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Endometriosis with PCOS and conception

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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 3 months after
morphology 4%
motility 40%
count 40 mill / ml

my tests 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
i took gonal F 75 iu for 5 days then my ultrasound shows one follicle 6.5mm lots of small cysts pcos
my endo thickness only 3 mm , after that i put on menopure 75 iu for extra 5 days , my ultra sound show 2 follicles 8 mm , 7 mm , my endo only 3 mm
now i am on menopur 150 for extra 3 days ,
i dont know if my follicle will grow up or not ? am i out this month
before decapeptyl i had good ovulation , why now
i really want to be pregnant

Category: Infertility Specialist

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Category: Infertility Specialist
 27 Doctors Online

Hello
Thanks for writing to us with your health concern.
Basically you are having an issue of anovulation.
The reason is that you are having PCOS ( polycystic ovarian syndrome ).
In this condition the ovary is studded with multiple small cysts, and there is basic hormonal disturbance, due to which none of them mature to form a good egg, leading to ovulation.
Decapeptyl will inhibit ovulation, but not after 3 months, you took it more than 3 months ago.
Women with PCOS often need stronger stimulation protocols ( more powerful injections ) and often they ovulate late.
NOrmally ovulation occurs around day 14, yours might be later than usual , owing to PCOS, so do not stress out.
ALso, sometimes you might need different protocol called Antagonist Protocol in IUI, for that injections are started from the previous menstrual cycle, that is before you get your periods.
SO if you fail to ovulate in this cycle, then you can discuss with your doctor regarding this protocol also.
YOu should have complete evaluation for PCOS.
THis would include - FSH, LH, TSH, Prolactin, OGTT, DHEAS, Freee testosterone, Fasting insulin, lipid profile.
THen, drugs like Metformin can be started which will control PCOS.
Also, losing weight if you are overweight will aid in ovulation.
Right now, for this cycle, continue taking the Menopur 150 for further 3 days, and then let me know what the folliculometry says.
There is definite possibility of a late ovulation in PCOS, so do not lose hope.
All the best.
Please feel free to ask for further clarifications.


Patient replied :

thanks alot doctor , before my laproscopy my ovulation was perfect with out medication , one egg 19 mm at day 13 , i wasnt have small cysts , but after laprocopy and decapeptyl 11.25 suddenly i had many cysts , i am afraid that may be my ovaries damaged , i will wait for my ultrasound results


Hi
It is possible that PCOS was not diagnosed then, or it developed later on.
Do not worry.
Hope for the best, avoid stress, think positive, and do keep me posted.
Take care.
Wish you loads of luck.


Patient replied :

hi dri am doing iui as i told you before and i have endometriosis grade 2 i did laproscopy last august and i took decapepty 11.25 on 29 aug and my period didnt came back since , so we deciede to try iui

first scan show pcos then i started gonal f 75 for 5 days
after that my ultrasound 1 folliclles 6.5 mm
and my endometrium thickness 3 mm
after that menopure 75 for 5 days
my scan 2 follicles 7 and 8 mm
and my endometrium thickness 3.2 mm
then menopure 150 for 3 days
my scan was today
3 follicles 7,8,9
and my endometrium thickness 4.6 mm

my cycle cancelled due to pcos ,
they wont increase dose as they dont want many eggs , so we cancell it and they gave me progyluton brown pills only , to brought my period

they told me as i had pcos and my ovary didnt response to small dose and they cant give me large dose as they dont need alot of eggs for iui so they advice me to go for icsi ,
i have endometriosis grade 2 and i did laproscopy on august they remove it and gave me decapeptyl 11.25 , i am afraid that my endometriosis come back agian before i got pregnant .

i am married for 2 years and i want baby ?
what is your advice for me what can i do for pcos i am 25 , 64 kg , 165 cm
so do i have to do icsi or may i got naturally pregnant ?

my husband semen analysis
morphology 4%
motility 40%
count 40 mill / ml

please tell me your detailed advice


Yes, this cycle seems to have failed.

Continue to remain sexually active though, even if no more injections are given, women with PCOS often have surprise ' late ' ovulation.

Also, for your case I would advise the following -
1. Ask your husband to consult an Andrologist, and have detailed evaluation for low semen count, motility and abnormal morphology. He should start medication to improve his semen reports.
2. This is just your first cycle of IUI. I would suggest two more cycles of IUI , using different injection protocols. Discuss with your doctor regarding Antagonist protocol ( here, injections are started from the previous cycle itself ) , and this protocol is generally safer for women with PCOS and more effective.
3. If 3 total IUIs fail, then yes, you need to consider ICSI / IVF.
4. Endometriosis can recur fast , so please have these attempts as soon as possible without wasting time.
5. Meanwhile have complete PCOS assessment, and try considering medications like Metformin for symptom control.

All the best.


Patient replied :

thanks alot doctor
1/ how much my husband semen analysis not good ? he did varicocele repair 4 months ago and taking supplements to enhance it

2/ i did 3 failed clomiphene cycles + 2 failed iui , they told me my husband semen poor cant concieve naturally is that true ?

3/ i am on metformin 1500 per day

thanks


1. Your husbands semen count is tolerably good, motility is borderline low, morphology is very poor.
2. You CAN conceive naturally, but chances are very low, and you cannot afford to waste time, else your endometriosis will recur. With 5 failed stimulation cycles, maximum go for 2 more IUI and then consider ICSI.
3. Its good that you are already on Metformin
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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