Should I check for endometriosis? — The Bump

Should I check for endometriosis?

Hi all! I’m new here. I’ve been dealing with unexplained infertility for about 2 years. We have tried Femara with timed intercourse as well as iui with Femara and Ovidrel 3 times. My husband found out last month he has a small vericocele, which he plans to have corrected in a few months. Once he has that corrected we will either try iui with injectables or just go right to invitro, we’re still deciding which one. So my question for you all is, should I have a laparoscopy to check for endometriosis too? My RE says we can check for it but that considering I don’t have any family history of it and no glaringly obvious symptoms, it’s likley that I don’t have it. However, the reason I question it is because while I don’t have painful or heavy periods (in fact my periods have gotten a lot shorter, 1.5-2 days, and lighter), I do get some unexplained sharp pains as well as pinching feelings in my pelvic area often throughout the month. I sort of think, “why not just check to make sure it’s not a contributing factor?” But DH says “why have an unnecessary procedure?”. Just looking for advice! Thank you!!

Re: Should I check for endometriosis?

  • I have had 3 different RE consults over the past year (and underwent treatment with two different clinics). I *do* have symptoms of endo and likely have it, but every RE I saw did not recommend the lap. They said that whether endo was found or not,  my next step in treatment was going to be the same (IVF...had already attempted 5 IUIs) and with endo,  the plan is always to get pregnant as quickly as possible so I should just move straight to IVF. They noted while laps used to be "handed out like candy", the medical community is moving away from that practice. My RE said that if I end up with more than one failure after embryo transfers,  we can look into prepping for a FET using the same protocol they would use for confirmed endo sufferers (down regulation using Lupron to shrink any suspected endo). 
    Me: 35 I DH: 38
    *TW loss and children mentioned*
    DD:2006 | Dx: Unexplained Secondary Infertility | DS: 2011

    TFAS since 2012

    Oct 16: Spontaneous BFP | m/c @ 9w1d (massive SCH) | D&C
    Apr 17: IUI #1 = BFN
    May 17: IUI #2 = BFN
    Jun 17: IUI #3 = Late BFP (18 DPO) | NMC 17Jul17 @ ~6w
    Aug 17: IUI #4 = Cancelled due to premature ovulation | TI = BFN
    Sep 17: IUI #5 = Cancelled due to overstimulation (10+ follies)
    Nov 17: IVF #1 = Cancelled due to non-IF related health issue | TI = BFN
    Dec 17: IVF #1 = Puregon 200, Menopur 75, Orgalutran, Suprefact trigger due to OHSS risk | 22R, 18M, 16F, 10B frozen  
    Feb 18: FET #1 (medicated) = BFN
    Mar 18: FET #2 (natural cycle) = CP (beta 1: 54; beta 2: 0)
    Apr 18: FET #3 (natural cycle) = cancelled due to missed ovulation
    Apr 18: FET #3 (natural cycle) = BFP! Beta 1: 201  Beta 2: 585 Beta 3: 3254 Beta 4: 9715 U/S 19May - one bean measuring on track with a HB of 125!
    EDD: 07Jan2019 Team Green
    My Rainbow Baby Boy born 03Jan2019 <3 

  • Its a hard decision. I didn't have any of the typical symptoms of endometriosis, except my periods are a little on the heavy side, and I would get mild cramping about a week before my period would start. This was enough for my OBGYN to offer a laproscopy to look for endo.  (we had already had 6 failed IUIs and some known MFI)
    It turns out that I did have endo, but it was a pretty tiny amount (about 3-4, 1-2mm lesions). The surgery recovery was easy, but the navigating insurance afterward was a nightmare; my insurance tried to get out of covering it because certain things were coded for infertility, rather than pelvic pain (which is the reason I went to my OB).

    So if you decide to do it, check to see what your insurance covers and make sure you get all the info you can ahead of time.. it was a nightmare for us for several months.

    We had 3 natural cycles and 1 more IUI after having my endo removed, and didn't get pregnant. We ended up moving on to IVF; I don't regret having the surgery done, but I wouldn't have paid out of pocket for it. 

    Me 34 DH 36 Married since July 2010 
    MFI (High DNA Fragmentation) & Mild endometriosis
    TTC #1 since June 2015 
    Aug 2016 - May 2017  6 IUI's with letrozole - BFN
    April 2017 - laparoscopy to remove mild endo
    June 2017 - Mini IVF letrozole 12.5mg, Gonal-F 75IU - Cancelled early ovulation, no eggs retrieved. 
    Aug/Sept 2017 - Mini IVF letrozole 12.5mg, Gonal-F 75IU, cetrotide - 13 eggs retrieved, 11 mature
    5 eggs ICSI'd 6 eggs frozen - 1 day 5 blast transfered, 2 expanded blast frozen - BFP!
    May 2018 - Baby girl born - Our Joy

    TTC #2 since July 2019
    July 2019 - FET - BFN
    Jan 2020 - FET - canceled due to family health issues
    Mar 2020 - FET - low beta - chemical pregnancy
    July 2020 - ICSI'd remaining 6 eggs - 3 fertilized - 2 survived to early blast stage, transfered both - Chemical Pregnancy

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  • I'd say no, don't have a lap if you don't have endo or if you do have it, the size is not as big as 10cm. I had my 7cm endo removed through lap last Jan 2017. It didn't cause me any kind of pain at all, I just knew about it when I got confined in the hospital from an undetermined severe stomach ache/cramp and through my X-ray, dr suggested that we pay our OB-gyne a visit because a cyst was there on my ovary. DH and I agreed to have it removed because our dr said it might have been the cause why we have not gotten pregnant (we haven't started ART yet at this point). Now, DH is expressing a little regret on having that lap. He feels that it had diminished the function of my rt ovary where the endo was removed. On my last IVF, we could only retrieve 4 eggs but only 1 made it to freeze. My IVF #1 was a bust. Now, I'm doing IUI and I have a 28mm endo on my left ovary. I had my IUI 1/12 and dr prescribed Duphaston to prevent that endo from getting bigger and to improve the condition of the endometrium. About that pinching pain on your pelvic area, there could be many causes of it according to dr google, it could be from the IVF meds, muscle strain from BD or from an endo. 
  • I have some symptoms of endo but my HSG came back normal so my RE didn't recommend a lap because it wouldn't change the treatment plan.

    TTC#1 Since March 2015
    MFI and FFI
    April 2017/May 2017 - IVF
  • I also have unexplained infertility. My last FET failed so I told my RE that during what would be my luteal phase which is a week before my period I get cramping. She said it’s not really normal to get cramping at that time so she gave me a Lupron Depot just in case I do have Endo. She said she wouldn’t go as far as doing a lap though.
  • Thank you so much for your replies, ladies! I did wonder if there was even much of a point to go forward with it considering it likely wouldn’t change the course of treatment. The nurse said if there is Endo present removing it could increase our chances of getting pregnant but considering it’s all speculation and it likely wouldn’t change our course of treatment at this point I think I’ll probably hold off. Thanks again for your advice and sharing your experiences! 
  • My RE also recommended holding off on surgery and doing IVF, since endo was just suspected. During both my fresh and frozen transfer, he was able to see a cyst on one of my ovaries, confirming what we had always suspected! After both of my transfers didn't work, I am doing the surgery, but I don't regret just skipping it to try IVF first!

    TTC since 2012 | Unexplained Infertility -- Sept 2017 found cyst seemingly confirming previously suspected endometriosis | IVF Sept/Oct 2017 Negative | FET scheduled early December

    "When peace, like a river, attendeth my way, When sorrows like sea billows roll; Whatever my lot, Thou has taught me to say, It is well, it is well, with my soul."

  • @latvaughanash thank you for sharing your experience. It helps to know you don’t regret skipping it to try ivf!
  • @latvaughanash thank you for sharing your experience. It helps to know you don’t regret skipping it to try ivf!
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