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Endometriosis.

Resolved Question:

I am 26
I got pregnant once naturally ended with misscaraige
After that we are trying ,
I took clomid 2 cycles , low dose and was good response (3 eggs )
Then i did laproscopy for my Endometriosis ( adheion in tubes )
After lap , i knew from my dr that he found pcos , and he did ovarian drilling
I was really afraid of effect of ovarian drilling on my ovarian reserve
So i did AMH , i did it in 3 different labs with different results

One is 7.6 ng/ml this is in infertility centre
Another is 3.7 ng/ml
The last is 2.51 ng/ml

These all in the same week
My dr said any thing over 1- is normal and
number isnt important
I have alot antral follicles , and good response to low dose stims ,
My fsh 4.9
my e2 - 25

So is my AMH good or bad for my age ,


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,

Yes, as far as AMH is concerned, anything over 1 is considered good ovarian reserve, and the number is immaterial, as long as it is not abnormally high or low.
Different labs often vary in their reporting of AMH.

However, even if all three of your values are seen, they are all good, and it is quite clear that ovarian drilling has not diminished your ovarian reserve in any way.

Also, low dose clomiphene has yielded good eggs everytime, which is further proof that you have good number of eggs.
So please dont worry about your ovarian reserve, in my opinion, it is optimum.

How many cycles of stimulation have you had totally ?
Have you had any IUIs so far ?
Please let me know this, so that I can guide you better.
Also your age, and totally since how many years now have you been trying for conception ?

Hope this helps, please feel free to discuss further.


Patient replied :

Thanks alot


How many cycles of stimulation have you had totally ?

3 failed clomid + 1 failed stimulated iui


I am 26 ,
I got pregnant naturally after 7 months trying which ended with misscarriage week 7 due to blood clots ( MTHFR c677t heteo ) they put me on baby asperine and methylfolate , and heparin inj if i pregnant


After that i did laproscopy == mild endometriosis behind uterine and adhesion tubes which removed by laproscopy ( endometriosis spots by laser )
Following lap i took decapeptyl 11.25 which stop my period for 6 months

In this time
My husband had poor semen morphology and poor motility
He did varicocele repair and took dupplements


And repeated his SA after 6 months of his surgery
His semen improved

Morphology 23%

A motility 0 %

B motility 40 %

Count 50 mil/ml

Voluim 2.5 ml


After 6 months without period due to decapeptyl my period come
Day 2 tests

Fsh 4.9

Lh 4.2

E2- 14 ng/ml

Clear baseline ultrasound


Then i took clomid 100 from day 3 to 7

On day 11 ultrasound

Dr found 2 large ( follicles /cysts )

Measured ( 29mm*23mm) and ( 25mm*21mm)

He said cant tell these follicles or cysts until day 21 progesterone
Now i am day 18


We are thinking to try another iui or go for ivf ?


Expert:  Dr. Aarti Vazirani replied 3 Days.

Did you go for the stimulation cycles PRIOR to the natural pregnancy ?
Or prior to laparoscopy ?
Can you clarify the order of events please ?

Also, as you are day 18, please go for one more scan ( follicular monitoring ).
That will clarify if ovulation occurred ( apart from day 21 progesterone, this is one more method of directly seeing if ovulation occurred ).
If the follicles were not cysts, they would have ruptured, atleast one of them.
So please go for that.
Also, if this cycle also fails, then it is better to go for IVF, as inspite of good ovulation, and improved semen analysis, if you are not responding to so many stimulation cycles, it is obvious that further attempts at IVF should be undertaken.

That will save your time and provide best possible procedure to combine with the stimulation injections.

Please feel free to discuss further.


Patient replied :

i will explain


first i got pregnant after trying naturally for 7 months without any stimulation ,
after misscariage in week 7 after we heard heart beats , i did tests and they told me the cause of misscariage because i have ( MTHFR c677t hetro ) and i should take baby aspiren and methyl folate ,


then we start trying again , for 8 months including
3 failed clomide cycles + 1 failed stimulated iui


all my test was good , my ovulation without stimulation also was good , so my husband did Semen analysis
which come with
poor morpholog 1%
poor motility 10%
count 16 mil/ml


in these time i felt alot of pain each period after my misscarraige + painful sex , so my dr said this may be endometriosis ,

After that i did laproscopy == mild endometriosis behind uterine and adhesion tubes which removed by laproscopy ( endometriosis spots by laser )
Following lap i took decapeptyl 11.25 which stop my period for 6 months

In this time
My husband had poor semen morphology and poor motility
He did varicocele repair and took dupplements

so , we did stimulation after misscarriage before lap and varicocele repair

then my period back after 6 months all my tests was good

And he repeated his SA after 6 months of his surgery
His semen improved

Morphology 23%

A motility 0 %

B motility 40 %

Count 50 mil/ml

Voluim 2.5 ml


last cycle first one after decapeptyl ( period off ) i took clomidand failed
this cycle i took clomid also
and now i am day 18

i will go for scan as you advice me

i have questions

1/ should i start ivf/icsi next cycle or take one cycle free ?
2/ i am taking
methylfolate + baby aspirin + coq10

my husband takes
profertile ( male multi vitamines)
l carnitine
co q 10
royala gele + ginsing

Is that good ?

also i have MTHFR c677t Is this affect fertility or icsi sucees ?

any advices

thanks


Expert:  Dr. Aarti Vazirani replied 2 Days.

Hello again,
Thanks for explaining in detail about your history.
I will clarify the following points for you -
1. Your MTHFR mutation CANNOT result in the miscarriage. You are just heterozygous for it, meaning only copy of the gene has a slight variation. Both copies have to be mutated ( homozygous ) for complications to arise.
2. You can go for one rest cycle to stabilize your mind and body, and then plan for IVF / ICSI.
3. The medications which you and your husband are taking are fine.
4. As stated, the MTHFR mutation has NO implication on the fertility or IVF success rates at all.
Wish you lots of luck for your future.


Patient replied :

Hi dr
Today is cd 20 , i did progesterone test which was 67.5 ng/ml
Also i went for scan , my dr found one sac (17mm * 5 mm ) and few very small antral follicles
He said this is normal after ovulation !

Do you you think i ovulated ?


Expert:  Dr. Aarti Vazirani replied 1 Day.

The progesterone levels and the scan findings suggest that one of the follicles / cysts ruptured, that is, you ovulated.
Did he find any free fluid in the pelvis ? That would further suggest that you ovulated.
Please do remain sexually active to maximize your chances of conception.

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
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