Confused and upset

Fertility doc refered me for lap as i wansnt conceiving naturally. Surgeon found extensive endo so he refered me for hormone injections and said he would see me in 6 months. I had another appt at fertillity doc today who said there is no point in anothet lap and just to stop injections (ive had 4 months of injections ) and try naturally agian while waitin on ivf.?? Now i dont know what the point of the injections were in the 1st place if im not having another op. I read somewhere that they treat endo during a lap then that can help you concieve naturally.?? lts like its just been a wast of time which is not on my side as im 37. Why the hell didnt i get referred for ivf in the 1st place. So confused.

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  • Hi - I'm afraid you have fallen foul of the ignorance of so many general obstetricians. I'm sure there must be some very good ones but those who don't seem to know the first thing about endo really let the profession down. The problem is that extensive endo is likely to severely impair your chances of conceiving naturally or with IVF and the injections will do nothing if the disease is not treated. The appropriate next treatment will depend to an extent on where you are located in the UK. Where are you?

    Do you know where your endo was found and did they stage it?

  • Im in glasgow area. They just said extensive endo but no grade. I know my bowel was stuck to uterous and one tube was completely blocked. I think they mentioned pouch of douglas but not sure in what respect. Im desparate to concieve but want to make sure im giving my self the best chance and i wasnt convinced by what i was told today. Should i ask for 2nd opinion - where should i go?? I do have private health insurance but not sure whether it would cover this.

  • Hi - you do have two endo centres in Scotland but you don't have NHS Choices like we do in Englad that gives us a lot more rights. You get referred through a process called Safehaven and they then assess your case and decide if you can be referred. The overriding guidelines called ESHRE do confirm that complex endo must be dealt with by a specialist team but some ladies in Scotland are having problems getting referred. Your private cover would definitely be your best bet. Who is it with?

  • Thank you so so so much for your help. My heath insurance is with aviva. Im going to my gp on fri so i want to be prepared with what im saying to her. Am i right in saying chances of getting pregnant naturally increase if endo is treated during lap.?? Im not desparate for another op but im thinking it might increase my chances even a little while we wait 1yr for ivf.

  • If you go down the private insurance route don't say a thing t your insurer about fertility or trying to conceive just to be on the safe side. Only say it's for treatment of endo which it is. If they hear anything about IVF you could get into a pointless argument with them which you don't need. They don't cover IVF but will try anything to avoid paying so just don't mention it.

    Your private insurance should cover you to see an endo specialist. Find the specialist you want to see and get a referral letter from your GP. Call your insurer to get approval and make an appointment yourself with the specialist's secretary and make sure the referral letter has been received.

    My view is that surgery would be better to do first before conceiving. If they need to do any work to your ovaries discuss the possible impact on ovarian reserve as this can be affected if they do surgery to the ovaries to remove any cysts.

    Good luck.

  • Hi - have a look at the link below to the ESHRE guidelines. Chapter 3.2 covers endometriosis surgery prior to natural conception and Chapter 4.3 covers surgery prior to assisted reproduction. Reseach has found a marked improvement in natural conception after surgery especially for severe endo (as opposed to deep - see below). With regard to endometriomas the general consensus seems to be that excision is favoured over drainage for natural conception but each case will be considered individually. With regard to IVF the treatment of endometriomas will depend on factors such as the size or whether there has been previous ovarian surgery that might have reduced ovarian reserve. Drainage might be favoured with ablation of the cyst capsule although this might affect ovarian reserve too. Again each case is individual. If you have deep endo 'nodules' in your rectovaginal area these would only be removed if they are causing pain and not to aid fertility.

    eshre.eu/~/media/Files/Guid...

  • if it was gnrh you were on then the injections temporarily stop certain hormones being created in your body and would decrease or possibly kill the endo cells. Endo can make it difficult to get pregnant even through ivf so the docs probably are trying to manage the condition first. my aunt had the same problem as you many years ago and after the injections became instantly pregnant. try not to worry, good things come to those wait. and all the best xx

  • Yes totally agree health insurance will not pay out if fertility related. You need to be referred to a Endo specialist following your diagnose of Endo and pain and symptoms are affecting your quality of life. I travel to see a private consultant which we have had to pay for but its been worth every penny. I wish you well & good luck.

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