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Endometriosis, Unexplained Infertility and More Moderated by Walid Saleh, M.D.
Dr. Saleh is listed as a Top Obstetrician/Gynecologist by The Consumers' Research Council of America and recently received a 2010 Patient's Choice Award - given to less than 6% of doctors across the USA.

Dr. Salah is a long-time advisor to INCIID. He is also a proud supporter of the "From INCIID the Heart" scholarship program. Dr. Saleh and SIRM are generous donors to INCIID's mission and very popular with patients who are looking for individualized and compassionate patient care. Dr. Saleh answer's patient questions and provides information about Endometriosis. Dr. Saleh's professional member profile is located here. Visit the Sher Institutes for Reproductive Medicine (Dallas).

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Old 07-22-2009, 11:12 PM
emlureav emlureav is offline
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Default endo in uterus???

I have a very long infertility/IVF history and feel like I am at a crossroads. I really need to some advice.

My husband and I tried to conceive for 1 year before seeking help form an RE. I have stage 4 endometriosis and he was diagnosed with low counts, motilit, & morphology. I had a lap 3 years before TTC and immediately before our 1st IVF/ICSI cycle. The cycle was a succes with 2 embryos (1- 8 cell, 1- 6 cell) transferred on day 3. Both stuck! We had twin girls at 33 weeks by emergency c-section due to a suspected plancental abruption. Both girls are typical and perfect!

Fast forward 2 years. We decide to TTC again.
*1st IVF ICSI- transferred 1 8-cell embryo...BFN
*2nd IVF/ICSI-transferred 2- 5 day blasts (1 hatched, 1 hatching...freeze 2....goooood cycle for us!)....BFN
*3rd IVF FET- cancelled due to fluid in uterus. Follow up with hysteroscopy & endo biopsy. Diagnosed with endometritis. Antibiotic course. New biopsy, all clear.
*4th IVF FET- transfer 2- 6 day blasts...BFP!!! Strong BETAs, strong heartrates! Lose baby at 11.5 weeks, no heartbeat. D&C...trisomy 13. Followed up with hysteroscopy and biopsy....all clear. NO endometritis!
*5th IVF ICSI- cancelled after ER due to fluid in uterus. The fluid was aspirated during ER and was "old blood"...also found endo in vagina. Lining was only a 6.
Spoke to nurse who relayed message from RE to begin course of antibiotics again for endometritis and follow-up with biopsy next month.

I feel soooo confused and frustrated at this point. I am not convinced this is endometritis again and feel the biopsy and antibiotics are unnecessary. I am wondering what else may be causing fluid or "old blood" to collect in my uterus. Is this a side effect of endometriosis, meds, hormone issues? Also, I should mention I have brown spotting almost entirely throughout my cycles.

I really need some advice and hope you have enough info here to help me out! Thank you so much!
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Old 07-23-2009, 11:12 AM
WalidASalehMD WalidASalehMD is offline
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I do not have the whole picture because I would have to review your records and determine if this is only a lining issue or whther there is also an egg quality issue (trisomy). I recommend an office hysteroscopy (no need for anesthesia) to determine the status of this lining. Also consider Viagra vaginal suppository to thicken the lining. Endo is not abnormal in the uterus meaning that is the normal place for endometrium. I would be happy to review your records and advise accordingly. Might I recommend that you call us at 877-665-BABY and set up a free in-person or telephone consultation with me at SIRM-Dallas. You can also contact the closest SIRM centers if you live in the States.
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Old 07-23-2009, 11:27 AM
emlureav emlureav is offline
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Thank you Dr Saleh,

I definitely do not have great egg quality, but I do not think it is the main issue. My husband had the DNA analysis done and it was normal. I am curious mostly about the fluid, why it would reoccur and how can I prevent it from happening in the future? Do you agree it is most likely not endometritis again, especially seeing it was removed and the RE described it as old blood? Does the lining just not fully shed at times with endo? My lining usually thickens great (12), just not this cycle. Could this be the case for my spotting throughout my cycles? Do you recommend the endometriosis diet at all?
Thank you so much!
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Old 07-24-2009, 11:24 AM
WalidASalehMD WalidASalehMD is offline
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I would have to look at the Embryology records. The egg is the source of life accounting for 80% of the equation. In other words, good seeds implant in most soils, while poor seeds will not implant even in the best soils. I often see fluid in the uterus and do not cancel the ET. This is not endo. An office hysteroscopy should evaluate what the uterine cavity is like. Hope that helps. Please do not hesitate to contact me for any additional questions.
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