How to treat and manage endometriosis AND still become pregnant

February 7, 2006 - Tuesday
7:56 PM to (EST)
Guest Speakers: Dr. Nora Miller
Connecticut Fertility Associates

Categories
Acupuncture • Donor Egg • Endometriosis • IVF • Miscarriage

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Symharmony	Is this the online class about Endometrosis?
deb_capone	yes
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Symharmony	thanks
leahshank	how does this work? do we read or do we type?
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deb_capone	both....
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kimba	Will we be starting the chat soon?
deb_capone	I hope so...I don't see dr. Miller online....
kimba	Gotcha, thanks.
deb_capone	we are supposed to be talking about managing and treating endometriosis and Still getting pregnant.
deb_capone	I am your moderator...
deb_capone	i am going to give Dr. Miller a call and see if I can reach her..
deb_capone	Thank you all for your patience.
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deb_capone	We are waiting for Dr. Miller...
Dan_Christy717	hello
deb_capone	I am so sorry for the delay...
Dan_Christy717	oh no problem
leahshank	hi everyone can you read this? I am having java difficulties!
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deb_capone	Leah, we can see you....we are having doctor difficulties...
deb_capone	Since we are waiting for Dr. Miller, we have two choices, we can 'chat amongst ourselves' for support and information or just hang for a while and hope for the best. What do you guys perfer?
leahshank	is the doctor in the room too?
Dan_Christy717	Hi everyone
deb_capone	I don't see her online and I haven't been able to reach her
leahshank	let's chat amongst ourselves!
Dan_Christy717	everyone here have endo problems?
deb_capone	Dr. Miller is getting close...
deb_capone	can't log on...
leahshank	i don't know if i have endo problems. once they mentioned that but now I will be starting ivf
leahshank	anyone else here doing ivf?
Dan_Christy717	oh ok. b4 we did the IVF thing, my wife got checked for endometriosis and found that she did have it.
Symharmony	I don't know if I have endo problems but I have painful periods and I'm having trouble getting pregnant.
Dan_Christy717	we have done it now 1 time
Dan_Christy717	didn't work.....VERY emotional
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deb_capone	YEAH Dr. Miller is here
leahshank	i'm so sorry danchristy
wordsworth22	Hi-I'm not sure if I have endo...I'm having surgery in a few days to find out...
deb_capone	Let's get started
leahshank	ok
Dan_Christy717	yes, my wife has very painful periods, hurt during sex, then her back began to hurt. thought it was her kidneys....found out it was endo
Dan_Christy717	oh ok
Dan_Christy717	hi doc
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Dr._Miller	Painful periods are a common symptom of endometriosis.
leahshank	i have always had very painful periods
Dan_Christy717	yea, my wife had that, painful sex, and lower back pain
Symharmony	I have had painful periods since day one but my cramps have improved with age...could I still have endometriosis?
Dan_Christy717	she had a ganglian cyst
Dr._Miller	Surgery is the definitive method of determining if the pain is due to endometriosis
leahshank	sex has always hurt but i thought it was because I am small
Dan_Christy717	she felt way better after surgery Oct 2004
kimba	I am in the same boat as Dan_Christy. I was diagnosed with endo in May from a lap, chemical preg from 1st IVF in Nov. Starting stims tonight for IVF #2. What are your feelings about IVF and endo---do we have less of a chance of it working because of it?
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deb_capone	Ok, gang, let's get on track with Dr. Miller. She is graciously answering your questions on managing and treating endo and still getting pregnant.
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deb_capone	THanks, for joining us Dr. Miller. We are thrilled to have you.
Melissa	I have a diagnosis of stage iii-iv endo plus two spots of focal adenomyosis. I was on depot lupron for three months to prep for an IVF cycle that failed. I am considering alternative therapy with indole 3 carbinol. Are you familiar with that and if so could you share your thoughts please. Thank you.
Dan_Christy717	We are from Minnesota Doc
Dan_Christy717	any really good doctors you know of up here?
Dr._Miller	Endometriosis can act via several ways to cause infertility: 1. tubal obstruction, 2. decreasing responsiveness to gonadotropins, 3. immunologic which is the hardest one to control for. The data says that endo patients have as a high a success after IVF as do tubal factor patients.
kimba	Thanks so much Dr. Miller!
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leahshank	when doctors monitor you during the ivf process, will they be able to detect endometrosis before the day of retrieval?
Dr._Miller	Melisssa, I would recommend trying again. As good as IVF is, it is still a 50% pregnancy rate. Don't be discouraged. I would still recommend continuing with standard therapy using lupron.
deb_capone	Dan_Christy et al...don't forget that The AFA has a wonderful referral database and we would be glad to help you in your area.
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Dan_Christy717	oh ok, thanks deb
Dr._Miller	Endometriosis can present as a blood-filled cyst on the ovary, but usually the diagnosis is not made by u/s but rather by laparoscopy/ surgery.
Symharmony	Is a lap the only way to determine if you have endometriosis? Someone told me about a dye test they can do.
Melissa	I should have mentioned that I did 3 rounds of depot lupron and 5 IVF. 3 cycles failed, one resulted in a miscarriage at 9 weeks and one was a chemical pregnancy. I feel that I need to give my body a break but I don't want the endo to get out of control. Are you familiar with Indole 3 carbinol?
wordsworth22	Dr.Miller hi-I've had multiple miscarriages and my doc suspects I may have endo...I have read that recent molecular bio research is finding that there certain differences in the reproductive organs of women with endo related to things like implantation and early development...any word on if clearing out the endo changes that body chemistry for the better?
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Dr._Miller	The HSG (dye test) is a study done in radiology to assess if the falllopian tubes are open or blocked. This could suggest endo if the tubes are blocked, but only surgery will confirm the diagnosis.
Cat	Should I continue on Gucophage. I lost a baby that died at 34 weeks.
Symharmony	thanks
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Dr._Miller	Surgery to remove endometriotic implants can help improve your chance to achieve a pregnancy.
Dr._Miller	Sorry to hear about your loss. Glucophage is used for women with PCOS or diabetes. I'm not sure why you were taking it.
Cat	PCOS
deb_capone	Thank you for joining us for tonight's Online Education Session. I am Deb Capone and I am your moderator. If you need to talk with me privately, please double click on my name in the left hand column.
Dr._Miller	You should have additional testing to rule out some other cause for your pregnancy loss.
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Cat	Like what?
Dr._Miller	A chromosomal analysis of the fetus to rule out an abnormality, testing you for a clotting problem, hormonal problem or infection.
Melissa	Not sure if you saw my second post re: my history. My understanding is that indole 3 carbinol acts to help estrogen imbalance by helping the body convert estradiol to less harmful forms of estrogen. Are you aware of any studies supporting this?
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deb_capone	Dr. Nora Miller from Connecticut Fertility has joined us tonight. Our discussion is about treating and managing endometriosis and still getting pregnant.
Dr._Miller	Again, I would continue treatment that has a history of being effective--lupron. I do not have any experience with the medication you are asking about. Sorry.
leahshank	Can acupuncture help with endometriosis or can acupuncture help with ivf in general?
Dr._Miller	Acupuncture can help improve your chances of pregnancy by decreasing your stress levels.
Symharmony	What about uterine massage? Can that help with endometriosis?
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deb_capone	Welcome Sheri_in_ct; we are talking with Dr. Nora Miller about endometriosis
Melissa	You mentioned that there can be immunologic factors associated with endo and infertility. Could you please elaborate on that issue?
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Dr._Miller	There is little data about uterine massage to say that it can help. If you are not trying to conceive yet, stay on lupron or birth control pills to keep the endo under control.
leahshank	how often should you do acupuncture in order to increase your chance of pregnancy?
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Dr._Miller	Unfortunately, endo is still a disease that we don't understand completely. Some women have difficulty conceiving or have miscarriages because of their endo. Their immune systems are not functioning properly to allow tolerance of the fetus. This means that the body rejects the pregnancy.
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Dr._Miller	Acupuncture can be done as often as it is beneficial. Some women prefer to do treatments before and after an embryo transfer or insemination.
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leahshank	Thank you.
Onecaras	Dr., I was diagnosed with stage 3 or 4 endo. I had bilateral cystetomy one year ago. first IVF cycle in Nov/Dec 05 produced zero eggs & I was poor responder to stimulating drugs. Currently have bilateral endometriomas & IVF Dr. is considering 2nd LAP before Cycle #2. can you give me your thoughts? thanks!
Dan_Christy717	Dr. Miller, here's our story as of now. My wife and I have tried all we could up to this point. #1 my wife had an autoimmune disorder called pemphigus. Not too many studies of what effects that could have on our chances. #2 She has endo, and got cleaned out 18 months ago. #3 the IVF doctor here told us my wife is a 'slow responder'. he tweaked every medicine, used up all our times we could do artificial incem, so we tried IVF. She grew 5 follicals, retreiving 5 eggs. Only two of those eggs were 6, whatever that meant (the size of egg, or 6 cells I guess?), only three could be used. So he put those three eggs back in. She took a week off, and bed rest. Didn't work. We have decided we are not going to adopt. We want to have our own child. What should our next step be, and should she maybe go in to get another laprioscopy? WOuld our insurance cover another Lap?
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Dr._Miller	You absolutely should try again! If your wife is having signs of endo again, she may want another laparoscopy. Insurance covers surgery.
leahshank	is endometriosis hereditary?
deb_capone	We are grateful to have Dr. Nora Miller, MD from Connecticut Fertility here tonight sharing her expertise on endometriosis.
sheri_in_ct	Do women with endo have a better chance with DE or will their body still reject the pregnancy? I have endo stage 4. I have had 3 laps and started IVF 6 times (only made it to ER twice). I am 37.
Dr._Miller	There are several theories as to the origin of endometriosis, but it is not considered to be a disease that is inherited.
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Dan_Christy717	I just asked her and she said she doesn't have any signs yet. No more painful periods, no more back pain, and sex doesn't hurt. She said it was so bad before she had the surgery.....I guess they could do that test again to see if the tubes are blocked...
Dan_Christy717	thanks Doc
Dr._Miller	You have a better chance using donor egg because you have diminished ovarian reserve (poor response to the medication). You also won't need to worry about getting genetic testing because the donors are young (<32 years old).
Dan_Christy717	why do you think she is a poor responder though?
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Onecaras	Dr., I"m 30 years old and stage 3 or 4 Endo. first IVF cycle produced zero eggs from 8 folicles. Would you suggest a second LAP? What are my chances that 2nd IVF cycle would produce low/no eggs? I currently have bilateral endometriomas.
Dan_Christy717	we are both going to the gym, and getting in good shape, trying to eat better....hoping this could help
Dr._Miller	Sherri said that 4 of her IVF cycles were cancelled.
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cmvttc	hello
Dr._Miller	I wonder why no eggs were retrieved. Did you take the hCG injection? Did your doctor check your bloodwork to confirm that you absorbed the shot before retrieval? You should have had at least a few eggs retrieved, even if some of the follicles were cysts.
Onecaras	YES; took ICG. and blood work showed absored.
Dan_Christy717	yea, they wanted to get 10 eggs, freeze the left overs....only got 5, lost two, two were size 6, one egg small, but threw it in anyways to try and get better odds
jjello	OK, this might be a wierd one....I recently had a lap to remove an endometrioma, which was found during an IVF workup. During the lap the doc found lots of endo, although I've never had a single symptom (was seeking IVF for male factor). Anyway, I'm familiar with the retrograde menstruation theory of endo - I've been doing yoga for 6 years, including inversion postures when I was menstruating - could this have caused the endo? Sadly my IVF ended in an early miscarriage.
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Dr._Miller	I do think that having endometriomas inhibit the ovary from a normal response of producing many eggs on the gonadotropin medication.
Onecaras	Dr., would you suggest having a 2nd LAP before cycle 2 (march/april)?
cmvttc	Hi
leahshank	Should we avoid yoga during ivf?
Dr._Miller	Sorry about your loss. I don't think that the yoga caused your endo. Some women do not have symptoms. It sounds like you are one of them.
jjello	Thank you Dr. Miller.
cmvttc	my name is candice my obgy just told me endometriosis they have me on lurpron. how long after can i ttc?
sheri_in_ct	You mentioned that the endo might casue your body to reject a pregnancy? Will the same thing happen with DE?
Dr._Miller	I would get a second opinion from another RE in your area before undergoing another surgery. You may need the surgery to optimize your responsiveness for IVF though.
leahshank	what is DE?
Dr._Miller	Even with endometriosis, women can achieve a healthy pregnancy. I don't expect that you will have a problem getting pregnant or maiintaining the pregnancy if you choose to using an egg donor. The pregnancy rates are very high for this type of IVF cycle--70% at my practice.
sheri_in_ct	DE= donor egg
cmvttc	can someone help?
Dr._Miller	You cannot get pregnant while taking lupron. As soon as you stop the medicine, you can try to conceive.
cmvttc	thats what i had said up there
Onecaras	Dr. what are the chances that someone with stage 4 endo with endometriomas can achieve pregnancy through IVF?
cmvttc	i have been ttc for 5 years i new something was wrong i have done two laps and i have stage three endo. what would be my best chance to get pregnant at this point?
Dr._Miller	Once the lupron is out of your system , you should resume ovulating normally again and be able to get pregnant. Not all women with endo have problems getting pregnant.
cmvttc	should my obgyn do blood work to see if i am ovulating?
Dr._Miller	I recommend fertility treatment since you have infertility.
ja	do you ever refer patients to chinese medicine (accupuncture & herbs) for tx of endo?
cmvttc	it seams my obgy is only doing little then she has too
Dr._Miller	I recommend all patients get acupuncture if it will help decrease their stress.
sheri_in_ct	Why would my body reject pregnancy with my eggs, but not a DE pregnancy?
cmvttc	fertility treamts like? clomid? iui? ivf?
deb_capone	As a reminder, if you aren't a member of the AFA, becoming a "No Barriers" member is easy and FREE...go to www.theafa.org and join now.
Dr._Miller	Depending on your situation, you may need any one of those treatments. I would recommend meeting with an RE.
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cmvttc	ok
cmvttc	is there anyithing that you would recoumend for pain at the moment?
deb_capone	The AFA maintains an extensive database of fertility docs like Dr. Miller. Just call and we can give you a referral.
cmvttc	and i have a book called endometrosis is that a good book?
jude	I'm doing accupuncture for pain management of endo, it's working for me in that capacity, but I think that everyone needs to find what works for them.
Dr._Miller	An embryo that is completely foreign--both egg and sperm are different from self--for some reason, is well tolerated by the woman who is pregnant.
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cmvttc	deb i did look up the zip code and the place they gave me is the very place my best friend just got pregnant
Dr._Miller	Depending on the severity of your pain, NSAIDs, low dose of narcotics or medications preventing ovulation such as the birth control pill, may help.
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Onecaras	Dr. This is my last question, can endo destroy your eggs? My RE thinks that may be why our first cycle produced no eggs and I responded poorly to repronex and gonal-F. My FSH is under 7 and my clomid challenge test was fine as well. Thank you for your time
ja	after 9 yrs of ttc, lupron tx 2 times, multiple laps and 1 failed IVF, I conceived with Chinese Medicine at age 37
cmvttc	yep i was on bc pills did not help
Dan_Christy717	Hi Doc...I have just one more comment/question: Was causes my wife to be a poor responder? She also takes prednisone (5mg/day), but I have just learned she hasn't takin it since Dec. COuld prednisone have an effect on pregnacy? Immune system issues...
Dr._Miller	Endo cannot destroy your eggs, but it can affect the quality of them.
deb_capone	We would like to thank Dr. Miller. This has been a great session. As a reminder, we are online every Tuesday night from 8pm-9pm Eastern. Next week Mindy Berkson will be discussing how to choose surrogate and/or agency.
cmvttc	that is great ja
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ja	i recommend it
Dan_Christy717	oops, one more thing, sorry: How can the quality of eggs be tested?
cmvttc	man i got here to late
deb_capone	We have about five minutes left with Dr. Miller. It is time to get those final questions in to her and then we will ask Dr. Miller for her closing comments and/or suggestions.
cmvttc	thanks for your time
Dr._Miller	Dan, I don't think that your wife is a poor responder. It sounds like she had many eggs at her retrieval. The pemphigus, another immune system disease, could be playing a role in her fertility problems. Some docs recommend prednisone to help.
deb_capone	CMVTTC: maybe we will be able to convice Dr. Miller to join us again for another session...
cmvttc	sould my obgyn testing me for ovulation?
cmvttc	that would be great deb. my friend told me to come to this chat
Dan_Christy717	cleft lip?
Dan_Christy717	palet
Dr._Miller	If you want to try on your own and not get fertility treatments, then you should monitor for ovulation or have your doc do blood work & u/s to determine if you are ovulating.
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cmvttc	ok thank you so much for your time
cmvttc	i will be here next tuesday early lol
sheri_in_ct	Thank you, Dr Miller.
Dan_Christy717	thank you Doc
Dr._Miller	Egg quality can be assessed to some extend by a day 3 FSH & E level.
deb_capone	Dr. Miller can you give us some closing remarks---to end the session.
cmvttc	thanks again dr. miller
Dr._Miller	Even though it seems tough right now, women with endometriosis are able to conceive, have a family and control their symptoms. You just need to find the right treatment for you.
deb_capone	I would like to thank you Dr. Miller for giving us this time. I would like to invite you back for another session in the near future.
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Dr._Miller	Thank you for all of your questions. It would be my pleasure to join you again Deb.
Dan_Christy717	thanks Doc
deb_capone	That brings our session to a close. Please do join us next week-Feb 14-at 8pm Eastern.
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How to treat and manage endometriosis AND still become pregnant

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