Endometriomas - what should I be asking?

ImplodingChickens

I had my sonohysterogram/mock transfer this morning to prepare for our first round of IVF with ICSI (due to motility & morphology issues).  During the ultrasound, my RE found a 30-ish mm cyst on each ovary, which he thinks are endometriomas.  His opinion is it looks like stage 3 or 4 endometriosis.  

I managed to think a few questions at the time.  He said that he doesn't think we need to do anything about them, that draining them carries a risk of infection and it's not worth it.  They shouldn't be a problem with IVF, he can work around them during the ER.  My AFC was 8 on the right and 7 on the left, so he doesn't think that they are impacting egg development.  He said that this just reinforces his opinion that going right to IVF will give us the most success.

But then of course I came home and googled, and now I'm freaking out.  I read that it may cause a poorer response to stims, results in fewer embryos, and overall a lower success rate.

I have my meds lesson in a few hours with the physician's assistant, and I'm trying to figure out if there is anything else I should ask when I see her.  Any guidance (other than leave google alone)?

Mrs.Umm

First - step away from google! WebMD is the Devil!

 

Seriously though, I have two endometriomas (one on each side) that usually measure between 20 and 30mm. They tend to grow a little during stims, but not too much. I've had them for about 2 years now (that I know of). 

The first RE we met with suggested IVF with ICSI because of the combination of my endo and DHs SA. Not knowing anything else, we were ready to jump on board.

Then we met with REs #2 and 3. Both suggested we try at least 1 or 2 rounds of IUI with injects first. This was partly because of our insurance (covers up to 3 IUI attempts, but absolutely nothing for IVF) and to "experiment" with meds. Both made a really good point that since we'd be doing injects, we could test doses and see how my body responds without going into massive debt for an IVF cycle that may or may not work.

So far, we've done 2 IUIs. I responded well to both, with 3 mature follies the first time and 2 the second. In fact, I responded too quickly, and almost ended up cancelled this cycle until we lowered my dose. 

Now, I'm not pregnant yet, and I have no idea if IUI #2 will work. One concern that all the REs I met with had was egg quality, and not so much quantity, in a medicated cycle. But, I'm glad we tried it. I'm glad we know how I respond to meds to better plan for and IVF cycle. The only thing we don't know is about egg quality.

 Gl to you!