QuestionHello and thank you in advance for any advice you can give me!
I am a 38 year old woman in California. My husband and I have been TTC for over a year with no success. I had an operation to remove an ovary which was producing too much androgens in my early teens. Following this, I was put on Ortho Novum and Spironolactone to regulate menses for a couple of years, but then stopped taking them when regular menstruation resumed. I have been having regular (33-36 day cycles) menses since then.
I am hypothyroid but take Levothroid to control it. And I was also recently diagnosed with diabetes which is now under control with Metformin. My blood sugar readings are very good. Both hypothyroidism and diabetes run in my family.
My doctor ordered uterine & vaginal ultrasounds to check for uterine problems, and I was just told that they showed both a possible fibroid and adenomyosis. My uterus was shown to be "bulky". Nothing else was found, but my doctor also wants me to do an MRI to be certain.
I have never been pregnant and do not experience heavy menstrual bleeding or pain. Though my periods were somewhat heavy (~ 7 days) in the past, for the last 1 1/2 years or so they have been much lighter (~ 4 days). I assume I'm ovulating because I always have regular and distinct cervical mucus changes in the middle of my cycle.
What I *do* feel some (though not every month) is a very slight cramp-like pressure/pain on my right side where my ovarian surgery was performed years ago; this starts around a week before my period and can get slightly worse (though not terribly so) but disappears after my menstrual cycle. Some months this slight pressure/pain is accompanied by a need to urinate constantly, which also disappears at the onset of menstruation. The discomfort is mild but noticeable.
My concern is this: will I be able to conceive and carry a pregnancy to term? My doctor told me that, if the adenomyosis is extensive, I might not be able to. I am very anxious about this possibility. Would assisted reproduction be an option for us? Would I more likely need to use a gestational surrogate? I have not yet consulted a fertility specialist but am planning to do so as soon as the MRI is performed.
Thank you again for any advice ...
AnswerHello Ramya from the U.S.,
Adenomyosis should not affect your ability to get pregnant or carry a pregnancy. In fact, pregnancy is a very good treatment for adenomyosis. With the pelvic pain that you had there is the possibility of endometriosis in the pelvis causing this. That could make getting pregnant difficult. In addition, your hypothyroidism, diabetes and history of previous pelvic surgery could also make things difficult. The more problems you have, the less the chances of natural pregnancy and the higher the likelihood that you'll need assisted reproductive treatment.
I think that the place to start is to see a reproductive specialist. You've had too much misleading information and treatment as it is with your general docs. Once does not remove an ovary for "increased androgen output" unless it is due to an ovarian tumor. Now that could be contributing to your infertility because of the possibility of scar tissue formation from the surgery. Again, IVF would be the treatment of choice in that case.
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
