Low Ovarian Reserve and Laparoscopy

[Skittles11]

Hi. After much to-ing and fro-ing I think we've finally come to a decision about our next steps. We are fed up of going through endless fresh cycles and think we will now move towards transferring the one and only euploid we have.

First, however, I want to undergo some tests to ensure my body is in the best position to accept an embryo. This decision was further cemented when my husband tested positive for covid and now I have! So probably best to move to frozen rather than fresh given we do have the option (this is not my main question but I have lost my sense of smell, has this happened to anyone and did it come back? Worried about it!)

So I am now looking to undertake tests and I wanted to ask you all about the scenario below.

I have asked similar before but I remain a little confused about best course of action:

I have low amh and have been a patient at two different clinics. Both clinics saw a small endometrioma on one ovary.

I have been advised by both clinics to leave it well alone due the the high potential of the laparoscopy further stripping back an already low ovarian reserve.

However I've also seen information suggesting laparoscopy is the gold standard for endometriosis. Both for egg quality and implantation. I don't want endometriosis to reduce my implantation chances especially if I'm doing all these other things to maximise chances.

Does anyone have any thoughts on any of this? Thank you x (apologies for long post)

[Chel91]

Hi hun, I got a lot of info from the Nancy's Nook FB Group. I used a surgeon on their recommended list, and I'm really glad I did honestly. I have heard that if it's done correctly it can even increase AMH and egg quality, but I'm really no expert on this. My AMH did go up a lot after surgery, but they never touched my ovaries as they were clear, so I've no idea why! It's such a big decision I can totally understand your concerns. I hope you are feeling ok xx

[Skittles11 in reply to Chel91]

Thank you, I will check out that Facebook page xx

[Hidden]

Hi Skittles,If you are still hoping for another egg retrieval I wouldn't do a surgery as it will affect your already low AMH. Or I would do it but after egg retrieval but before an egg transfer. I had exactly the same dilemma and decided to not go for a surgery before an egg retrieval.

Also, all the doctors I spoke with, were saying that my endometriosis will not affect embryo implantation but to be fair, if I could go back in time, I would transfer only after a surgery, as a lot of other studies do sugest otherwise. But now it's too late.

I wish you all the luck! x

[CDMWEEDOR in reply to Hidden]

good morning from my side, myself don’t have solutions to your questions because I also am facing some of the problems you have listed above 👆🏾. I have endometriosis , low eggs quality, limited eggs production and my clinic have said I am having low ovarian reserves day by day it worries me too, all my 3circles have failed 😣 my last 3 failed circle was just a week ago. And all I have been doing is prayer 🙏🏾

Am considering another circle soon again

So I wish you all the best in the struggle. Hugs!

[Skittles11 in reply to CDMWEEDOR]

Thank you for this, so sorry you have a similar situation in this respect. It's so hard to know what to do for the best isn't it xx

[Skittles11 in reply to Hidden]

Its a huge dilemma because I think it means I have to be done with egg collections prior to having any surgery. The way its going for me I have this chance to transfer a euploid embryo and hope it works but if it doesn't work it is a hard thing to accept that I might not be able to do a fresh collection ever again due to the ovarian reserve. You're damned if you do and damned if you don't it seems. Its all worth thinking about though. Interestingly I did have a successful implantation just over a year ago with my endometrioma there but had to interrupt the pregnancy for other reasons. But the endometrioma did not prevent implantation on that occasion xx

[Rhea2022]

Hi Skittles - I’m in a very similar situation and also struggling with the decision. If you ever want someone to chat with, feel free to reach out.

[Skittles11 in reply to Rhea2022]

Thank you, I'll drop you a message xx

[Positivechangeplease]

lost my taste and smell for a couple of weeks then it started to come back and came back fully after a couple of months I think. Maybe sooner.

[Skittles11 in reply to Positivechangeplease]

Thank you for this, it's reassuring xx

[Positivechangeplease in reply to Skittles11]

really hope it’s the same for you. I doubt now you’ve had it, it will affect anything. X

[Eternalwarrior]

Hello lovely

I think our stories are very similar in a way. It was our last chance with our own eggs and we were transferring an euploid embryo. We had two. I had had endometriomas on my ovaries but some consultants kept saying it wouldn’t affect implantation. I did have an MRI that showed deep infiltrating endometriosis everywhere and the laparoscopy confirmed it and I had excision for endometriosis surgery.

I truly believe that removing the endo (or as much as they could in my case as it was a mess inside!) lower my inflammation and helped with implantation. I had a suspected complex hydrosalpinx seen on MRI (never on any other scans) but it ended up being an endo nodule. My advice would be that if you have decided you are going to do a laparoscopy to check for endometriosis, you should do it in a BSGE accredited centre (we are not allowed to name doctors or clinics but check out the BSGE endometriosis accredited centres) and depending on the stage of your endo, you should have excision surgery with a specialist and not ablation. I know you said you have a small endometrioma, but how big is it? The only thing is that if you want to do another egg collection in the future, if they do the lap and remove the endometrioma it may lower your AMH.

I think you know our story but in addition to the lap we also did EMMA, ERA and ALICE. We wanted to do as many tests as possible as it was our last chance with our own eggs.

Please feel feee to ask me any questions you may have.

I hope you feel better soon and recover from COVID.

Praying for your miracle rainbow baby. Please keep us posted.

Lots of love xxx

[Skittles11 in reply to Eternalwarrior]

Thanks so much for this, the practical info is very useful, would it be okay for me to send you a private message? X

[Eternalwarrior in reply to Skittles11]

Of course! Anything I can help with, it will be my pleasure 😇 xx

[hazzahill12]

hi just a thought have you tried down regulation drugs instead of surgery at all?

I have endo and adenomyosis fortunately my ovaries are the only area not affected yet.

My womb is full of adenomyosis and bowel abliterated by the endo. I have only had x2 laparoscopy’s and they were diagnostic rather than any removal. My specialList felt he’d rather down regulate me than operate to start with. It will depend how much time you have as I had to go on zolodex for at least 3 months prior to egg collection and transfer also did the long protocol. X

[Skittles11 in reply to hazzahill12]

Hiya, this is an interesting thought regarding down regulating to calm down any endo. I think this is definitely an alternative worth considering. I have done down regulation before prior to fresh egg collection just to help give the clinic more control over my cycle but my ovaries would not wake back up afterwards in response to stimulation drugs. However if it was for a frozen transfer I guess that would be neither here nor there. Thank you for highlighting this as an option xx

[hazzahill12 in reply to Skittles11]

hi glad I could give you some thoughts about it. I waited years for diagnosis and endo was diagnosed before adenomyosis. The adenomyosis was my biggest issue as implantation was just looking impossible with my womb. I had zolodex for 6 months prior to my first egg collection but was meant to be 3 months but got extended due to covid. My ivf dr my endo specialist both agreed for me to stay on it less periods I had the calmer inside was, was the theory. I’m not going to lie zolodex was horrible it put me straight into the menopause with horrid flushes, moods and extreme dryness. But my endo and adenomyosis symptoms did really almost disappear. It was like exchanging one lot of symptoms for another.

I had buserline as long protocol down regs for about 4- weeks before starting stims and then alongside stims. 100% balancing act to now wake my ovaries up but I was realistic and new my AMH wasn’t good we got 4 eggs and 3 fertilised but only one made it to blast day 5 AB so very good quality, no success from transfer. Next decision was to stay on down regs until next stims starting which was a couple of months. The drs wanted me back on zolodex but I had struggled so much, but found taking the buserline easier not quite as bad. I pretty much got the Same one 5BA this time. This was frozen. As we had realised although not many I got good quality embryos next was to do a frozen transfer.

I didn’t get this far I conceived my miracle naturally, he’s now 9 months old. I have horrible large focal lesion of adenomyosis at the fundus of my uterus as well as scattered patches, my womb is not hospitable and was always told I had a less than 1% chance. I believe it was the down regs to allow for implantation. Xx

[supportplease]

Hi Skittles

Laproscopy is gold standard for endometriosis diagnosis and some treatment. Having a laproscopy doesn't mean that endometriosis will not return. It most definitely will. Infact im starting to believe in leaving things as they are without touching it with a knife. I think it somehow aggrevates it. But its probably just my mind set.

It depends on where the endometriosis is. If it's on the ovaries then I wouldn't touch it if you would want to have further egg retrievals. I wasn't told about how much surgery would affect my amh. The doctors always said it would go down a little. Mine went down from 7 to 1 and it was a shock of my life. To add to it the cysts were not even removed completely due to other complications I have so they were purely drained.

I also spoke to other consultants who suggested i could down regulate with Zoladex injections and that could help with endometriosis but knowing my body I knew it would induce menopause or similar and hence I flatly refused it. Its difficult as it is but the mental stress is beyond words. So I told myself to let my body alone and deal with things with as little intervention as possible.

Also endometriosis should ideally not interfere with implementation unless you have adenomyosis too. I would definitely suggest a 4d ultrasound for them to have a good look.

Agree its a difficult decision but wishing you the best with whatever you decide x

[Skittles11 in reply to supportplease]

Oh my goodness I'm not surprised this was a huge shock to hear the AMH level after surgery. That must have been horrendous to hear. Thank you for pointing this all out to me though. I have an AMH somewhere between 3 and 9 although I'm sure it has dropped again since my last test which was actually a couple of years ago come to think of it). The endometrioma is on one of my ovaries so I imagined I would also have endometriosis on my ovary/ ovaries and possibly in other places although I really have no idea on that. I have heard about down regulating to quieten the endometriosis prior to transfer but that is again something I have not really discussed at all up to now with a doctor. Adenomyosis is something that has never been discussed with me although I did have a hysteroscopy and was told all looked fine, would that have picked up adenomyosis do you know?

Thank you for sharing your experience, what is next for you? Xx

[supportplease in reply to Skittles11]

If you have endometrioma on ovaries then I would day egg collection first followed surgery and then transfer. I'm not sure about hysteroscopy and adenomyosis

How long back was this done ?

I've changed clinics and they re waiting to set a plan depending on the next cycle. xx

[Missionofendo]

Hi Darling so sorry your poorly during this run up to a sensitive time for us with the loss of our babies.

I’m finding it hard so I’m sure you are too.

Before my IUI which I feel pregnant I had an MRI for my endometriosis check which came back clear.

My wellness coach advised me to check this but the fertility Doctors don’t see endo as an issue as the progesterone decreases progression of this awful disease.

I would def seek a gyno for better advice but do also see if you can get the scan on NHS unless the delays are too long.

Sending love and light to you and your husband.

Holly you were tremendously supportive to me over the last year coping with loss.

I wish you both peace 💖 and I’m grateful to have met you via this platform.

Your in my thoughts,

Claire 🙏X

[Skittles11 in reply to Missionofendo]

Hello lovely. Thank you for your thoughts, words and suggestions which as ever mean a lot. I'll drop you a private message this week xx