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Endometriosis and Conception

March 25, 2008 - Tuesday
8:00 PM to 9:00 PM (EST)
Guest Speakers: Mickey Coffler, M.D., Huntington Reproductive Center

Categories
Endometriosis • Fertility • IVF • Pregnancy Loss


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[Tue Mar 25 16:51:56 PDT 2008] moaichaHello
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[Tue Mar 25 16:54:19 PDT 2008] Corey_WhelanHi everyone. Welcome to tonight's chat on endometriosis with Dr. Mickey Coffler of Huntington Reproductive Center. I am Corey Whelan, your chat moderator. We will officially being in five minutes.
[Tue Mar 25 17:00:55 PDT 2008] Corey_Whelanfolks, any time you are ready\, please feel free to post your questions for Dr. Coffler, who has joined us.
[Tue Mar 25 17:01:54 PDT 2008] Corey_WhelanHi cheeboo
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[Tue Mar 25 17:03:21 PDT 2008] Dr._Coffler Good evening my name is Dr. Coffler, I am glad to be here. I would love to answer any questions you may have about emdometriosis and fertility.
[Tue Mar 25 17:03:58 PDT 2008] cheebooHello there, has anyone heard of children of vietnam vets that were exposed to agent orange linked to endometriosis and or high fsh level??
[Tue Mar 25 17:05:01 PDT 2008] Dr._Cofflercheeboo- I am not familiarwith any link between the exposure to agent orange and an elevated fsh
[Tue Mar 25 17:05:54 PDT 2008] cheebooWhat about high dioxin levels ?
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[Tue Mar 25 17:06:04 PDT 2008] moaichaI have endometriosis and had been removed twice but still I canot conceive for 11 years. I had 3 failed IVF,
[Tue Mar 25 17:06:31 PDT 2008] moaichahow can I maximize my chances
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[Tue Mar 25 17:07:11 PDT 2008] wsbemusI have had 2 miscarriages, of course they could not explain why. Since the 2 miscarriages I have lost 50 pounds, we’re starting going to a new dr. do you think that losing that much weight increases my chances?
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[Tue Mar 25 17:08:18 PDT 2008] Dr._Cofflermoaicha- Im sorry to hear aboutyour troubles and your failed IVF cycles. At Huntington Reproductive Center we have alot of experience with endometriosis patients who have had previous failed cycles.
[Tue Mar 25 17:09:34 PDT 2008] aquamarineIs the evaluation for a woman with endo any different than for any person who is having fertility problems? Are there things I should pay special attention to?
[Tue Mar 25 17:09:41 PDT 2008] Dr._Cofflermoaicha-other facors could be be contributing to your IVFfailure such as reduced ovarian reserve.
[Tue Mar 25 17:10:00 PDT 2008] moaichaI live in Washington DC, where is it located
[Tue Mar 25 17:10:39 PDT 2008] Corey_Whelanmoaicha, if you need a referral in the DC area, you can call the AFA helpline and we can give you several, no prob there
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[Tue Mar 25 17:11:24 PDT 2008] moaichaI go to Shady Grove Fertility center
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[Tue Mar 25 17:11:38 PDT 2008] Dr._Cofflermoaicha- we have 6 offices in Southern California. I am located in Laguna Hills and Fullerton. Huntington Reproductive Center sees patients from all around the world.
[Tue Mar 25 17:12:02 PDT 2008] moaichaI had 2 miscariage at 7 weeks unexplained
[Tue Mar 25 17:12:33 PDT 2008] Dr._Cofflerwsbemus- Congratulations on your weight lss success it will definitley increase your chances at achieving a successful pregnancy.
[Tue Mar 25 17:13:21 PDT 2008] Dr._Coffleraquamarine- the evaluation is the same
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[Tue Mar 25 17:13:35 PDT 2008] wsbemusi do have type 2 and i take oral meds, I too have endometriosis removed twice and had been trying to conceive for 9 years
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[Tue Mar 25 17:16:04 PDT 2008] Dr._Cofflerwsbemus- your DM does not affect your endometriosis, both can affect fertility. You should definitley see an nfertilty specialist an evaluation
[Tue Mar 25 17:16:22 PDT 2008] Jen2694I've have stage 4 endo and had surgery to remove it two years ago. I have had 2 failed IVF cycles and am going for a 3rd. REcently did a uterine biopsy that showed i should go on lupron for a few months before the next cycle..any other options to enhance my chances?
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[Tue Mar 25 17:18:01 PDT 2008] Dr._CofflerJen264- That woud be my recommendation as well. No further sugestions at this point
[Tue Mar 25 17:18:39 PDT 2008] Jen2694Thanks, do you think that acupuncture would be a good compliment therapy? I had it on the last cycle and got alittle discouraged
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[Tue Mar 25 17:21:23 PDT 2008] aglickptDr. Coffler-I have stage 2-3 endo. After 3 unsuccessful IVF's I conceived a daughter after a Lap 2.5 years ago. I have recently done 2 IVF cycles that were also unsuccessful. We are considering another Lap and then possibly IUI as IVF is no longer an option due to financial difficulties. Do you think I have a chance to conceive after another Lap and with IUI?
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[Tue Mar 25 17:21:55 PDT 2008] Dr._CofflerJen2694- though there are no studies to ultmately support accupncture treatment to improve the success of IVF with endometriosis, I would ecourage you to give it another try
[Tue Mar 25 17:22:07 PDT 2008] Corey_Whelanaglick, how old are you?
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[Tue Mar 25 17:22:56 PDT 2008] aglickptI am 38. I will be 39 next month
[Tue Mar 25 17:23:04 PDT 2008] Jen2694Thanks Dr Coffler. do you know how common it is for women to need add back therapy while taking Lupron? I'm concerned about the side affects..
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[Tue Mar 25 17:24:05 PDT 2008] Dr._Coffleraglickpt- your chances with IUI will always be lower than with IVF but thatis your only option at ths point yu should continue with that.
[Tue Mar 25 17:24:24 PDT 2008] moaichanow I'm doing accupuncture even though I will not be doing IVF until May. is it good. once a week
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[Tue Mar 25 17:24:41 PDT 2008] Jen2694 To[Private] Dr._CofflerDr Coffler, I was hoping to find out what your professional opinion is of Dr Schoolcraft. I have a few friends who have gone there and had success. We are thinking of switching from RMA of Michigan (Dr Miller, Dr Keye)
[Tue Mar 25 17:24:43 PDT 2008] aglickptIn addition, I have read that restricting certain types of exercise such as running keeps the endo at a minimum. Is this true? What about diet? I also read a gluten free diet is better for Endo. what are your thoughts?
[Tue Mar 25 17:25:27 PDT 2008] wsbemusi did lupron therapy and my side affect was i got VERY MEAN!!!
[Tue Mar 25 17:25:46 PDT 2008] aglickptIf Endo prevents pregnancy or makes it difficult to achieve then why isn't a primary diagnosis of infertility rather than a secondary diagnosis?
[Tue Mar 25 17:25:50 PDT 2008] cheeboo JEN 2694 let me tell you i had taken that horrible stuff called lupron which basically strips all the estogen out of your body, shots on the thigh and doing a 360 on your emotions ( please be careful)
[Tue Mar 25 17:25:57 PDT 2008] Jen2694wsbemus- Thats what I'm worried about! I already went through clomid rage..haha
[Tue Mar 25 17:26:05 PDT 2008] Dr._CofflerJen2694- Are you concerned about the side effects of the add back or the Lupron?
[Tue Mar 25 17:26:10 PDT 2008] Jen2694the lupron
[Tue Mar 25 17:26:30 PDT 2008] Jen2694i heard the add back helps with the symptoms brought on by lupron
[Tue Mar 25 17:26:39 PDT 2008] amalarconHi dr. I had Endo stage 3. Already had 2 surgeries. Last one a year and a half ago. I was on lupron since July. I had my first period two weeks ago. Do you think I should wait to conceive or to go ahead with IVF. I am 31 years old
[Tue Mar 25 17:27:52 PDT 2008] cheebooDoes any one know if having a lap done 10 years due to endo would have increased my chances of continusly being infertile adn going into DOR way early?
[Tue Mar 25 17:27:55 PDT 2008] Dr._CofflerJen2694- that is correct the ad back does help greatly minimize the side efects of Lupron
[Tue Mar 25 17:28:52 PDT 2008] Jen2694Thanks Dr Coffler...i will mention it to the doctor and push for the add back if i feel it necessary. This is already a stressful enough time.
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[Tue Mar 25 17:29:42 PDT 2008] Dr._Coffleraglickt- I ma not aware of any good studies showing that diet and exercise can improve endo
[Tue Mar 25 17:31:15 PDT 2008] Dr._Coffleramalarcon- you are young but it depnds on how long you have been trying so far
[Tue Mar 25 17:33:55 PDT 2008] aglickptThanks for your answers...One more question...Those with endo, do you go into perimenopause earlier than individuals who don't have endo?
[Tue Mar 25 17:34:35 PDT 2008] amalarconI went to a specialist and he said that I should waist time, but he want to close my tubes and that scares. What if IVF does not work .....can they be open again?
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[Tue Mar 25 17:35:54 PDT 2008] Dr._Coffleraglickpt- endo does not affect the onset ofperimenopause, but ovarian surgery for endo may affect ovarian rerserve and the onset of menpause
[Tue Mar 25 17:37:01 PDT 2008] hopingSorry if I missed this already, but does that mean the endo surgery can bring on premature onset of menopause?
[Tue Mar 25 17:37:07 PDT 2008] Jen2694What do you mean by "ovarian surgery". is that the removal of endo from the ovaries during LAP?
[Tue Mar 25 17:37:55 PDT 2008] aglickptI did have a small portion of my left ovary excised during my first lap(due to an endometrioma). Not the last one though. So that can affect my ovarian reserve? Is an FSH level the only way I will know how much time I have left?
[Tue Mar 25 17:38:00 PDT 2008] Dr._Coffleramalarcon- that would depend on the type of surgery you have done on your tubes. We reccomend removing the tubes prior to IVF if they are dilated due to previous infection.
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[Tue Mar 25 17:38:36 PDT 2008] kxc156Hi Dr. Coffler, I was just diagnosed with endo (stage 1) and my endo was removed through a lap. Does surgery for mild endo help chances of conception? I've read a lot of mixed reviews
[Tue Mar 25 17:39:17 PDT 2008] Dr._CofflerJen264- any surgery on the ovary that removes a significant portion of it
[Tue Mar 25 17:39:55 PDT 2008] cheebooDR is there any other way to tell how infertile you actually are besides the FSH?
[Tue Mar 25 17:40:22 PDT 2008] Jen2694What can you tell me about the ovaries adhering to the uterus post surgery. Ultrasound shows that my left ovary is behind my uterus, but no doc has said its for sure adhered
[Tue Mar 25 17:40:43 PDT 2008] Dr._Coffleraglickpt- since it was a small portion, typicaly it should not affect OR
[Tue Mar 25 17:42:15 PDT 2008] acrosbyI joined late so I'm not sure if anyone already asked a similar question. I had a laparoscopy 1 year ago and the doc said I was a level 2-3 for endo. I did insemination once shortly after surgery- no luck, and twice before surgery and we have been trying for 4 years total. Currently not undergoing any medical treatment but if I were to begin what would you reccommend?
[Tue Mar 25 17:42:32 PDT 2008] Dr._Cofflerkxc156- there is no definitave agreementin the literature on this topic
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[Tue Mar 25 17:43:18 PDT 2008] amalarconMy left tube is dilated based on HSG but the right one is fine. I though you just need one tube to get pregnant....
[Tue Mar 25 17:43:33 PDT 2008] Dr._Cofflercheeboo-yes there is an entire infrtility workup inluding a semen anlaysis on your partner
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[Tue Mar 25 17:44:57 PDT 2008] Dr._CofflerJen2694- it is impossible to dtermine if that would affect your ability to coneive
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[Tue Mar 25 17:45:39 PDT 2008] Jen2694is the adhering a common thing? I had endo covering most of my left ovary
[Tue Mar 25 17:47:17 PDT 2008] Dr._Coffleramalarcon- that is correct you only need one healthy tube but the dilation of one tube typically means that both tubes are affected by previous infection
[Tue Mar 25 17:47:47 PDT 2008] Jen2694what test is used to determine if a tube is dilated and why would you remove the tube for that?
[Tue Mar 25 17:47:53 PDT 2008] sfhscottdoes endo affect the ability of the embryo to implant (using IVF)?
[Tue Mar 25 17:48:55 PDT 2008] Dr._CofflerJen264- adhesions with enometriosis is vry common and we think it may contribute to infertility but not patients with adhesed ovaries are infertile
[Tue Mar 25 17:49:22 PDT 2008] Dr._CofflerJen2694-not all patients^
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[Tue Mar 25 17:51:30 PDT 2008] Dr._CofflerJen2694- that would be a hysterosalpingogram (HSG), dilated tubes reduces IVF pregnancy rates
[Tue Mar 25 17:52:29 PDT 2008] Dr._Cofflersfhscott- endometriosis of the uterus (adenomyosis) reduces implantaion
[Tue Mar 25 17:53:48 PDT 2008] sfhscottI thought that endo was the uterine lining that had grown outside of the uterus. is it possible to have endo inside the uterus? or are you referring to endo on the outside of the uterus?
[Tue Mar 25 17:54:20 PDT 2008] poopalinahope its not too late. I have severe endo since '90. multiple laps and ivf's. in '04 got pregnat via IVF and at 26 weeks had placental abruption and a severe uterine rupture, with other multiple complications, pulmonary emb, dvt, emergency small bowel resection. etc. i am sure the scarring is probably horrible since then, I won't let drs in to check. what do you think my chances are
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[Tue Mar 25 17:55:02 PDT 2008] Dr._Cofflersfhscott- yes it is possible to have endo inside the uterus it is called adenomyosis
[Tue Mar 25 17:55:33 PDT 2008] poopalinai meant scar tissue, endo implants
[Tue Mar 25 17:55:40 PDT 2008] Jen2694poopalina, so sorry for what you've gone through, but you gotta let the doctors in to check..i know you're scared of what they'll find..but they can help you.
[Tue Mar 25 17:55:50 PDT 2008] sfhscottthank you. are there tests you can perform to determine if adenomyosis is present of is a lap necessary?
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[Tue Mar 25 17:56:00 PDT 2008] Jen2694what test to determine adenomyosis?
[Tue Mar 25 17:56:05 PDT 2008] amalarconWhat do you think would be better: have a surgery to fix tubes or to close them??
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[Tue Mar 25 17:56:28 PDT 2008] PamHello- what are the chances of conception with mild endo? I'm 38
[Tue Mar 25 17:56:45 PDT 2008] Dr._Cofflerpoopalna-following a uterine rupture it maybe safer to use a surrogate
[Tue Mar 25 17:57:31 PDT 2008] poopalinadr -actually we did and we now have an 8 month old after 13 years ttc. we are blessed, however, i want another child
[Tue Mar 25 17:57:46 PDT 2008] Dr._CofflerJen2694/shscot-the best test to check for adenomyosis is an MRI of the uterus
[Tue Mar 25 17:58:01 PDT 2008] Corey_Whelanfolks, we have about three minutes left to our chat. I invite you to utilize the chat room as long as you would like to, but we officially end at nine.
[Tue Mar 25 17:58:22 PDT 2008] poopalinabest of luck everyone....
[Tue Mar 25 17:58:34 PDT 2008] wsbemusThanks
[Tue Mar 25 17:58:37 PDT 2008] Corey_WhelanI want to take this opportunity to thank you all for being here and to thank Dr. Coffler for being here as well. Thanks so much to all.
[Tue Mar 25 17:58:40 PDT 2008] Dr._Coffleramalarcon- pregnacy ates following tubal surgery are lower than with IVF
[Tue Mar 25 17:59:09 PDT 2008] amalarconthanks dr. best wishes to everyone
[Tue Mar 25 17:59:11 PDT 2008] PamHi Dr. I'm 38 yrs old and was diagnosed with mild endo. I've had three pregnancies so far. 2 via IUI and 1 IVF and lost all three. One was an ectopic. What are our chances of conceiving naturally with mild endo?
[Tue Mar 25 17:59:13 PDT 2008] Corey_Whelanand of course, best of luck to ALL of you as well. I know it's hard. Stay positive!
[Tue Mar 25 17:59:38 PDT 2008] Jen2694Thanks so much Dr Coffler, was very infomative
[Tue Mar 25 17:59:39 PDT 2008] Dr._CofflerThank you all and best of luck at buiding your families!
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[Tue Mar 25 17:59:57 PDT 2008] Corey_Whelanbaby dreams, and good night all. xo
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[Tue Mar 25 18:00:21 PDT 2008] Jen2694One more quick question...does lupron help with adenomysis?
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