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Conception in woman with endometriosis and husband with repaired varicoele

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i am 25 old , married since 2 years , i got pregnant once 1 year ago naturally which ended with misscarriege at week 7

my husband semen analysis first shows :
morphology 1%
motility 20%
count 16 mil / ml

after that he did varicocele repair and took multivitmine his semen analysis after 3 months
morphology 4%
motility 40%
count 40 mill / ml

my old test at CD 2
fsh 6
lh 4.8
prl 13
tsh 1.8

i did laprocopy 4 months ago , they told me that i had endometriosis stage 1-2 and they remove it , and i recieved decapeptyl 11.25 mg inj on 29 aug

on 4 december after 100 day of decapeptyl 11.25 my period not come back , i did tests

fsh 1.2
estradiol less than 5

dr told me that we can start I.U.I cycle
we start mini stimulatin as i had pcos
but due to no response ( follicles size after 14 day injections 7,8,9 ) we cancelled it ,

now i had hot flushes , i dont know why decapeptyl not wear off from my system
as my fsh only 1.2 and my estradiol less than 5

i hate my self , why i took this bad injection which made me feel i am 65 ,
i want to remove it from my system and start try to conceive again ,

my questions

1/ is my husband semen analysis enough to get pregnant naturally ( i want to get preganant as soon as i can )

2/ why i had pcos ( i did ovarian drilling + decapeptyl 11.25 ) so how these poly cysts formed ? i am on metformin , 25 old , 165 cm and 64 kg

3/ how can i make my hormens come back to normal and wear off decapeptyl , i hate my self due to decapeptyl side effects , can i take medicaine which remove it from my system and make my PG work again ? any tests can i do to know if it start to wear off or not ?

4/ my failed cycles ( 12 months trying ) 3 clomid cycles + 2 iui ( all failed )
what shoul i do ?
they told me i cant try stimulation with ir without iui because they afraid that all follicles grow together ? so shoul i move to icsi directly ?

Note : my blood tests before decapeptyl 11.25

at CD 2
fsh 6
lh 4.8
prl 13
tsh 1.8

my blood test after 110 days of decapeptyl 11.25
fsh 1.2
estradiol less than 5

Category: Infertility Specialist

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Category: Infertility Specialist
 19 Doctors Online

Hello,
Thanks for your consult at DoctorSpring.com
Let me answer your questions in the order in which you have posed them -

1. Your husband's count has definitely improved after varicocele repair, and spontaneous natural conception is possible with this count. However, percentage of abnormal morphology of sperms is quite high in his report. After endometriosis surgery, there is high chance of recurrence of this condition. As long as you were under the effect of Decapeptyl, it would not come back, but once the injection wears off, chances of its coming back are high.So with this report, you might take time to conceive. Taking help of IUI / ICSI will save time and speed up the process, since his report is better than before, but not optimum for conception.

2. You had ovarian drilling. This means you already had PCOS earlier also. Ovarian drilling is the treatment of choice for PCOS, so this condition did exist earlier too. The reason why some women have PCOS is not known, it is basically a hormonal disorder, and endometriosis often coexists with PCOS.

3. The effects of Decapeptyl generally last for 3 months or 100 days, so now your body will gradually start recovering from its effect. It does take time and happens gradually , not overnight. The stress of multiple stimulation cycles and residual effect of Decapeptyl plus side effects of the stimulation injections must be leaving you feeling pretty wretched. Just give yourself some time. You need not take anything to kickstart your hormones again naturally, as that will only add to the side effects. Just staying medication and hormone free for a month ( rest cycle ) will make you feel much better. FSH and serum estradiol are done to know if the effects are wearing off, and these have been done in your case. They show that residual effect of Decapeptyl still persists, so you need more time.

4. Women with PCOS have high chances of OHSS ( ovarian hyperstimulation syndrome ) , so you cannot be given more strong stimulation.

As so many cycles of stimulation have failed, ICSI seems the next logical choice, particularly as you are running out of time from the endometriosis point of view. Before that, request your consultant to give you one rest cycle to feel better in body and mind. Then one more IUI can be tried with Antagonist Protocol ( less chances of hyperstimulation ) before proceeding for ICSI.

All the best.
Please feel free to discuss further.


Patient replied :

thank you so much doctor

ok you told me to take free cycle , but i want you to know that my period didnt come back sinc i took decapeptyl in august and we start stimulation with out period
after stimulation failed my dr gave me progyluton ( only brown pills ) and she told me that my period will come back ( but i think this will be not reall period ) as we make it by medication , What do you think ?
when this medicated period come Do i have to test fsh and lh and e2 ?

thanks alot again i really need advice and support


Hello
Thank you for your appreciation.
I would be always happy to guide you and help you.
After taking Decapeptyl, you might get your normal period after 5 months or more.
So do not worry.
The pills prescribed by your doctor contain estrogen and progesterone and taking them will help to bring back your hormones to normal.
Wait for a couple of cycles before restesting FSH and estradiol.
The period will be an artificial one , induced by outside hormones, but it will help in kickstarting your hormones again.
Take care.


Patient replied :

hi dr
yesterday i felt huge pain lower back and on both sides of my ovaries it was horrible after that i find little brown discharge , my period after decapeptyl didnt back and as i told you before after i took stimulation i jectionand no response , dr gave me progylotun i took brown pills , last pill was 4 days ago , my question
Is this period ? how can i know if this period or no ? can i do blood testd to know if this period ?


Hello again
Yes , I think this is your period in response to the withdrawal of the hormones.
You can confirm it by the following ways -
1. Pelvic ultrasound scan, which will show the status of the endometrium.
2. FSH
3. Serum estradiol
All the best.


Patient replied :

thanks alot doctor , blood starts so this is my period , but how to know if decapeptyl actions stop ?


Hello
To know whether the effects of Decapeptyl have worn off - the following tests will show that
1. FSH
2. LH
3 . Serum estradiol
4. Regular resumption of your periods
5. Probably recurrence of symptoms of endometriosis - pain during periods, painful intercourse, pain in passing bowel movements etc.
Take care.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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