All of us coping with infertility have in common similar struggles. But we've arrived where we are for different reasons. I want to explain one of my reasons. (And I'll explain the others later).
I have endometriosis. Stage III (Advanced) endometriosis to be exact.
Endometriosis is:
A condition where the lining of the uterus, which is usually shed during the monthly period, begins to grow internally outside of the uterus. There are different theories as to why and how this happens, but a common one is that the lining, at some points in time for certain people, flows back and out the fallopian tubs. Then, rather than my immune system taking care of these foreign cells immediately, they attach themselves to other organs and grow and shed there, often causing scar tissue.
My endometriosis was found on my abdominal walls, uterine walls, bladder, and ureters. Microscopic endometriosis was growing within my uterine walls causing it to be spongy to the touch. I had an endometrioma growing on my right ovary that was likely causing the pain I experienced prior to surgery, and my doctor was shocked at the advanced stage of my condition.
Because my endometriosis was extensive enough and because some of it was not removed during surgery (those cells in my uterine walls that were making it spongy), my doctor decided my best course of treatment would be to take six injections of depo Lupron over the course of six months. One shot would be given every four weeks. Depo Lupron is a GnRH agonist, and while I don't want to get into the specifics of how it works and what it does (not because it would be dull, but because I'm sure I don't totally understand), I will give you my explanation... Apparently GnRH agonists shut down your reproductive system and eliminate hormones from your system. They allow your system to rest while eliminating those microscopic cells. Depo Lupron essentially sends you into a temporary menopause for however long you continue the injections. I was prepared to be in a state of menopause for six months -- complete with all of the symptoms of menopause that women experience.
How does endometriosis cause infertility?
Many women diagnosed with endometriosis will find that cells have caused damage to their ovaries and/or to their fallopian tubes. Damaged ovaries could result in poor egg quality and/or prevent proper ovulation. Blocked fallopian tubes would prevent fertilization by keeping the egg and sperm from meeting. In addition, it is thought that certain toxins are released in the body because of endometriosis around the time of ovulation. These toxins can affect the uterine lining and the overall environment for fertilization and later implantation. Any interference on the part of endometriosis in this delicate process can be detrimental -- obviously.
It is widely recognized that IVF is the most successful option for women with advanced and severe stages of endometriosis. Many doctors will begin by offering IUI treatments when endometriosis is less severe, but research shows that success rates are low. Always do your own research but also consult your doctor when making these important decisions -- infertility is not predictable, so one case doesn't determine the outcome of another.
Some literature out there suggests that women with endometriosis have a slimmer chance of success with IVF than the average woman undergoing the same procedure but for different reasons. I've found some articles that argue this point and others that refute it. Those that suggest this lower success rate do seem to note at least a subtle correlation between those toxins I mentioned earlier and difficulty with implantation. IVF removes the whole process from the body, so obstructions in the fallopian tubes and influence of these toxins on sperm would not be factors. Either way, though, women with advanced to severe endometriosis have highest chances of conception through IVF.
My concerns lie in the fact that I do have advanced endometriosis and I did have an endometrioma (or chocolate cyst as they are sometimes adoringly called -- isn't that just the cutest name?). The literature that suggests my chances are lower than others undergoing IVF freaks me out. I should probably stop reading it, but I'm out of control. I wanted to go into this procedure with a realistic but positive outlook, and it's really hard to marry the whole realistic thing and the positive thing when we're dealing with infertility here. They just don't work well together.
Without really getting in there and beginning stimulation, we don't know how my ovaries will respond, how many follicles I'll produce, or whether or not those follicles will contain healthy, mature eggs. It's such a gamble. I know for a fact that my tubes aren't blocked (structural stuff was checked out during my lap surgery), so that's not my issue. We don't know my endometriosis's impact on my egg quality, and I'm afraid that these "NKa" toxins will inhibit implantation once we've done all the hard work.
In the meantime, in an attempt to ease my worries, I've been ignoring other pressing tasks in order to stalk message boards for evidence that there are women out there (and hopefully lots of them!) who have advanced or severe endometriosis and have gotten pregnant through IVF. And they do exist.
I just hope I can join them.
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