Endometriosis and Conception

Question:

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.

Answer:

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.

www.montereybayivf.com