QuestionI had my second laproscopic surgery for endometriosis in April 2009 with my first surgery in 2005. My first surgery had small pockets everywhere and my second was confined to larger area ALL over my left side with one endometrioma cyst. There was none found on the right side. My husband and I had tried for one calendar year before April and have now tried 3 cycles, 2 naturally and one with Clomid 50mg. I am now taking clomid 25mg with plan for ultrasounds, trigger shot, IUIs and progesterone suppositories for this month. I have a couple of questions:
1) How much does an IUI up your chances of conceiving?
2) With my first month of clomid while taking 50mg (June) I grew two HUGE cysts on my left side which were VERY painful.. does clomid cause this? Do you always still "ovulate" even with clomid and HCG shots?
3) I ovulate usually 2 months left and one month right (which I can obviously feel).. Should we plan to focus on these drugs & IUIs while ovulating from my right side that didn't have the endomtrioma cyst or will this make a difference?
4) I am only 110ibs (while not on progesterone.. haha) and am super sensitive to birthcontrol pills. I have a history of growing painful cysts if I even look at BC pills since I was 19, will clomid or these drugs increase these or grow my endo more?
5) How long should we try before we just head to IVF? We live in Alaska which has no IVF clinics so we'd have to travel to stay which is extra money.
Thank you for answering my questions.. I truly appreciate it.
Answer
Dr. Ramirez
Hello,
From what you describe, you have stage III endometriosis (there are 4 stages. Stage 4 is where the pelvis is completely encased in adhesions). Stage III and IV have been found to have a significant impact on a person's fertility and decreases pregnancy rates. This is both in natural treatments (ovulation induction with timed intercourse or IUI) and IVF.
Without knowing your age, it is difficult to give you a precise chance of pregnancy with IUI, however the range is 1% to 24%. The younger you are, the better your chances. In general,
<35 it is 24% per cycle, 35-36 it is 12-15% per cycle, 37-39 it is 5-10% per cycle, 40-41 it is 3-5% per cycle. IUI is not recommended in stage III and IV endometriosis.
Cyst formation is a side effect of Clomid, if ovulation does not occur. That is why most fertility specialists will use HCG to trigger ovulation. Even then, cysts can still form and so a baseline ultrasound should always be done prior to starting a Clomid cycle. If a cyst is present, Clomid will worsen (grow) it and ovulation and pregnancy will not occur.
The side of ovulation does not matter in terms of getting pregnant. Studies have shown that a person with only one tube can get pregnant no matter what side ovulation occurs on. That is because, unlike popular thinking, the egg does not necessarily go into the tube on the same side. The egg exits the ovary, from what ever point on the ovary it is formed, and ruptures into the culdesac. From there, it reaches the fimbria of the tube on one side or the other (the fimbria are usually hanging down in the culdeas in the normal anatomical position.
If you are bent on trying IUI's, which is the minimal treatment I would recommend at this point, then you should only try 3-4 cycles. Statistically, most women will become pregnant by 4 cycles of IUI, then the pregnancy rate decreases substantially. You would then go directly to IVF. If you are not bent on trying IUI's, and if you were in my clinic, I would recommend that you go straight to IVF.
I hope this helps,
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.
