My pelvic transvaginal ultrasound results were:
FINDINGS: The uterus is normal in size measuring 7.9 x 3.9 x 4.6 cm. No fibroids or other myometrial abnormalities are visualized. The double layer endometrial thickness is normal measuring 7mm. No focal endometrial abnormality or endometrial cavity fluid is seen.
Right ovary is enlarged. The right ovary measures 6.1 x 4.4 x 6.1 cm. Homogeneous hypoechoic structure in the right ovary measures 5.1 x 3.9 x 5.7 cm previously 3.9 x 2.6 x 3.8 cm (on 18Nov2012 ultrasound). The left ovary measures 4.2 x 2.5 x 3.9 cm. Hypoechoic structure in the left ovary measures 3.6 x 2.5 x 3.2 cm previously 2.0 x 2.0 x 2.4 cm (on 18Nov2012 ultrasound). No abnormal free fluid is seen.
IMPRESSION: Normal uterus. No uterine fibroids are seen. Homogeneous hypoechoic structures in both ovaries, increased in size since 18Nov2012. Findings most likely represent endometriomas.
Thank you so much for any advice you can give us. L. from Virginia
Answer:
Hello L. from Virginia,
First, I think that your blood testing is incorrect. The reason is that the FSH test is only valid if done right at the beginning of the cycle, generally cycle day#2 or 3. I suspect that the test was not correct because your estradiol was above 100 in both tests. This shows that the ovaries were not at rest i.e. not in the early phase.
Second, I am sure that you can find a clinic or doctor that is compassionate enough to allow you to try IVF (in vitro fertilization) with your own eggs, but that will be with a complete understanding of your chances. For example, I don't have a blanket policy to not allow patients to try as long as they understand the risks and chances.
Third, you have to understand the major problems you are facing and the impact that has on your chances. The first major problem is your age. This is what we call the "age related egg factor". This basically means that because of a woman's age, the quality of her eggs decreases so that the majority are no longer viable. As a result, the pregnancy rate decreases and the risk of miscarriage due to genetic abnormalities increases. Even with IVF your chances will be decreased, BUT they will much better than trying naturally! The second major problem is Stage IV Endometriosis. When you have endometriomas, that automatically makes it stage four, which is severe endometriosis. As a consequence, IVF is the treatment of choice. You can, and probably should, try to find a very good gynecologist to remove the endometriomas laparoscopically, with specific instructions to NOT remove any ovarian capsule tissue (that is the layer that has the eggs). That will help to give you the best chances of pregnancy. However, it is not an absolute necessity. Third, you have a decreased antral follicle count (AFC), which is supposed to represent the number of follicles available, but frankly, I don't rely on that too much.
You can achieve pregnancy if you go about it with an open mind and choose a good clinic. For more information on endometriosis and infertility, as well as other age-related factors please see these pages: “Endometriosis” and “Age Factors” in my website’s section on Understanding Infertility.
Good Luck,
Dr. Edward J. Ramirez, M.D.,
Executive Medical Director
The Fertility and Gynecology Center Monterey Bay IVF Program www.montereybayivf.com
Executive Medical Director
The Fertility and Gynecology Center Monterey Bay IVF Program www.montereybayivf.com
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