need advice, please
3 Replies
scout - December 4

I'm so glad I found this forum. Thank you for giving such useful information and thoughtful responses.

My question is... should I request that my RE do an exploratory laparoscopy before my next round of ICSI?

Here is why I'm asking...
I had surgery (laparotomy) for severe endo about ten years ago. I never had any pain or irregular periods. I had one incidence of pain that, after several drs. trying to tell me it was "gas pains", was discovered to be a cyst on my ovary. When they went in to remove it, they found endo "everywhere" and had to do open surgery to remove it all. I did six months of lupron after that, and bcp since then.
When my husband and I began trying to conceive, we assumed our failure was due to "leftover" endo issues. But, his SA revealed horrible morphology (0-2%), and moderate motility and count issues.
We've had 3 failed IUI's and one failed ICSI.
Since we've discovered our male factor issues, the drs seem unconcerned with any possible problems on my side of things, and I am worried we are overlooking something important.
Should I insist that a lap. be done before we begin our next round of ICSI? Also, my clinic does not include lupron in their protocol.
(by the way, I responded fast, too fast, to the meds last time... I did ER after only 5 days of stimming). Lots of eggs, medium quality embryos.
I would really appreciate your input. Thank you,


B. Jacobs, M. D. - December 5

Since I have not been a participant in your evaluation or care, I cannot make a meaningful recommendation. I can suggest you read the information I have provided on our web page, <>. I think you will find answers to most of your questions there.
Good luck.


scout - December 5

Thank you, Dr. Jacobs. I understand. Could I ask, though, in general, based on your experience and knowledge of current research, is it a good idea to treat endometriosis before ivf/ icsi? Or does ivf bypass the need for treatment?
I'm also trying to understand the pros and cons of lupron suppression before ivf. What is the purpose of it, and what might be the reason NOT to use it? (My dr. doesn't include it in his typical protocol).
Thank you for your time and help.


B. Jacobs, M. D. - December 5

There are data in the literature that one of the adhesion molecules felt to be important for embryo implantation may be suppressed by endometriosis. I test my IVF patients for production of this adhesion molecule. If it is not produced when it should be present, I treat endometriosis. If it is present, it does not seem to matter if I treat endometriosis.
Good luck.



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