficulty getting pregnant. Clomid does nothing for that.
Another possible cause is the endometriosis. Endometriosis causes an inflammatory reaction in the pelvis. This inflammation will attack and destroy the egg upon ovulation because the egg has to traverse the pelvis in order to find the tube. It can also cause scar tissue formation such that the egg gets caught in the scar tissue (like spider webs). Laparoscopy is a good treatment for existing endometriosis but it is not good at treating any microscopic endometriosis that cannot be seen. I usually will recommend a 3 month course of Lupron after the laparoscopy to get rid of microscopic implants.
A third possible cause is the surgeries you have gone through. Surgeries cause scar tissue formation. As explained above, this scar tissue can interfere with movement of the egg from the ovary to the tubes.
My recommendation would be to see a fertility specialist at this point. They can counsel and treat you appropriately.
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
