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Thread: Endometriosis & how to proceed

  1. #1
    Join Date
    May 2012
    Posts
    1

    Default Endometriosis & how to proceed

    Hello Dr. Saleh,

    Thank you so much for taking the time to respond to this forum. It is incredibly informative.

    My history:
    31 yo female
    - Stage 3-4 endometriosis officially diagnosed at age 17 (1998) after laparascopy, placed on continuous suppression, scarring to left tube
    - 2nd laparascopy performed 2004, new lesions found on bladder, hysteropexy performed, placed on provera for 1 year, IC diagnosed & treated
    - mild to moderate Crohn's dx diagnosed at age 11 (1991), placed on prednisone & ASAs for years, Imuran started in 2004
    - moderate asthma at age 1
    - suspected to have some kind of overall "immune problem"
    - cousin has anti-phospholipid syndrome & crohn's which was found to be on my paternal side

    34 yo husband - happy & healthy!

    Fertility history:
    Came off of BCPs in fall of 2008, had 60-70 day cycles without pain or abnormal bleeding between periods. After 6 months consulted IF Clinic in Cleveland. Recommended IVF but got pregnant with healthy baby cycle before treatment. Stopped Imuran upon becoming pregnant and switched to Entocort. Restarted continuous BCPs after birth and continued Entocort.

    Came off of BCPs in December 2010. Had lengthy cycles without pain or abnormal bleeding between. Continued exclusive breastfeeding which I stopped in May 2011. +HPT in July 2011. Missed miscarriage diagnosed at 14 weeks. D&C performed. No testing done except to confirm products of conception.

    Following D&C cycles are 32-35 days apart, painful with light post-menstrual vaginal bleeding and cramping occurring from cycle day 10 to approximately day of ovulation (period lasts roughly 5 days). Intercourse is painful (was painful prior to being placed on continuous suppression).
    Clomid 50mg days 5-9 started. 2 cysts ruptured during first cycle. Chemical pregnancy occurred during 2nd cycle. Stopped after 3 cycles due to no success.
    Back to having cycles without medication and post-menstrual bleeding and significant discomfort has returned from roughly cycle day 10-18. Intercourse is well timed and pregnancy has been unsuccessful. Discomfort is starting to interfere with every day activities as it did when first diagnosed.

    Basically, I have had two miscarriages since my live birth. No further testing done to include checking for anti-phospholipid syndrome. I am no longer on the Imuran. My cycles very much resemble the cycles I had for 1.5 years prior to my first laparoscopy and I am in discomfort most of my cycle. I live in Napa, CA and have been referred to a local RE.

    Is is possible that my endometriosis has worsened now that I have been off continuous suppression or being pregnant for 18 months? Is there an immune issue that is interfering...not being on the Imuran anymore or having an immunologic implantation dysfunction?
    Can any board certified RE properly diagnose & treat an immune related issue or do I need to travel to SF or UC Davis area?

    Thank you in advance for your time!

  2. #2
    Join Date
    Nov 2015
    Posts
    3

    Default

    The influence of endometriosis on embryo implantation

    1) Impacts on oocytes and embryo quality


    The study has found that, if the donated oocytes are from endometriosis patients, the recipients will have a decreased pregnancy rate and implantation rate. It is obvious that this is caused by affected oocytes and embryos. Peritoneal fluid flows into the fallopian tubes and uterine cavity, playing an important role in the stability of the environment for embryo growth. So the change of peritoneal fluid composition can directly act on the embryo, causing its development retardation and even death.


    Studies have also shown that the endometrium can induce inflammation in the abdominal cavity, increasing the quantity of macrophage, many cytokines, prostaglandins and adhesion molecules. And some of these increased contents will be toxicant to embryo.


    2) Impacts on the endometrial receptivity


    The endometriosis patients will have an increased level of prostaglandins. And this stimulates the uterine contractions. It is estimated that the contraction of endometriosis patients is three times than that of the normal females. Once the uterine contraction varies, the sperm conveying and embryo implantation will be affected, declining the ability of getting pregnant.


    2. Methods to improve the embryo implantation rate of the endometriosis sufferers


    1) The application of GnRH-a


    Up to now, it is only a long-time use of GnRH-a that works. Adoption of GnRH-a for 3 to 6 months before IVF will increase about four times of pregnancy rate.


    2) Anti-inflammatory therapy


    The NSAIDS can inhibit the production of prostaglandins. Through lessening the uterine contraction, NSAIDS increases the success rate of embryo implantation.


    3) TCM treatment


    Patients can take patent medicine fuyan pill. Fuyan pill can promote blood circulation, nourish spleen and eliminate pathogens like bacteria, virus and chlamydia. This method has been accepted by more and more patients for its effectiveness, safety, low recurrence rate and no side effects. More important, endometriosis patients can be cured through this treatment. There is no need to have an IVF.


    4) Surgical treatment


    It has been proved that surgeries can treat endometriosis and improve the natural conception of endometriosis patients. Surgery removes the lesions in the surface of abdominal cavity and pelvic cavity. In this way, it can improve the virulent environment in pelvic cavity, reducing the growth chance of lesions in the process of ovulation induction.

    Quote Originally Posted by ferrelea View Post
    Hello Dr. Saleh,

    Thank you so much for taking the time to respond to this forum. It is incredibly informative.

    My history:
    31 yo female
    - Stage 3-4 endometriosis officially diagnosed at age 17 (1998) after laparascopy, placed on continuous suppression, scarring to left tube
    - 2nd laparascopy performed 2004, new lesions found on bladder, hysteropexy performed, placed on provera for 1 year, IC diagnosed & treated
    - mild to moderate Crohn's dx diagnosed at age 11 (1991), placed on prednisone & ASAs for years, Imuran started in 2004
    - moderate asthma at age 1
    - suspected to have some kind of overall "immune problem"
    - cousin has anti-phospholipid syndrome & crohn's which was found to be on my paternal side

    34 yo husband - happy & healthy!

    Fertility history:
    Came off of BCPs in fall of 2008, had 60-70 day cycles without pain or abnormal bleeding between periods. After 6 months consulted IF Clinic in Cleveland. Recommended IVF but got pregnant with healthy baby cycle before treatment. Stopped Imuran upon becoming pregnant and switched to Entocort. Restarted continuous BCPs after birth and continued Entocort.

    Came off of BCPs in December 2010. Had lengthy cycles without pain or abnormal bleeding between. Continued exclusive breastfeeding which I stopped in May 2011. +HPT in July 2011. Missed miscarriage diagnosed at 14 weeks. D&C performed. No testing done except to confirm products of conception.

    Following D&C cycles are 32-35 days apart, painful with light post-menstrual vaginal bleeding and cramping occurring from cycle day 10 to approximately day of ovulation (period lasts roughly 5 days). Intercourse is painful (was painful prior to being placed on continuous suppression).
    Clomid 50mg days 5-9 started. 2 cysts ruptured during first cycle. Chemical pregnancy occurred during 2nd cycle. Stopped after 3 cycles due to no success.
    Back to having cycles without medication and post-menstrual bleeding and significant discomfort has returned from roughly cycle day 10-18. Intercourse is well timed and pregnancy has been unsuccessful. Discomfort is starting to interfere with every day activities as it did when first diagnosed.

    Basically, I have had two miscarriages since my live birth. No further testing done to include checking for anti-phospholipid syndrome. I am no longer on the Imuran. My cycles very much resemble the cycles I had for 1.5 years prior to my first laparoscopy and I am in discomfort most of my cycle. I live in Napa, CA and have been referred to a local RE.

    Is is possible that my endometriosis has worsened now that I have been off continuous suppression or being pregnant for 18 months? Is there an immune issue that is interfering...not being on the Imuran anymore or having an immunologic implantation dysfunction?
    Can any board certified RE properly diagnose & treat an immune related issue or do I need to travel to SF or UC Davis area?

    Thank you in advance for your time!

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