Living with Advanced Endometriosis: Experiences and Lupron Concerns

Question
I was diagnosed with stage IV endo. in feb.09 when my lap. was done. My GYN told me he could not take the cyst due to my endo being in my bladder and bowel etc. (the cyst being the reason I was having a lap). He immediately put me on lupron (playing down the side effects) after my surgery. I am now on my fourth shot of lupron and do not know what to do. I have repeatedly told my GYN of my side effects and how they interrupted my every day life (I'm in the military and can not just stay home because I'm feeling bad for the day). I have found a endo specialist in Charleston SC (I'm located in Sumter SC) but cannot get an appointment until August, by then I will be off of lupron.  I'm wondering if I should just finish the lupron and go to a fertility specialist like my GYN recommends or don't finish the lupron and just wait until August when I can get an appointment with the endo specialist. I'm desperately trying to conceive and would like to know all my options and get the best advice out there. thank you!

Answer
Hello,

With stage IV endometriosis, your only viable treatment option is IVF (although I have had some exceptions in my career).  As such, we only recommend preceding the IVF cycle with three months of Lupron then proceeding directly into an IVF cycle.  So, I would recommend that you see a reproductive specialist as soon as you can.

In terms of the side effects, this is due to the estrogen suppression caused by Lupron.  Ask your doc to give you an "ADD-BACK" therapy.  This is where we use progesterone pills like Micronor or low dose Estrogen to reduce the side effects.  As long as they don't give full dose estrogen, it will not negate the purpose of the lupron.  That should help your side effects.

Bethesda has an IVF program for military but I understand that there is a long waiting list.  If you are active duty, you would have priority, however, over dependents.  Otherwise you could go private but it is expensive.  There is an excellent IVF clinic in Charlotte.

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.