Endometriosis and implantation

[Booda21]

I wondered if anyone had any knowledge with this. So I have been confirmed to have endometriosis after 5.5 years ttc. I have had one failed round of ivf using icsi. I got 7 day 5 blasts which none made it to a viable pregnancy. One implanted but ended in very early miscarriage.

My consultant had said there’s not much to do for endometriosis etc. I do have an endometrioma on each ovary but was told as they are 2cm and 4cm that surgery can do more harm than good. Which I have read about anyway so that’s fine. My AMH has been retested and it hasn’t dropped too much. My consultant said it’s measured differently now as they use a different lab and was 32.5 but I don’t know what this means in relation to other numbers I see people using, plus I have no idea what it was when I was originally tested 2.5 years ago. Anyway I’m waffling on, I just wondered if endometriosis can affect implantation success? Does anyone have any experience with this? And is there anything suggested to improve the chances of implantation?

My partner has had a test for oxidative stress on his sperm which was slightly raised and is taking proxeed plus for 3 months to bring it down. His motility has improved from 31% to 44% and morphology is now 1.5% up from 0.5% in 2019. This is before taking anything and he has also now massively cut down on drinking. So I’m hoping for more improvement come January when he is retested. So I don’t know if this could have also been a factor as know fragmented/damaged sperm can affect the outcomes.

I think we are having our embryos tested as well as recommended after our failed attempts last time with seemingly healthy looking embryos.

Sorry for going on so much here! Thanks for any information anyone can provide 🤗

[ace3]

Hi Booda! Thank you for sharing. I have endometrioma on each ovary and we have very similar issues. I am 40 and we had to do ICSI. Got 4 embryos and one fresh and one frozen cycle unsuccessful. For the third cycle they put me on Prostap for a month before starting the FET cycle to shrink the cysts and calm endometriosis down but it resulted in a 70 day cycle for which I had to take another drug to bring the period on. Then on day 15 of the FET cycle the cysts were about 2-4cms and I had brown spotting and we had to cancel the cycle and have hysterescopy and now I am waiting for laparoscopic surgery for endometriosis. A bit terrified to be honest. Happy to keep you posted as I go along. We had two A grade embryos which we used and they didn’t implant despite the uterus looking great and no issues with lining. But the consultant said they don’t want to “waste” the next two embryos and suggested surgery as endometriosis does indeed affect implantation, so I am told. Not very positive news perhaps but I wanted to share this just in case it is or can become helpful. Sending you positive wishes. 🙂

[Booda21 in reply to ace3]

Oh yes please, I will follow you to see how you get on. Good luck 🤞 keeping everything crossed. There’s just so many levels to it all isn’t there, it’s too much for my small brain 😂 xx

[Roobs33]

Heya, sorry you are having issues related to Endometriosis. I’ve got stage 4 endometriosis and have just had a first failed cycle of IVF with one frozen blast to try soon. I was told mine was a top grade and so I’m only assuming that implantation is the issue. I had two surgeries last year - one to remove endometriosis and then another to clip my right Fallopian tube which was really inflamed and could have potentially leaked toxic fluid. I reached out to people on here in a similar position and a lot of people mentioned that Prostrap had helped their IVF work. Some taking it for 3 months and some people 6 months. I think it stops the endo from flaring up and can help reduce cyst size. A few people mentioned a low dose of Aspirin can also help with implantation. So you could ask about this maybe too?

All the stimulation meds made my endometriosis symptoms really bad, so I wasn’t that surprised that it didn’t work out. Speaking to the consultant on Thursday and hoping they have a good plan going forward. Did you notice any pain during your previous cycles? Endometriosis can cause hormonal imbalance so I guess testing things like progesterone levels etc could be helpful too in the lead up to transfer. I wasn’t offered this so I’m going to ask. I think you can get endometrium receptivity testing done at some clinics too. I have no idea what that involves though.

I’ve started doing acupuncture again to try and reduce inflammation and to help with blood flow to the uterus. I have no idea if it will help but willing to try anything!

Wishing you lots of luck xx

[Booda21 in reply to Roobs33]

Thanks for your reply! Sounds like you’ve been through it too. Nothing is ever simple is it 🙄. I have asked about aspirin before and told it can have a negative impact if not needed. I’ve nearly had every test under the sun to see if I have any issues and because they didn’t find any issues with clothing etc said I don’t need it.

I haven’t experienced any pain during my medicated cycles no, well not that I’m aware. In more recent times I do sometimes get twinges in my ovaries but now assuming this is because the cysts are there! I had no cysts this time last year. Only one in feb and then the two have been there since august, maybe earlier but that was when I next had my scan.

How did you go about the surgery for endo? Did you just get referred? Did you already know you had endo before starting fertility treatment?

Hope you fall lucky on your FET 🤞 xxx

[Roobs33 in reply to Booda21]

Heya,

Sorry for my late reply. I got referred last year through NHS after an internal scan showing a large cyst. I had investigations as my periods were agony and v.painful and had been trying to conceive for a year. I was told the wait would be a long time, so I ended up going private in the end with help from family members. I then went private for an MRI 6 months later due to a mix up with NHS referral. And then went private again for my second op. It was all through the same consultant that also works for NHS. I have since seen her in NHS so that I am in their system as it’s likely I will need bowel surgery at some point, but I’m hoping to have a baby first. I also have suspected Adenomyosis.

I would say it could be worth having a laparoscopy as it is hard for them to see any other endo that is lurking in there without having one. My symptoms were quite minimal and they found a 10cm cyst and stage 4 endo with bowel involvement. I think if IVF continues not to work it might be worth thinking about. I know people on the endo forum that have had surgery to excise endo and then managed to conceive after. But there are also people that have managed to conceive/have successful ivf without the surgery. It all depends on each persons own condition. Prostrap seems to be something that had been successful for others. I have a 4 year old daughter conceived naturally after trying for 1.5 years. I was still unaware at this point that I had endometriosis. I guess from a surgery point of view they would be able to diagnose it properly and treat if needed. It’s not to say it won’t return again, so a bit like IVF it’s a gamble.

I really hope you get some answers and I’m wishing you the best of luck with everything. And I am happy to share my experience if you have any other questions, I’m new to IVF so am just starting to navigate through it. I have my drs appointment today! Ah! It’s all such a rollercoaster and very draining!

Xx

[WeeJacs]

Hi Booda I have endometriosis also. Never had a natural pregnancy, 3 attempts and we’ve had 2 miscarriages out of the 5 attempts, mix of fresh and frozen. Have u had a hysteroscopy? Just had 1 to check the healthiness of inside my womb, no issues. I think it depends where your endo is, mine is on my left ovary and tube. Consultant advised me it can effected egg quality and cause inflammation. We’re now having immune testing before we try again. I’d recommend the book I’d your body baby friendly by dr beer it’s really informative and gives you good insight in to possible problems xxx

[Fruitandflowers]

There are different forms of endometriosis and some women present and react differently to meds, but for me my issue is oestrogen dominance/progesterone resistance. So my progesterone levels can be ok (if not high) in the blood but my womb doesn't react properly to it or the oestrogen overrides it - so I always spotted way before my period, even when the progesterone level was good. So it's worth getting your hormone levels checked to see if there's an obvious imbalance, and then even if it's ok seeing if something like progesterone pessaries vaginally help to get your progesterone to where it needs to be (progesterone rectally gave me super high blood levels really fast but I had two losses at 6 weeks on that and spotted a lot on one, whereas vaginally my levels were lower but climbed steadily and I got a BFP at 3dp5dt so it took straight away). x

[Booda21 in reply to Fruitandflowers]

Oh really? I never knew this! Congrats on your bfp. What wonderful news. I will definitely ask if I’m ok to do this on my next round. Looking at end of jan beginning of feb following my boyfriends retest of his sperm. I have only bled before test day on my first ever transfer but I think this was because my window of implantation is slightly displaced. So I need a certain amount of progesterone which can’t be done following a fresh transfer!

Thanks for the reply, really appreciate it xxx

[Fruitandflowers in reply to Booda21]

I saw your comment about aspirin - my consultant said he wouldn't prescribe it as I don't have a clotting disorder (and even if I did he would prescribe something better) but I said I wanted to do anything that would help. He said he had no problem with me taking an aspirin a day and it wouldn't hurt. I did that for the FET and continued after BFP. They routinely prescribe it to women at risk of preeclampsia in pregnancy and none of the midwives or doctors are bothered about me staying on it (I get the feeling they don't think it makes any difference but if it makes me feel better, ok) so I was happier to continue taking it. Btw the number of 5 day blasts you got was great so I really hope you can get the implantation issue sorted - doesn't sound correct to say there's not much than can be done for endo as many of the women on here can suggest things that have worked for them, but it just seems to be so individual - I have had no classic endo symptoms for years and my second laparoscopy showed no lesions - so it can also go into remission (if that's the right word) - but I've still got weird hormone reactions and bleeding and it's taken so long to find something that works x

[RedA28]

Hi Booda, I'm in a similar position. 3 rounds of IVF with 4 transfers and no joy despite decent embryos. The last transfer was an FET and I did have a chemical from that, but that's as close to implantation as I've got. I did do some tests as well for repeated implantation failure which all came back with no issues. After the third round I had a laparoscopy and they found grade 4 endo. I decided to give IVF another go and they suggested an ultra long protocol. Apparently some studies suggest this is better for endo/adenomyosis patients, as it shrinks endo and creates a less inflamed environment. I have to have three months of decapeptyl injections before starting stims. (I think some other people on here have done similar but with prostap, I think it's pretty much the same thing). Perhaps you could ask your clinic about that? I've just had my first injection of decapeptyl. I'm going to try and update on here as I go as I think there are fewer people who have done this kind of protocol so I'm hoping it helps.

[Booda21 in reply to RedA28]

Thanks for your reply! I will keep an eye on your progress and really hope you get a positive outcome this time 🤗. I will definitely ask about it. Do you do this before you even have the egg collection? As I’m due to do this in the new year. I asked my consultant yesterday about the treatment for endo and she did say the only thing to treat it is stops you have periods but they need me to have periods for my next round. It’s so confusing!

Good luck again 🤞 Xxx

[RedA28 in reply to Booda21]

Yes, three doses of decapaptyl then start stims then do egg collection etc.

It is so confusing! My clinic hasn't said anything about needing a period before starting stims, they've just said I'll start stims two weeks after my third decapeptyl dose.

Is it short or long protocol you've done before? Are they doing the same again next time?

[Jess1981]

I have endometriosis not endometrioma it was the only "issue" we had. Everything else was normal! It took a very long time to diagnose but once it was diagnosed we had a chemical pregnancy after my third surgery but this time with an endo surgeon we went onto have our now 2 year old daughter! My endo grew in places where implantation was affected ie punch of Douglas and uterus ligaments which made my uterus lining uneven. We could've done numerous ivf attempts and nothing would've worked until my endo was treated. Since having our daughter we decided to try again we conceived which surprised us as it had been such a struggle to have our toddler but lost the pregnancy at 20 weeks last November and had another 2 early losses. I am now 26 weeks pregnant and so far all is ok 🤞🏻 I'm also 40 so not young! Getting my endo diagnosis and treated was the turning point in our journey. It is your right to ask for a second opinion. My first nhs fertility specialist was rubbish and dismissed my concerns I knew something wasn't right when we were referred to our second nhs fertility specialist he was everything the other dr wasn't he was so supportive and very pro active we felt he was on "our side". Changing clinics can be helpful. I wish you the very best I am so sorry for your loss miscarriages are awful especially after such a struggle. Every pregnancy is different and there is no reason why another pregnancy couldn't be successful. My fertility specialist said after we had our first loss " through the dark cloud the silver lining is you DID conceive and this is positive and big progress. "After 6 years of not managing to we saw it as progress as until then we weren't sure we could conceive! Xx

[Booda21 in reply to Jess1981]

Thanks for your reply! And congratulations on your daughter and little one on the way. Sounds like you’ve had quite the journey to get there.This is what is concerning me I don’t want to keep just doing ivf over and over with the same outcome. I feel like something needs to change to get a different result. But feel like I’m not the expert so just go along with what they say. I think if I have this next round and get some decent embryos and I transfer one and it doesn’t take I am definitely going to push for further investigations/ new treatments. As how many time can you do the same thing.

Will also definitely look at changing clinics if I need to. I’ve still got 2 full rounds on the nhs. I am sometimes tempted to lend money and go private to see if I got better communication but then I know people who are private who have similar experiences!

Good luck with the rest of your pregnancy 🥰 xx

[kittie2]

I have endometriosis, and it definitely had a negative impact on my egg quality. We lost a lot of good looking embryos due to them coming back abnormal from genetic testing. I also believe my endo was the cause of my first FET ending in a chemical. I’m in the U.S. and depending on the doctor, there are a few common options:

Steroids (prednisone) plus blood thinners (low dose aspirin & lovenox/clexane injections) in addition to the standard estrogen tablets and PIO injections

A minimum of 3 months of Prostrap (we call it Lupron over here) before FET

Laparoscopic surgery to remove the endo followed by a couple months recovery and then FET

Because I had 5 tested normal frozen embryos left (and I’m impatient), I chose to start with the first option for my second FET. For me, the prednisone was enough to calm my inflammation, and I’m currently 20 weeks. Had it not worked, I probably would have opted for surgery. I was too worried that the prostrap/lupron wouldn’t work, 3-4 months would be wasted and then I’d still need the surgery anyway. This is just my silly brain though. I did recently see an article that said 90 days of prostrap was just as effective as surgery (I wish I remembered where I read this!)

Since it sounds like surgery would not be a good option, you could discuss the possibility of adding steroids to your FET prep (start taking 10-20mg on CD3 and wean off after 10 weeks pregnant), or doing the 3+ months of prostrap.

Wishing you all the best!

[Booda21 in reply to kittie2]

Thanks so much for your reply! And all the information. Congrats on your current pregnancy, wonderful news! Yes I definitely need to look properly in to all the avenues, and find out if I need to change protocol. I have had tests for all these things which came back negative so when I have questioned steroids/thinners etc I get told I don’t need them. But this was all before they knew I had endo so surely that changes things as it clearly causes some kind of issues! I’m 34 (well this week) and been ttc since I was 28 so it’s not like age hasn’t been on my side. So infuriating!

Thanks for the well wishes 🤗 xx