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Milly - October 15th, 2007 10:38 AM

Complicated question, I'm sorry. I'm 39 and have a history of severe endometriosis with left oopherectomy. I have several medical conditions that have developed over the years, including autoimmune disease, mild pulmonary hypertension and adrenal insufficiency possibly due to a pituitary microadenoma. I have used estrogen/progestin and HRT pills for years for treatment of endo, but they cause circulation problems in me. Anyway, I stopped the HRT pills and my period returned. So now I was hoping to have a baby. Unfortunately, severe pain in my abdomen has recently returned and I went to a specialist who discovered by ultraound several endometriomas, a fibroid displacing my uterus, a polyp possibly, and what may be a corpus luteum cyst. At the same time, my Day 3 FSH measured at 42. So now I'm wondering is there is any chance of pregnancy at all. If not, I don't know what to do about all of the other problems. Why do I have such a high FSH along with endometriosis and fibroids? What tests would you do next, a laparoscopy, hysteroscopy, or none? I can't take any more hormones given my other medical conditions. I'm wondering if a hysterectomy is the best route for treatment if there is truly no chance of pregnancy. Thanks.

B. Jacobs, M. D. - October 15th, 2007 5:35 PM

Your FSH is so high because you are running out of eggs. Your ovaries are failing. You will need an egg donor to become pregnant. The fibriod may be a problem, but it is easy to remove uterine polyps. I have grave concern about your pulmonary hypertension. Pregnancy could be a disaster for you. Please discusyour desires with your internest or with a maternal-fetal medicine specialist. Certainly you could use a gestational carrier, so that you could have a child which is geneticly your husband's, even if not geneticly yours.
Good luck.


Milly - October 15th, 2007 7:29 PM

Dr. Jacobs, thanks for the reply. I am concerned about the PH, too. I take about 240mg up to 360mg of Cartia XT for my PH and it remains very mild on that dose. But without the Cartia XT, the PH progresses quickly. Therefore, I would have to take this throughout the pregnancy and if it stopped working, I would definitely be in deep trouble. Aside from that, I also wonder if the medication could harm the developing baby. But from what you and others have said and from what I've read, it looks like I won't be able to have a baby anyway. I think the best route would be a surrogate mother with egg donor, if this is ever done and is affordable. I worry about the legal and other ramifications of this arrangement but there's not much choice. Thanks.

B. Jacobs, M. D. - October 15th, 2007 10:05 PM

There is a difference between surrogacy and gestational carrier. Unlike a surrogate, the gestational carrier will not have a genetic link to the pregnancy. The laws will vary from one state to another. In Texas, the couple using a gestational carrier can go before a magistrate and have the pregnancy declared theirs. In that case, your name would appear on the birth certificate as the mother, and you would not have to adopt your own child. You will need to investigate the law where you live.
Good luck.


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