I have a big decision to make and need your input

Ok, here is the deal. This will be long (sorry).

I met with my RE today. I asked her what is the longterm plan here. She recommended IVF. I asked whether it's worth pursuing laparscopic surgery first and she said it might be worth a try, but she believes, even if I have endometriosis, she doesn't think it is severe enough to be a complicating factor in my fertility. But, she conceded, you just never really know.

Here is my history. About 10 years ago I was getting the worst AF pain, to the point where I passed out. My doc put me on BCP's and the pain never returned.

Fast forward to 3.5 years ago. Dh and I decided to start TTC. I went off the pill that I had been on for 10 years. We used condoms for 2 months upon my doc's recommendation and the first month we actually tried, we got pregnant. I miscarried at 7 weeks. One week later I got pregnant again and carried to term successfully. I had my daughter by emergency c-section on Sept. 24, 2005.

January 2007 we decided to TTC again, so I went off the pill. Nothing happened. Started charting in July. Still nothing. Started the CBEFM in August. Still nothing. In October, 2007 I finally consulted with an RE.

During the battery of tests I underwent we discovered three things. First, my TSH levels were off. They were 9.5. With Synthroid we've gotten it down to 2.

Second, she noticed a cyst on my ovary. She thought it was a dermoid cyst but she sent me to get an MRI just in case. The MRI shows it is small, less than half an inch, but that it is, in fact, an endometrioma, which indicates I do have endometriosis. The question being, is it mild, moderate or severe. My RE believes it is mild because the cyst is tiny, because I have no other symptoms, the HSG was clear, and because I got pregnant so easily with DD. Note, too, the cyst was not present on my ovary when I got pregnant with DD.

Third, two post-coital's showed I have hostile CM.

So far we have done 2 unmedicated back-to-back IUI's. After those didn't work, we proceeded with medicated IUI's. The first medicated cycle only produced one egg. The second medicated cycle on follistim produced 3 eggs. None of them have worked. We plan on doing ONE more medicated IUI and then we have to make a decision on how to proceed from there.

So I'm at a crossroads now. I can either elect to do the laparscopic surgery next month to see if I have endometriosis and to what extent. If it is there, she will scrape it out at that time, or depending on how severe it is, may treat it with medication for a few months, and then we'll go back to the medicated IUI's.

Or, I can go straight into IVF.

We do not have coverage for IVF although I DO have drug coverage so my cost will be roughly $8k. We are lucky in that we DO have the money. We CAN afford it, but it will certainly be tight for us.

My RE believes I'm a very good candidate for IVF. I have, in her own words, "perky" ovaries, and respond quite well to the stims. My husband has excellent numbers, over 100 million count with usually 75+% motility. And I'm still fairly young, at 33.

So, if you've read through this schpiel without falling asleep, please tell me, what would you do?

Message edited 7/15/2008 12:22:05 PM.

Re: I have a big decision to make and need your input

Honestly Beth I think you are ready for IVF. I know money is an issue as it is for many of us who may do this, but I agree with your RE.


Having said that though, we know our bodies and it's possible that with the surgery you could find out something but then what? Scrape it out of there is anything? What impact will that really have? Has the RE explained if that's really significant?

Hard choice..whatever you decide I will be standing by your virtual side cheering you on!

Re: I have a big decision to make and need your input

Being someone who avoided IVF for 3 years, I understand the decision. My advice though, is to go for it as you have tried other avenues. I do not know a lot about endo but I do know you could have very few symptoms and have lots of it or you could have lots of symptoms and only have a bit. I might ask for a water sono or for them to somehow look at your uterus with a scope before IVF to make sure the lining is sufficent to support a pregnancy. best of luck. IVF is really not that hard IMO. It is a few weeks of PITA for the best reward ever

Re: I have a big decision to make and need your input

Posted by Blu-ize

Honestly Beth I think you are ready for IVF. I know money is an issue as it is for many of us who may do this, but I agree with your RE.


Having said that though, we know our bodies and it's possible that with the surgery you could find out something but then what? Scrape it out of there is anything? What impact will that really have? Has the RE explained if that's really significant?

Hard choice..whatever you decide I will be standing by your virtual side cheering you on!

Re: I have a big decision to make and need your input

Posted by melijane

Being someone who avoided IVF for 3 years, I understand the decision. My advice though, is to go for it as you have tried other avenues. I do not know a lot about endo but I do know you could have very few symptoms and have lots of it or you could have lots of symptoms and only have a bit. I might ask for a water sono or for them to somehow look at your uterus with a scope before IVF to make sure the lining is sufficent to support a pregnancy. best of luck. IVF is really not that hard IMO. It is a few weeks of PITA for the best reward ever

Message edited 7/15/2008 12:30:25 PM.

Re: I have a big decision to make and need your input

I think you should head to IVF since you have exorted other attempts at IF. I am not sure I would put myself through the laparscopic surgery without their being a guarantee that an IUI would work. Since you can afford it too, I would just go to that step. I am sure that your RE is giving you all the options but ultimately would like to see you pick IVF. You seem to be a good candidate for it

Re: I have a big decision to make and need your input

Posted by Bxgell2

Posted by melijane

Being someone who avoided IVF for 3 years, I understand the decision. My advice though, is to go for it as you have tried other avenues. I do not know a lot about endo but I do know you could have very few symptoms and have lots of it or you could have lots of symptoms and only have a bit. I might ask for a water sono or for them to somehow look at your uterus with a scope before IVF to make sure the lining is sufficent to support a pregnancy. best of luck. IVF is really not that hard IMO. It is a few weeks of PITA for the best reward ever

Oh no, I understand the reality and DH and I are totally on board for doing IVF. I just don't know at this point whether it's worth doing the laparscopic surgery BEFORE we shell out $8k. Is it a waste of time, energy and money? Or is it worth the invasive procedure? I just don't know. I would hate to spend all that money for IVF and then for it not to work, and then I'm left with all these "what if's", you know?

But I also hate the idea of doing an invasive procedure that will waste even more time and money.

Re: I have a big decision to make and need your input

I was given the option to have laproscopic surgery for ovarian drilling. Totally different than what you're experiencing- but when I asked my dr for a %, he said it was a 50/50 that it may or may not get my body to start ovulating.... those odds weren't good enough for me and DH and I agreed on IVF... it was not IMO in my best interest to have a surgery that may leave me feeling uncomfortable and then have to wait however long to heal, and possibly not have the outcome that we wanted from it... instead I chose to take that time to look into new drs w/ their own labs and grants, and am very happy where we are now.
I 'think' I'm half way done w/ stimming and I agree w/ PP- it's not as bad as I expected it to be (so far). If you're dr feels you have perky ovaries then you'll probably be an awesome responder to IVF- which I 'seem' to be as well (knock on wood)... which again I think is a great benefit, b/c you'll have embryos to cryopreserve in the event that the first cycle didn't work or if it did and you wanted more children down the road. HTH and doesn't confuse you more. GL w/ whatever decision you make!!!

Message edited 7/15/2008 12:46:21 PM.

Re: I have a big decision to make and need your input

I might reconsider getting a 2nd opinion. It doesn't hurt to have another RE look at your records and maybe, there is something your current RE missed. If the second RE has the same suggestions, I would get the surgery first.

Sure, IVF is a breeze to go through for some but, when it doesn't work, you will have all the what if's going through your mind. It's an emotional roller coaster and you want to have everything taken care of before you start. Trust me, I'm still over analyzing every step of my last cycle to figure out what I could have done differently to make it work. I've come to one conclusion, not sure if it's it but, I'm working on the issue now. I want to be in near perfect condition before I try again.

Re: I have a big decision to make and need your input

I had a lapo done on 4/10 and the found moderate endo. My RE started with blood work (they found thyroid) so got on synthroid for a couple of cycles,went back and he said hsg was next, had that done and both tubes were clear. Lapo was the next step. I never had any symptoms before but he wanted to rule it out. The RE said I would not get pregnant the next 2 cycles because your body is still infamed and destressing. He said that with endometriosis there is a fluid that develops as well that propels the sperm so he sucked all that out. He thinks I should be able to get pregnant on my own and is giving me to sept. The first 2 cycles after the lapo I tried to conceive nothing happened, I just started my 2 week window today so we will see what happens. If you dont want to waste time I would do the IVF but if you think you have endo I would do the lapo and get it all cleaned out. If you ever stop the pill your periods will definetly not be painful anymore. Good luck!

Re: I have a big decision to make and need your input

I had the exact same decision to make last month. I've done several injectable IUI's but was not successful. I also responded really well to the meds and my husband sperm is fine.

I also have no insurance coverage and was deciding between just moving on to IVF or doing lap surgery first as a last ditch effort to see if there is anything going on that the other tests have not discovered. I do have some symptoms of endometriosis and a slightly bicornuate or"heart" shaped uterus, so they want to investigate these.

I went back and forth on the surgery for a while, but after talking to two REs in my practice, I have decided have it. It's scheduled for next week and I'm nervous, but looking forward to the possibly of find out answers and maybe even correcting something that will help

Re: I have a big decision to make and need your input

Beth, why are you so opposed to another opinion? How about taking a trip to NY and see someone at Cornell or RSNY (jersey?)

Just for another opinion? To help you make your decision.

I know you love your RE but there is a difference and all doctors are not the same and have different knowledge and experience. Think about the doctors our of the scope of REs..you would get a second opinion if you were faced with another medical issue no?

Re: I have a big decision to make and need your input

Beth, if I remember correctly you are in Philly, right? I highly recommend (and I know other girls on here do to) RMA of NJ. I know it's not around the corner, but...

If you do decide to stick with your doctor, it does seem like IVF would be your best bet - since your DH has no male issues and you have "perky" ovaries (lol). I feel like it would be successful.

Re: I have a big decision to make and need your input

I might consider a second opinion in your case but I know that my RE would probably tell you to go straight to IVF.

Re: I have a big decision to make and need your input

What effect, if any, would the extent of endometriosis have on the likelihood of IVF success?

Re: I have a big decision to make and need your input

I can't give you advice about IVF. I haven't gotten to that point yet. I did however wanted to let you know that I have Severe, Stage 4 Endometriosis. It was first discovered with a cyst on my right ovary while I was PG with Caiden (my first), but at the time, the biopsy was inclusive to being Endo. Then before we got PG with Connor (my 2nd) I was having pain during intercourse so I went to the doctor and was sent to the radiologist. It was then they discovered 10cm worth of chocolate cysts on the same ovary. So, I then had to get a Laporoscopy. It wasn't that bad at all. I was very scared too. I had the Lap done on Dec. 2, 2005, I got one period and ovulated on Dec. 30, 2005 and got PG that first month. So for me, and actually a lot of people if you have Endo and you have a Lap to get "cleaned out", it's helps to get PG. I still had a lot of small Endo all of over. Too small to scrape, but the huge cysts and anything else was removed. Thankfully my tubes were perfectly fine. Anyway, I would try the Laporoscopy first. You never know. You might or might not have Endo, but at least you'll know. The recovery is not bad at all. I had the surgery when Caiden was 23 months old. It really only hurt/was sore the first couple of days. But it's a personal decision. If you have the money, go for it. Since we don't have the money we would probably have to try everything else we possibly could to get PG.

Good luck!

Re: I have a big decision to make and need your input

Re: I have a big decision to make and need your input

I would get the lap....then try a medicated IUI one more time. If it fails, then move to IVF.....tough call, though!!

Re: I have a big decision to make and need your input

Posted by leighdvm

I would get the lap....then try a medicated IUI one more time. If it fails, then move to IVF.....tough call, though!!

Re: I have a big decision to make and need your input

Thanks everyone This certainly helps!

I am not opposed to getting a 2nd opinion, but the problem is the last time I attempted to get a consult for one, the earliest opening was 2 months away and I don't want to stall waiting for a 2nd opinion. But, my ob/gyn did recommend to me another RE practice close to my home in which the two RE's specialize in endometriosis. So, I will give them a call and set up an appointment.

I asked my RE what effect, if any, would the endometriosis have on the success rate for IVF. She indicated the research shows there really is no effect. There is only one study that indicated that when you have endo, it may cause you to have antibodies that interfere with implantation, but that research is controversial and never supported by anything else. I did some of my own research on the issue, which shows the same thing.

So, for us, going the advantage to doing the laparscopy is that IF I do have severe endo, they may be able to treat it, which may give us a greater chance of conceiving without IVF. That's a nice benefit considering we're paying for IVF out of pocket, but my insurance coverage for everything else is pretty good.

The reason why I'm not THRILLED with the idea of doing the laparscopy is simple. I'm a baby. I'm scared of surgery, no matter how minimal, and I'm TERRIFIED of getting an IV. I know it's probably required of IVF as well, but I'd rather just pick one and do it, rather than torture myself with both. Stupid reason, I know.

So, I think I'm leaning towards taking one last ditch effort and getting the laparscopy done. In the meantime I will set up an appointment for a 2nd opinion. Now, I just have to get Dh on board

Re: I have a big decision to make and need your input

Beth...I had the lap done before I did my injectable IUI's...I did not had endo, but I had some other issues (only 1 tube, unicornia uterus), so the RE did the procedure to "map things out" as he called it. the sugery itself was a piece of cake...I didn't feel a thing and I was back on my feet the next day.

My plan was to exhaust all my IUI's covered under my insurance before moving onto IVF, because IVF was not convered. Luckily...we got PG on IUI #5 (2nd round of injectables). The injectables are similar to the meds given for IVF.

If your insuance covers the lap, I would do the lap as you said, as your last ditch effort. If there is no endo found, or anything else, you can then go onto IVF with a clear mind that you tried everything in your power. Good luck and lots of

Re: I have a big decision to make and need your input

i think i would just go straight for IVF rather then put myself through the lap and not even knowning it will help with another IUI JMO

Re: I have a big decision to make and need your input

I think you have a good plan now. The real problem is, you don't want to waste time. But, you can't push time with this. You need to do what is right for you. And if taking a little time to get 2nd opinion, for peace of mind, then that is what you should do.

I had ear surgery when I was 18. I have this weird thing in my left ear and we had gone to this one doc who wanted to do surgery behind my ear. So, we got a 2nd opinion. I really like DR #1, he was one of the best in his field. DR#2 agreed with the diagnosis but he was going to do surgery from the front of my ear. This was something new (he was younger than DR#1) and it would avoid a possibility of the ear collapsing inside itself (can you imagine?). Well you can guess who we went with (yes#2). I would never had thought that we would go with our 2nd opinion doc. But, you never know. My ear is good now, and there isn't even any scar.

Just don't make yourself nuts with time. You are 33, so in my book you have some time to look into this.

Re: I have a big decision to make and need your input

I would deal with the endo first. If there is any slight chance of the endo interfering with the implantation of the embryo, I wouldn't risk that in an IVF.

Also, have you been getting your periods reguarly and with regular flow? How is the cramping?

Re: I have a big decision to make and need your input