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Endometriosis and Infertility

February 6, 2007 - Tuesday
1:00 PM to (EST)
Guest Speakers: Eric Surrey, MD
Medical Director, Colorado Center for Reproductive Medicine

Categories
Endometriosis • Infertility • IUI • IVF • PCOS • Pregnancy Loss


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foxyk91 Hi
cpvaughn06 hey
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foxyk91 how are you ladies tonight?
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cpvaughn06 I am doing well
cpvaughn06 and yourself?
foxyk91 I'm ok thanks. I've never joined in on one of these sessions so I thought I would see what it was like.
cpvaughn06 me too
foxyk91 lol..I guess we'll see together
cpvaughn06 yeah grin
foxyk91 where are you from? I'm from upstate NY
cpvaughn06 My hubby and are in SC stationed at Parris Island, SC
cpvaughn06 Are you trying to concieve?
foxyk91 ah..I've always wanted to move to NC but my hubby won't budge..lol We are foster parents up here to teens so really can't move at this time in our lives anyways
foxyk91 we have been trying for 3 1/2 yrs with 8 miscarriages
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cpvaughn06 I have been trying for a year
foxyk91 I never would have thought it would be this difficult later in life. I'm 33 with a 11 yr old son
cpvaughn06 I understand I am only 23 but I never thought I would be a woman with an infertility problem... I have PCOS and my hubby has a very low sperm count
foxyk91 They really don't understand what is wrong with me. I've been tested for almost everything but nothing seems to surface. My doc thinks I have endo but I've never actually been diagnosed with it
foxyk91 I can get pregnant, but can't stay pregnant
cpvaughn06 that is very intresting and scary at the same time... I hate not knowing what is wrong. I hope maybe they will find some answers you are looking for
foxyk91 it's deffinately been a long hard roadas I'm sure everyone feels the same way
cpvaughn06 I agree
cpvaughn06 You foster to teens? I wanted to eventually get into that but since we are military we move around to much
foxyk91 yes..right now we have 2 14yr old boys..2 19yrold girls..a 16 yrold girl & our son who is 11
cpvaughn06 have you ever thought of adoption?
foxyk91 yes but these children aren't up for adoption
foxyk91 have you thought about adoption?
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cpvaughn06 yes... we are looking into those options as well.
Corey_Whelan Wow we have a lot of early birds tonight. Hi everybody! I'm Corey Whelan, Director of Development for the AFA and tonight's chat moderator. Good to see you all!!!!!!
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Corey_Whelan In about 5 minutes, we will be joined by Dr. Eric Surrey, a world renowned RE who has lectured extensively on all aspects of infertility medicine, including reproductive surgery and endometriosis. He is with the Colorado Center for Reproductive Medicine. And here he is!!!!
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Corey_Whelan Quickest five minutes ever. Welcome Dr. Surrey. We have a number of early participants in the chat room, so, we can get started now. Please post your questions for Dr. Surrey, folks. We are very, very lucky to have him here tonight.
Corey_Whelan Please don't be shy. This is really a great opportunity to get your questions answered.
Corey_Whelan foxy, 3 1/2 years, 8 miscarriages. No questions?
esurrey It is a pleasure to join you. Please ask away.
cpvaughn06 I have a question I have PCOS and my husband has a very low sperm count and we have been give so many questions without answers... some one told us we would have to go IVF route and another said medications would just worK?
karend Can endometriosis affect the quality of your eggs?
foxyk91 well I'm not quite sure what to ask other than why can I get pregnant but not stay pregnant?
foxyk91 I've been on clomid, progesterone..had all sonos done etc but still nothing
esurrey cpvaughn06, Women with PCOS can often be helped to ovulate with various meds. Sometimes when sperm is only slightly compromised, possible to go IUI, however if sperm is very compromised, IVF may be the only approach. It would be very important to speak with an RE.
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Corey_Whelan cp, I had pcos and male factor, and conceived my twins through ivf. We have pco chats coming up next month and the month after, and a pco message board, so I request that we table pco questions for the duration of this chat - but you can email me privately at corey@theafa.org and I would be happy to talk to you.
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foxyk91 I did have a cone biopsy on my cervix done a while back & was wondering if that could have something to do with it
cpvaughn06 thank you
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jillian Is this the chat for endometriosis & infertility?
AmandaUNCC I think so, that is why I am here
Corey_Whelan welcome Jillian, you're in the right place.
jillian me too
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esurrey foxyk91, You meet the medical definition of recurrent miscarriage which is 3 in a row. It is very important to undergo evaluation to rule out possible reasons which would include blood tests to evaluate hormonal abnormalities, decreased ovarian reserve and abnormal blood clotting. In addition, it is important to make sure there are no genetic issues with you and your spouse which could also be determined through blood tests. A hysteroscopy would do well to make some evaluations. PGS with iVF could be helpful as well. It is unlikely Clomid would help your situation. Definitely speak with an RE
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foxyk91 we have done all of those tests & they were all in the limits or normal
Jennylynn Hello Dr. Surrey. Just wanted to say hello. I am currently a patient at you clinic and am so pleased with the clinic and staff. We will be undergoing IVF with ICSI in March. I am 29 with PCOS and my husband has low sperm count, but we are very excited.
Corey_Whelan Jenny, you're very lucky to be at one of the best clinics in the world. Good choice of state!
esurrey foxy, Typically cone biopsies can cause cervical scarring making it harder to get pregnant...more commonly problems in the 1st trimester
Corey_Whelan welcome lhsu. Please feel free to jump in and ask any questions about endo.
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foxyk91 all my miscarriages were in the first trimester
jillian Well I have a dr visit on the 13th b/c my endo has come back & I was wondering can I still do IVF if I am not ovulating?
Corey_Whelan Hi Tamtribb, welcome to our chat
esurrey Jenny, We will do all we can to help.
AmandaUNCC I have just had my first cycle of IVT and had OHSS. It was horrible. I have just promoted more growth of scar tissue during this?
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TAMTRIBB HELLO
jillian Hi Tamtribb
TAMTRIBB HI
MHenderson Hello Dr.
Jennylynn I have been digagonosed with endo and had surgey, but the Dr did not remove it. Can it grow and cause further complications with IVF?
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jillian I had surgery too & it could not be removed b/c it was on my colon
jillian I had to take Lupron shots
karend Can endometriosis affect the quality of your eggs as well as implantation?
AmandaUNCC It will definitely come back
esurrey jililan, endo typically doesn't prevent ovulation. Your doc needs to make sure there are no treatable causes for your lack of ovulation, however when you are receiving ovar stim meds to prepare for IVF, the drugs will stimulate matruation of eggs as long as your ovarian function is otherwise normal.
Corey_Whelan guys, let's let Dr. Surrey catch up. We have some really good questions on the board but everyone take a breath for a few minutes please
jillian Well its b/c of the Lupron
AmandaUNCC Depo Provera was helpful when not TTC but the side effects were bad for me
davinafankhauser Hello Dr. Surrey. I am 36 with an FSH of 6.9. I have had four IVF cycles over the past few years where I produce four to seven embryos (five to eight eggs retrieved), the majority of which are abnormal (genetic testing). I recently had a laporoscopy where they found Endometriosis on both of my ovaries. I'm wondering if I will produce more eggs or better quality eggs now that the Endometriosis has been removed. Thank you for your time and providing this wonderful service to the infertility community.
kris Hello I am 29 and am suffering from stage IV endometriosis. I was on birth control for 3 years and I got married stopped the pill and got pregnant our first month trying. I shortly after had a miscarriage. We then attempted ICSI, which failed and am currently looking into possibly less invasive thearpies. Is there anything new available. I am left with only one ovary and tube due to my endo. My husband and I want a baby more than anything and have been trying to conceive naturally for 15 cycles with no luck. Any advice or suggestions would be greatly appreciated.
esurrey amanda, there is no evidence to suggest OHSS, miserable as it may be, would promote the growth of scar tissue. IF your cycle was unsuccessful, it may be wise to try a lower dose stimulation.
MHenderson I have been seeing a RE for over a year - 2 miscarriages at 9wks - I asked my doctor about blood tests for autoimmune antibodies and/or clotting factor. He did not think it was necessary perhaps because I also have endometriosis. Do you think I need a second opinion. I am 40 yrs. old
TAMTRIBB I've have endo, have had two laps one resulting in bowel perforation. Still have server endo and adhesions. Have had myomectomy and recently polyp removed. Still having heavy & painful menstural cycles. At a lost of what to do?
AmandaUNCC I have not had the transfer yet due to my condition. we are waiting for another two months to let everything heal. Only 2 embryos from 43 eggs. Not good results so far :( Thanks for your input
esurrey Jennylynn, IVF is the ultimate treatment for infertility stemming from endo. There is no evidence to suggest removing non ovarian endo surgically prior to IVF improves pregnancy rates.
jillian I have been off of the Lupron since Feb 2005 & still don't ovulate & now once again my periods are out of control. I am scared to go back on the Lupron are there any other methods?
esurrey karend, It doesn't appear endo affects egg quality..there are some studies that implantation may be in some women who are missing a protein in their uterine cavity called BetaIntegrin. we have been evaluating in a research trial the potential benefit of giving Lupron to women undergoing IVF, have endo and are missing this protein.
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AmandaUNCC I am most worried about implantation. After 4 failed IUI's I wonder why nothing sticks. Now I am taking Avandia. No, I do not have PCOS. Will this help embryos stick? Is there anything else?
karend Can a bloodtest determine if your missing this protein?
esurrey davina, The ovarian surgery unfortunately will not affect quality...there is very little data to suggest otherwise. Neither the surgery nor endo will affect the genetic make-up of the eggs.
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Jennylynn If you have a small amount of endo does it just keep growing? Or does it just stay dormant? I was told it can spread to other organs also, is that true?
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Corey_Whelan Hi Red. Welcome
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redruby76 hello
Corey_Whelan Hi Kimi. Welcome to our chat on endo with Dr. Surrey
esurrey kris, there is no question that IVF would be most successful for you but also very invasive...it would be wise to check into the missing protein I mentioned earlier. the fact that you conceived suggests there are no anatomic issues...maybe less invasive would be Clomid but pregnancy rates are significantly lowered.
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Corey_Whelan great name, welcome cosmiclobster.
cosmiclobster thanks!
kris Doesn't clomid and other estrogen based fertility products feed the endo?
AmandaUNCC That's what I thought
esurrey mhenderson, I think it is always helpful to have a second opinion, it is not likely endo is the cause of miscarriages, you might consider an expanded evaluation to rule out treatable causes.
kimi hello! Dr what exactly is endometriosis? How does it differ from other adhesions? I just had a lap that revealed no endo, but 2 adhesions -- the lab said it was "inconclusive" to what they were...
evaeric What is your thinking about changing diet, accupuncture and clear passage Physical therapy to ameliorate endometriosis?
esurrey jillian, there is research suggesting Lupron treatment just prior to IVF improves preg results, even when Integrin is not evaluated. We have published a study in this regard in 2002 which reported 80% success in pre-treatment vs 54% in those who weren't. Most woman will begin to ovulate again within 3 months after Lupron therapy. No other neds designed to treat symptoms of endo has been shown to improve spontaneous preg rates.
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esurrey jennylynn, Good question!! Unfortunately, the only way to truly know if endo spreads would be to do sequential surgeries which really isn';t ethical. No evidence untreated symptomatic endo will progress in all women. it is reasonable to consider birth control pills if not trying to get pregnant,it would also make sense to delay pregnancy if at all possible.
TAMTRIBB Dr., Tamtribb can you address my question about endo and treatment.
AngelsAreEverywhere Hello Dr. Surrey. Thank you for chatting with us. I am 34f TTC 6 yrs with no success. I've had 2 laps, 1st to discover the endo and 2nd to remove it but my endo returned quickly. I'm in Canada and have waited over 2 years to be able to see an OB/GYN (No RE's where I live) I'm told it's "unexplained infertility" I do ovulate. My question has 2 parts: 1) Is endo a cause of infertility and why? and 2) what would you say my next step should be?
jillian I took Lupron b/c the endo was on my colon & could not be lasered. I had my last shot in November 2004 & the med was out of my system in Feb 2005 but I am still not ovulating since that time. I took Clomid w/ no results. Now I am heading back to the dr. to see if I can go straight into IVF. Not sure if that is possible?
esurrey kimi, endo is the prsence of uterine glands which implants outside the uterus. This disorder can cause pain in some but not all women, as well as infertlity is some. Adhesions are scar tissue which can come from many different sources such as endo or prior infection, surgeries or other types of inflammation. Surgical biopsy doesn't always completely accuratey diagnose endo sometimes it can be diagnosed visually.
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esurrey tamtribb, is your primary goal to get pregnant or to achieve pain relief. If pregnancy is your goal, IVF would be your most successful approach. If pain relief is goal, maybe consider medical therapy to suppress symptoms to avoid future surgeries.
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esurrey angels, endo can be a cause of infertility. it can cause scar tissue which may distort pelvic anatomy, woman with endo are in an inflammatory state which can make it difficult for embryos to implant. it is important to have a FULL infertility eval by a specialist, IVF may not be your only option but possibly the most successful. I recommend being seen by a RE.
naomifior I am a 32 and have been TTC for 1-1/2yrs. I was diagnosed with Endo at 22 and have had 3 laps to free up my intestines, releive pain, free a twitsted right tube, remove adhesions, chocolate cysts and part of my large portion of my left ovary (which is now completely missing - my Dr was unable to find it with multiple ultrasounds and my last lap). My insurance does not cover IVF. MY QUESTION IS THIS: What are the odds of IVF being successful with advance stage endo? We don't have a lot of $ for many tries.
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esurrey jillian, make sure your doc assesses ovarian reserve to be able to determine IVF success
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Corey_Whelan The AFA has a help line where referrals to RE's in your state can be given. It's toll free, please call us at 888-917-3777.
Heather Dr. Surrey, I am wondering if you have seen much research on the link between endo and gluten intolerance. I had an amazing decrease of symptoms after going gluten free (after being diagnosed with gluten intolerance).
corgimommy I am 26 and I've done 4 Clomid with IUI all ovulated but no preg. PCOS but on Met. Normal HSG, husband has low morphology. Wondering if I should be concerned about endo? Have a consult with my RE this week and wondering if I should ask about a lap to check for endo??
esurrey naomi, it does sound IVF is your best option. also very important to have your ovarian reserve evaled which may be compromised due to your missing ovary. it would be important to research a variety of clinics to make sure programs are successful due to your monetary situation.
TAMTRIBB thank you Dr. Yes I have a DVD from Clear Passage, are you familiar with their program and if so would you recommend it?
Jennylynn We are deciding whether or not to do the "Shared Risk Program" Im 29 with endo, PCOS and a small thyroid problem, my husband 33 has a low sperm count, and they swim in circles! Would you suggest going with a shared risk? I would just like YOUR opinion.
esurrey heather, there is some suggestion that women who have low carb diets may have symptom improvement. there is alot of info that can be obtained through Endo Association.
knogaki I am curious about any new developements with endo and IVF. I successfully conceived my first child born in October. The csection confirmed that my stage four endo has spread, and I will probably need a hystorectomy after my next child. What can I do to preserve my fertility? Should I have my next right away or can I wait? They have put me on birth control pills to help (cant believe it after all i went through to conceive!)
AmandaUNCC Dr Surrey, could you please advise on enhancing implantation rates. I just started Avandia, although not diagnosed with PCOS. what other treatments might help implantation
kris I was wondering about clomid and other estrogen products and them feeding the endo. Is there any other pill based options or something else that may help?
esurrey corigmommy, at this stage there a several treatment options which would include using Gonaditropins w/ IUI, lap or IVF. If spouses sperm is significantly compromised, IVF will help more effectively with that. Surgery would not help if it's a sperm issue.
esurrey tamtribb, I am not familiar with Clear Passage.
naomifior Thank you Dr. One other question. Is there any link between ovarian cysts/irregular cycles and lap for endo? My last lap was in Oct '06. Since then, I've had irregular cycles and many cysts in my remaining right ovary.
Corey_Whelan Tamtribb, there is positive and negative opinion about Clear Passage in the medical community. Sorry to be so vague. If you are in the NYC area, you can meet Larry Wurn at our Conference on April 29th.
esurrey jennylynn, Shared risk is primarily a financial decision not a medical one. the advantage is the refund should you not have a child after 3 cycles. however, at your age the likelihood of success with IVF is extremely high. Shared risk may be a safety net in the event of multiple cycles.
davinafankhauser Dr. Surrey, I've heard what you said before. But I wanted to check with one of the top doctors in the country. It's hard to hear, but I deeply appreciate your time and respect your honesty. Thank you for all that you do. Best wishes, Davina
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corgimommy Would a lap to look for endo be too risky -- if there is no suspesion of endo (i.e causing scar tissue)?
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puja76 Dr esurrey - I have Endo and had a lap in May 05 after which I had 2 iui's & 2 IVF's but no success - Is the implantation rate lower with women who have Endo - Is there any way to increase it???
esurrey knogaki, the use of BCP's is beneficial but not a definitive treatment for endo..I may recommend trying to conceive as soon as it is reasonable for you. there are a host of experimental drugs that are being evaluated for endo, unforturnately none are being looked as potential treatment for infertility associated with endo.
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AngelsAreEverywhere Dr. Surrey, with all the women you have treated, what would your best advice be for women living with endo?
esurrey naomi, some women have abnormal cycles after laps, but no relation between lap and occurrance of ovar cysts. there is relation between ovar cysts and irregular cycles. you may want to avoid future surgeries if at all possible.
puja76 Also would you advice to be on BCP's till my next IVF cycle which won't be befor Sept of this year
naomifior Thank you, Dr Surrey. I appreciate your time and advice.
knogaki Thank you Dr. I appreciate your time and advice as well!
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esurrey corgimommy, studies show that 30% of women with unexplained infertility will have endo. most will have few or minimal symptoms. one study from Canada suggest that surgical treatment of minimal endo improves spontaneous preg rates 3-6 months after surgery. the decision for lap has to be weighed against risks of surgery especially with no visual endo.
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kris thanks for ignoring my same question from above twice. I'm no longer interested in what you have to say. Thanks any way.
corgimommy What are risks from a lap? Thank you for all your help! You rock.
esurrey angels, your question is a little broad, but I would suggest that whether goal is pain relief or pregnancy that she seek advise from an experienced clinician who can provide multiple options for therapy and gives opportunity to play a role in chosing what is most comfortable in her unique situation.
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Corey_Whelan kris, this is a very busy chat. Please understand that fingers can type only so fast. Obviously it isn't personal. You can post your question on our message board if you choose to, or not.
donnahuneycutt Dropping in late to the party, but I hope you don't mind two questions: 1) Would you suggest that someone with symptomatic endometriosis, that had previous treatments years before trying to conceive, undergo surgery and/or GNRH treatment prior to fertility treatments? 2) Does it make sense for someone with endometriosis (but clear tubes) to undergo IUI, or should they just skip to IVF?
Corey_Whelan Folks, I need to give you a five minute heads up.
Jennylynn Thank you Dr. Surrey for you time. We hope to meet you in March. We have heard wonderful things about the clinic. GOOD LUCK TO YOU ALL AND BEST WISHES!!
esurrey corgimommy, the risks for lap are infrequent, only about 4% develop problems. these range from wound infections to damage to bowel, bladder and major blood vessels as well as other internal organs which can require further major surgeries to repair.
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jillian Thanks for the answers. Everyone have a great night.
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Jennylynn Thanks to Corey too!
Corey_Whelan Thanks Jenny!!!! Good luck to you!
Corey_Whelan But we're not done yet. Three minutes left.
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karend Dr. Surrey, I am 35 and I have been diagnosed through laparoscopy with stage IV endo. I have had 6 IUI's and 6 IVF's resulting in 3 miscarriages. I have been told that the quality of my eggs are not good. In your opinion do you think continuing IVF may be my best chance of getting and staying pregnant and if yes do you think I should go on Lupron for three months prior to my next IVF cycle?
Corey_Whelan I think that was our last question, folks.
donnahuneycutt DR.Whelan, I'd be so grateful if you could answer my questions. I promised my friend in Italy, where it's 3 a.m. now, that I'd log on and ask for her.
puja76 my question is still not answered....
Corey_Whelan LOL, Dr. Surrey. But thanks for the compliment.
AngelsAreEverywhere Dr. Whelan?
AngelsAreEverywhere lol
Corey_Whelan nope
Corey_Whelan It would have made my mother happy though
AngelsAreEverywhere hehe
esurrey donna, welcome to the party. i would recommend if you have no symptoms that your doc perform a basic eval for other issues, include ovarian reserve testing, sperm testing, etc. if these are all normal it would be more prudent to try Clomid with IUI for 3 cycles and if not then re-evaluate before moving to IVF, maybe a lap. if you have symptoms, it is still important to undergo evals, but earlier lap would make sense.
Corey_Whelan Dr. Surrey, we are SO GRATEFUL for your time tonight. Thank you so much. You gave us all much needed information to help on these journeys. And thanks also to all of you for putting yourselves out there and asking questions, so that we could all learn and benefit. I wish you all SO MUCH LUCK. Our chat is officially over, the best, best of luck to all of you and good night, and sweet dreams.
AngelsAreEverywhere Thank you Dr. Surrey - I appreciate the time that you took to speak to us
donnahuneycutt Dr. Surrey, your response is so appreciated. Thanks and have a great night.
esurrey puja, most studies suggest implantation is not lowered with less severe but opposite for more severe. if the embryo quality was compromised it may be an inherant problem. i would perform a biopsy of the uterine lining to eval presence or absence of beta3 integrin in women with endo, failed ivf and good embryo quality. if the protein is missing maybe consider GNRH agonist therapy.
esurrey Thank you very much for inviting me, it was a pleasure to participate!
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foxyk91 Pretty much..IVF was the answer to everyquestion, but what if you can't afford IVF? I take it thats it
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