Saturday, October 13, 2012

You have questions...We have answers

Actually I need your answers, so if any of this sounds familiar please post your experience/knowledge in the comment section.

On Tuesday night, I attended a seminar at my old clinic ACRM, here in Atlanta. I described some of it here and also pinky-swear promised to post the questions I posed to the new doctor during the Q&A session. (Ok, I didn't really pinky-swear, but I wrote I would, which is almost like the same thing.)

So here are the questions I asked.

1.) Can endometriosis affect the outcome of an IVF cycle if the woman is using a surrogate?
A.) Yes it is possible. [Sadly I have forgotten the reason behind it. I believe she did mention that there could be an effect on the eggs in a follicle and thus less eggs retrieved, but for the life of me I can't remember if she said certain things or if I am confusing it with stuff I have read.]

2.) Besides cost, what are some of the downsides of using ICSI?
A.) There have been studies done of the offspring conceived by ICSI and it was noted that the male children had a higher rate of sperm problems. Whether this is a cause of the ICSI or due to genetics (ie, the father having sperm issues thus ICSI was used) is unknown. 

[This one I already knew the answer to, but I wanted to make sure there wasn't anything else I didn't know about. Primarily because our clinic in India uses ICSI as a default with no extra charge (unlike here in the States).]

3.) How long after a laparoscopy, do you need to wait to start an IVF cycle?
A.) Generally the recovery time is short and we like to do the next cycle as soon as possible. Especially if the woman is older.
[I know they can't do it the same month as IVF, so I'm guessing that means you just have to wait until the next month.]

I'm getting conflicting statements about #1 and I'm a little concerned about it. Everything I read regarding endometriosis and IVF revolves around the woman carrying the baby, there is very little info for women using a surrogate.

My new OB/GYN did not seem to think that endometriosis would be a problem for me (with regards to lowering my IVF success rates) since we weren't using my uterus. In fact he thought there was a low likelihood that I had it since some of my symptoms were relieved with my cryoablation. He advised for me to find out if the cyst I had aspirated during my first IVF cycle was a chocolate cyst. He did mention at the end of our lengthy consultation that he did not specialize in reproductive endocrinology, so I'm guessing that was his out if he was wrong. The only surrogate cases he probably has is if someone walked into his office who IS a surrogate and already pregnant. Also this WAS before they locked me in the bathroom.

Conversely, Dr. GS on SIRM's forum indicated endometriosis could cause a problem in my case, but it was hard to tell if he understood that I would not be CARRYING the child. Even though I definitely mentioned it. (I am awaiting on a response for that clarification.) He mostly pointed me to articles that either talked about the problems in the woman's lining (and toxins activated in it) or in one case a long article he wrote with one tiny sentence that suggested a gestational surrogate would be a better option. That seemed to contradict his reply to me. Anyhow, I've awaiting clarification.  [UPDATE: Dr. GS did reply and state he missed the part about gestational surrogacy. He said that in the case of immunologic implantation dysfunction, it wouldn't apply to me, but an endometriotic cyst would affect egg quality.]

The REASON I'm even asking is because I don't know if I should be tested for it. We have decided to cycle again, but this may be my last one and I want to optimize my chances. If endometriosis can affect my eggs pre-aspiration, then it seems like a good idea to be tested and get any problems fixed. On the FLIP side, scheduling and doing a laparoscopy  plus recovery time could add a couple of months to the process - thus lowering our chances. PLUS some doctors advise against laparoscopic surgery for poor responders as it can further lower your ovarian reserve and raise FSH levels.

What to do, what to do. Time to go have a real one-on-one with our ACRM doctors again.

As I said at the beginning, feel free to chime in. 


  1. According to Schoolie at CC.RM, endo does not affect the eggs when doing IVF. He said the shell of the egg protects it and it's aspirated during an IVF procedure. If you are not doing IVF, then there's a problem, because the egg comes in contact with the toxicity of the endo while traveling through the fallopian tubes. It made sense to me.

    1. Yea, that's the problem, so many diff opinions on it. Check out the link's I put in response to MGB. (Look at the links the doctor recommended for me on the forum.) I immediately thought of you with the NkA and immunology issues. Since they do free phone consultations, I may just schedule one.

    2. I spoke with Dr. Fisch from SIRM on the phone twice and done bloodwork with them, NKcells, etc. No answers for me, still. So frustrating.

    3. Did it at least rule anything out? I can't even begin to imagine how frustrated you must feel.

    4. I just went back and read my post from last year after my conversation with him, in case you want to read details it was in November of 2011. My NK cells were at 11 and they want to see it at 10 or bellow. He recommended Intralipids, which I've heard are not as good as IVIg. I brought this up with Schoolie at CC.RM and he thought it was all bogus and that my immunology panel was totally normal, and I went with it. I had to pick a path and I did.
      My friend that also had NK cells at 11, consulted with Dr. Kim Kwak in Chicago (very famous) and she told her that with intralipids there was only 50% change she would get pregnant so she went the surrogate route and now has twins. I don't want to waste my only 2 embryos gambling on this. I don't want to use my uterus, I'm pretty set on that. Thanks so much!

    5. Yea, that exactly what I was thinking when I thought of it for you. I only breezed through it though and don't know all of your details, so didn't want to put something out there that I only know a little bit about. There was another clinic (in chicago I think) that had similar info online. I was thinking about it with your IUI post.

      There are so many paths we can take and we must make sure not to beat ourselves up with the paths we do choose. Other paths are just as likely to turn into nothingness. If we took them, we would be wondering if we should have taken the first. We can't possible take them all. :-(

      Regarding FET and clinics- I recently read this post: and it made me worry. Maybe it is specific to her case, but I would def want verification.

    6. There are a bunch of people in the comment section that have had success with it, I think most of them are from the same clinic, but maybe you could double check with them.

  2. I have a friend with her first failed IVF with stage 1 endo - with a past history of stage 2 treated endo 10+ years ago. She's 40 and was advised to go straight to DE cycle - he MD said history of endo usually indicated poor egg quality regardless of IVF . At 4o with an AMH 1.1 FSH 11 - ( normal enough numbers) and one failed cycle I thought it was pretty harsh feedback -

    Her Md and mine ( when I was convinced a surrogate was what I needed since I have no hope for my body producing a baby after 5 failed cycles) both said a Surrogate only helps if you've got healthy normal , chromosomally heatly eggs and that I / we would not have greater success with a surrogate if using our eggs and my clinic will not cycle me again with my own eggs ( due to poor response - otherwise healthy female w not known infertility problems). Apparently not many excellent REs - reccommend a surrogate using their own eggs over 40 unless they are certain it's an implantation problem - generally due to egg quality , age , cost (100k+) call it 150k with a de cycle.

    2 ) ICSI increases your risk for birth defects an additional 3-5% on top of the added 1% risk for IVF alone. Generally only male issues are seen when directly related to MF that lead to IVF

    3) since I have a 25mm cyst on my left ovary ( postponing my DE frozen transfer) I got this information first hand yesterday!! Of course were going to watch the cyst and not rush to treatment but I had to ask worst case . laparoscopy would be necessary to remove the cyst if it grew bigger and I'd be out of the IVF treatment for 2 months ( but sometimes 3 months )

    1. Sorry for the typos -
      Should add that the 2 months include the month of the surgery so I guess it's " only one month to re".

    2. Thanks for the info!

      Have you read some of the stuff from SIRM's website about endo/immunology issues/DE? They have some really good stuff. Here is one:

      Here is the thread I had with SIRM:

  3. Thanks!
    Ill take a look at the info -
    I have unexplained infertility with very slight MF problem - which should be NO PRoblem with iVF. I've honestly had every work up available - to the pint when I consulted with CCRM - dr G had no great suggestions and thought the sperm looked rather healthy and considered it with in the normal range. I've been seen at Cornell - dr Spandorf , NYU - griffo and RMA - dr cooperman/ Sandler - all seem to think ill get pregnant with DE and have no problem getting pregnant. Which is what we're currently working on . we are working with Melisa Brisman for a surrogate incase I don't get pregnant with a DE we have a fall back plan . My FET is in 2 weeks if my cyst goes away!!!

    I wish you much luck in India - sadly based on the info you provided it's not an option for us bc we are not even tryin for a biological child at this point.

    My friend with the endo problem has her phone consult with CCRM next week - ill have her ask this question about De and surrogate.

    1. There is some pretty interesting stuff about on those links about why someone might have implant issues even with donor eggs.

      India lets you use donor eggs, but it can get rather complicated. Especially if you don't want an Indian donor.


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