Wednesday, November 25, 2009

Endometriosis and Conception


Hello, I am 20 (almost 21) years old. I was diagnosed with endometriosis in September of 2007. I had a laparoscopy done, there was too much to be removed. My doctor at the time said that the endometriosis had not affected my reproductive organs, yet, thankfully. From 10/07 to 1/08 I took Yaz birth control to help maintain my disease, it didn't help. So, 03/2008 I started Lupron Depot, every month for six months. My last shot was Sept. 2008, my first cycle was December 2008 which was only 2 days of dark spotting. March was my next cycle and it was very painful and back to normal like my disease is still there just as before the shot. This month (April 2009) I have had my "third" menstrual cycle and it was horrific. My fiance almost took me to the hospital I was in so much pain. I don't to back to my ob/gyn until June. I have called with concerns but they said to wait it out until June.

My biggest concern is being able to get pregnant now. I have accepted that this is the way I have to live with this disease, painfully. Now I am focusing on having a child. I want a baby more than anything but I can't seem to conceive. I am not on birth control or any type of contraceptive, and never have been except the four months before the Lupron. I am so scared that I will not be able to have a baby, and we are trying. I have not resorted to a fertility doctor because I want to try and let it happen naturally first. But, I do not want to wait too long because I know women with endometriosis are encouraged to have children asap.

My question to you is, could my endometriosis have spread during the birth control or Lupron and gone to my ovaries? Should I have another laparoscopy to see if it has spread or if the injections even helped? Would my disease harm my pregnancy if I ever do get pregnant? Is the Lupron out of my system (it's been 8 months)? And lastly, any suggestions on trying to concieve with my disease and also just dealing with my disease in general, especially with that one day a month when I first start my period that is just so painful words can't describe?

Sorry for so many questions but with me being so young, people kind of don't want to help you get pregnant and tell you to just wait or that I am too young to be trying to get pregnant so young. But I feel like its something that I need and want and so does my fiance. We own our own home and financially and mentally feel that we can do this. Now its just making it happen!
Thanks for you time and help.

Hello....let me answer your questions one at a time, since there were so many of them.

1.Birth control pills are not a good treatment for endometriosis because they contain estrogen, which feeds the endometriosis. The progesterone component helps a little, but it would have been my last choice. Lupron is the treatment of choice followed by Depo Provera. So, it is very possible, and likely, that the endometriosis has worsened over time. That is in its nature to do.

2. Another laparoscopy would be indicated, but that depends on the stage of endometriosis that was found to begin with. If you had stage III or stage IV, then the laparoscopy does nothing to help your cause (i.e. getting pregnant). In that case, I would go directly to IVF to achieve pregnancy. If you had a lower stage, then repeat laparoscopy with treatment might help you to become pregnant.

3. Endometriosis will not harm the pregnancy. In fact, pregnancy is a great treatment for endometriosis and that is why we recommend getting pregnant as soon as possible. Unfortunately, getting pregnant is not easy with endometriosis. This disease, whether it is on the ovaries or tubes or not, can prevent pregnancy no matter where it is located because it causes the pelvis to be inflamed. That inflammation kills the egg upon ovulation. Therefore, the entire pelvis tends to be a hostile environment.

4. The Lupron is out of your system by now.

5. As I mentioned above, your treatment would depend on the stage of endometriosis that you have, but the bottom line is that you should try to get pregnant as soon as possible. You certainly have options. You could have a repeat laparoscopy, with treatment of the endometriosis surgically, followed by another course of Lupron Depot for 3-6 months, then aggressively try for pregnancy (possibly IUI's ) or you could proceed directly to IVF. Based on the fact that your doctor said he could not get all the endometriosis out in the first laparoscopy, I would presume that you had stage III or IV endo. In that case, the treatment of choice would be IVF. This is the only treatment that can bypass the endometriosis and get you pregnant. The pregnancy will then help your symptoms, because you won't have periods and, it may even CURE the endometriosis (pregnancy is a great treatment for endometriosis). This latter option is what I would recommend for you.

It sounds like you are NOT seeing the right physician. You should not have to wait so long. I would recommend that you see a fertility specialist so that you can become pregnant as soon as possible. The problem with endo is that it worsens with time. You don't want to end up having a hysterectomy, and not be able to get pregnant, because the pain is too severe and you waited too long!

I have had quite a few patients with the same problem that you have. They opted for IVF and got pregnant. Afterwards, they ended up having a child or children naturally as well, all because the endometriosis they were afflicted with had been resolved by their first pregnancy.

I hope this helps.

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. Hi I am to 30 years old. I am stage 4 with endomitriosis and trying to conceive but is not working. I was on a birth control shot and I stop taking it in July. and I didn't still not receive my period yet!
    How was 18 years old and I had bad mental pain each and every month. and I didn't know that I had endomitriosis until later on and life. now I'm trying to conceive but I don't know what else to do, and I will like to know that to anybody have a vice to give me?

    1. Hello,

      If you have stage 4 endometriosis, then your only option for fertility treatment is IVF. Stage four endometriosis means that your pelvis has severe scar tissue which, not only impedes the egg from reaching the tube, but the increased inflammation destroys the egg. The only way to get pregnant is to take the eggs directly from the ovaries and bypass the pelvis and endometriosis. That is what IVF does. Sorry that I cannot offer you any better options. Anyone who says they can is not telling you the truth or they don't know any better.

      Good Luck

  2. Hi Dr. Ramirez,

    Thank you so much for your blog. It has been a huge source of helpful info!

    I was wondering if you might be willing to give me your opinion regarding my case.

    I'm 31, with stage 4 endo (dx in 2010). I've had 4 endometriomas removed (via 2 lap surgeries-- first surgey was 10cm and 4cm, second was and 6cm and 2cm) and now I have another endometrioma on one of my ovaries that is 6cm. I am currently seeing an RE, and both he and I think I should have another lap and have the cyst removed, then start my first cycle of IVF.

    My day 2 labs were: FSH 8.9 and estradiol 61. No AMH was done. I had a total of 9 antral follicles (only 3 could be seen on the ovary with the endometrioma).

    Given I'll have had three surgeries on my ovaries prior to IVF, I believe that IVF is most likely not going to work. My RE has told me (regarding IVF probably not working) that I am a realist, and that is a good thing. I feel like I need to try IVF however before having a hysterectomy.

    What is your opinion regarding my case?

    Thanks so much!

    E. from CA

    1. Hello,

      IVF is definitely going to be the treatment of choice with stage four endometriosis. With that plan in mind, I would agree that having the endometrioma removed first would give you the best chances of pregnancy in that attempt.

      Good Luck

  3. Hi. I just had my Semi-IVF but it failed. All my test since day 1 until my blood test after my embryo transfer were all very good. They transfer 2 fertilized eggs, one is with 8 cells whiles the other one has 4 cells. I take the medications properly, no jogging or light lifting, more water intake and lessen soda as much as i can, had very very light cramps for a few seconds and NO BLEEDING EVER. Today is my 13th day when i had mu 2nd pregnancy test thru bloodtest and its FAILED. I called my doctor buy she cant also explain how iy happens and just promise me that she will review my test...2 days to go and it will be my 2WW, shall i wait for that and try again or even wait for my period to be missed? PLEASE ANYONE. THANKS...i feel so awsful right now...

    1. Hello,
      I'm sorry that your cycle failed. There is no way to know exactly what caused the failure. Once the embryo is replaced into the uterus, there are still four steps left for a pregnancy to occur and these are natural steps: the embryo has to develop into a blastocyst, it has to hatch and exit from its shell, it has to attach to the lining and the lining needs to growth over the embryo (implantation). It could have failed at any one of these steps and we do not have the technology to make these steps happen. Just like a woman trying naturally has to try several months before a pregnancy occurs, with IVF you sometimes have to try several times because of these last natural steps.

      Good Luck

  4. Hello
    I had 2 embryos transferred at a 5 blastocyst last week today is day 6 after my transfer and I went to use bathroom and wiped and a spot the size a dime in red blood appeared wiped again and nothing should I be concerned this is also my second ivf attempt first one I lost at 9 week could not find heart beat



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