# Endometriosis age +ivf



## ruthie

Dear Peter
I am now 38 partner is 37 we have been trying to have children for 4 years. I was diagnosed with endometriosis 3 years ago after failing to conceive. I had a 5cm endometrioma on the left ovary. I had a laparoscopy with diathermy and treatment of adhesions. I then had zoladex for 4 months but stopped early as according to everything I read it makes no difference for fertility and apart from fertility problems I have been asymptomatic.
I had a first cycle of IVF in Mar 2002 it was a long protocol using 300u gonalF. I had 10 follicles but only 2 eggs were retrieved and only 1 fertilised normally I had a 4 cell embryo transferred but the cycle failed. I was told that my chances were very low and I should have zoladex again for 3/12 before IVF but felt this wasnt the right advice so we went to several other clinics. All said the response was unusual and that I should try again and maybe consider further surgery - as in the first they only drained the cysts. I tried again in Oct 2002 this time with a short protocol and 300u gonal f - this time there wer 6 eggs but only 3 fertilised normally and 2 arrested so again there was only 1 embryo to transfer. Unfortunately I had an ectopic pregnancy and had to have another laparoscopy. In Mar 2003 I had another laparoscopy for laser of the endometriosis but after 6/12 and 2 monitored cycles we hadnt conceived so did another cysle of ivf. It was a short protocol with 375u gonal f but there were only 5 eggs collected. I did notice on the scans that initially 5 follicles came up and some smaller ones started growing about half way through - the stimulation was for 9 days. This time all fertilised normally and there were 2 embryos at 7 cell and 5 cells transferred but no pregnancy.
Is this a common sort of picture. Is it worth me continuing -do I have a chance? I think we interpreted the ectopic as a positive sign - but is that wrong? Can anything be done during the stimulation to maximise the number of follicles containing eggs that develop?


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## peter

ruthie said:


> Dear Peter
> I am now 38 partner is 37 we have been trying to have children for 4 years. I was diagnosed with endometriosis 3 years ago after failing to conceive. I had a 5cm endometrioma on the left ovary. I had a laparoscopy with diathermy and treatment of adhesions. I then had zoladex for 4 months but stopped early as according to everything I read it makes no difference for fertility and apart from fertility problems I have been asymptomatic.
> I had a first cycle of IVF in Mar 2002 it was a long protocol using 300u gonalF. I had 10 follicles but only 2 eggs were retrieved
> 
> This is poor, any reasons given?
> 
> and only 1 fertilised normally
> 
> What happened to the other one?
> 
> I had a 4 cell embryo transferred but the cycle failed. I was told that my chances were very low and I should have zoladex again for 3/12 before IVF but felt this wasnt the right advice so we went to several other clinics. All said the response was unusual and that I should try again and maybe consider further surgery - as in the first they only drained the cysts. I tried again in Oct 2002 this time with a short protocol and 300u gonal f - this time there wer 6 eggs but only 3 fertilised normally and 2 arrested so again
> 
> This is unusual, do you have any further details?
> 
> there was only 1 embryo to transfer. Unfortunately I had an ectopic pregnancy and had to have another laparoscopy. In Mar 2003 I had another laparoscopy for laser of the endometriosis but after 6/12 and 2 monitored cycles we hadnt conceived so did another cysle of ivf. It was a short protocol with 375u gonal f but there were only 5 eggs collected. I did notice on the scans that initially 5 follicles came up and some smaller ones started growing about half way through - the stimulation was for 9 days. This time all fertilised normally and there were 2 embryos at 7 cell and 5 cells transferred but no pregnancy.
> Is this a common sort of picture. Is it worth me continuing -do I have a chance?
> 
> Yes you need to consider blastocyst culture, sperm DNA fragmentation studies and also aneuplody screening
> 
> I think we interpreted the ectopic as a positive sign - but is that wrong?
> 
> No, it is very positive
> 
> Can anything be done during the stimulation to maximise the number of follicles containing eggs that develop?
> 
> yes, I am glad to see that you are on Gonal F but you could be given more to increase the response.
> 
> Good luck!
> 
> Peter


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## ruthie

Dear Peter

Thank you very much for this helpful reply. In answer to the questions you aksed - in my first cycle 2 sperm got into the second egg. In the second cycle of the 3 eggs that didnt fertilise normally 2 sperm got into 2 of the eggs and 1 didnt fertilise at all. In the 3rd cycle the embryologist said 2 of the eggs hadnt fertilised quite as perfectly as they would like but didnt explain this. I had a third embryo that was definitely a 2 and possibly 3 cell 2 days after egg collection. I was advised only to have 2 embryos transferred to reduce risk of multiple pregnancy. I had thought we could freeze the third but they didnt think it was worth it so I think if this happens again I would ask for 3 embryos to be transferred.

What do DNA fragmentation studies tell you?
and
What is aneuploidy screening?
How are these done?

Thank you again
This is a very helpful site and a relief to hear lots of experiences.


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## ruthie

Dear Peter
Sorry I forgot to say - in the first cycle I was told that the poor egg retrieval was something they often see in women with endometriosis. They really were incredibly negative and we nearly gave up but have since gone to The Hammersmith who have been much more helpful and I do think are good from what I can see although teir results aren't as impressive as some I do feel a bit suspicious of how they are arrived at
R


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