QuestionHello,
Thank you so much for considering my question. I am a 35 year old female (will be 36 in 3 months) writing from Atlanta, Georgia.
I recently had a 7 cm dermoid removed laparoscopicaly. All went well during my surgery and they were able to save my (very stretched out) ovary. My other ovary appeared slightly distended, but they did not open that one. We'll just watch it over time.
Before the surgery:
1. I was having severe night sweats a few times a week for the previous 6 months. No changes in diet or vitamins seemed to help.
2. I had a hormone panel with the following results (CD3):
TSH = 2.14
FSH = 7.5
LH = 8.7
Prolactin = 15.2
Estrogen = 41
During the surgery they found a large polyp inside my uterus, which was successfully removed, as well as a small polyp on the outside of my uterus, which was not removed.
Since the surgery I have not had night sweats. I have had a regular period (every 27-29 days) for the majority of my life.
I was under the impression that night sweats and uterine polyps are signs of low estrogen. So, my questions are:
1. Can dermoids affect hormone levels (ie, is there an explanation for my hormone levels appearing "normal" while at the same time having night sweats and uterine polyps)?
2. Should my blood work be redone post-surgery?
3. Given all of the above information, would you recommend medicated or unmedicated IUIs and how many cycles of IUI would you recommend before moving on to IVF? (please note that I don't have experience TTC at home as my partner is a woman)
Thank you so much for your time and for the help you offer all women facing fertility issues.
J.
AnswerHello Java from the U.S.,
1. Dermoids do not affect hormone levels.
2. Your blood work was normal, so I don't think it needs to be repeated.
3. I always do IUI's using fertility medications. That is what increases the chances of pregnancy over trying naturally (i.e. increasing the number of eggs ovulated). Getting the sperm into the tubes helps a little but not much. I have had lesbian women do "natural cycle" IUI's, which means no medication is used and only one egg is ovulated per month, which would then just give you your age related natural chances of pregnancy. At the age of 36, this PR would be 30% per year of trying or 7% per month. Since you would be trying naturally, keep in mind that a normal 36 year old will take 6-12 month of trying in order to achieve pregnancy. If you use fertility medications to enhance your ovulation and get 3 eggs to ovulate per cycle, then your chances would be increased to 15% per month. That is what I recommend. In that case, we recommend up to four IUI cycles. Statistically, the PR decreases significantly if you don't get pregnant by four cycles, so at that point we recommend proceeding to IVF.
I would refer you to my blog: www.womenshealthandfertility.blogspont.com where I discuss ovulation induction with IUI in one of the topics. That will orient you to what I consider to be the best method. In addition, you might want to visit one of my patient's blog "two chicks and a hatching", who are a lesbian couple and have been doing IUI's with me (and recently became pregnant).
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 follow me on Facebook at http://bit.ly/9Iw9oV
