Dear Professor Winston,
I am in my late 30’s and 4 years was diagnosed with severe endometriosis after suffering extremely painful periods since the age of 15 (masked a number of years in my 20’s by taking contraceptive pill) and treated via laparoscopy. My periods have been brilliant ever since.
Six months later I joyously became pregnant having just scrapped in one the deadline I was given before needing to see consultant again, and now have a fabulous son and will eternally feel blessed for having him.
However we have been trying for a second child for over a year now (14 months) without success. I am charting my temperature every morning and taking OPK tests (only ever had a positive result once. With my first pregnancy I never got a positive) to try and assess when is best time to try and conceive. I have also been referred to gynaecologist via GP next month. I have had blood tests for ovulation which came back fine. I’ve also had a transvaginal ultrasound and all came back as normal.
For reference I had a transvaginal ultrasound prior to my endometriosis diaganosis and was told it was normal, but then found all my organs were stuck together and fallopian tubes twisted – although dye went through fine one side and very slowly the other side.
However my cycle is on short side (average 23 days) and my temperature tracking suggests I may be ovulating late in month (around day 16) so I may have short luteal phase.
Just wondered if Professor Winston had any advice. I’m concerned my age, endometriosis and potentially short luteal phase may mean we can’t conceive again.
Would like to remain anonymous please but happy for story to be shared in the hope it may help someone else.
You might be surprised to learn that your situation is an extremely common one. Unfortunately severe endometriosis often causes this kind of scarring and adhesion formation. I have to say, that in my view temperature charting and 0PK tests are unlikely to be helpful and I will be inclined to discourage you from using them because I think it can actually affect the quality of your sex life and there’s no question but this does not help infertility.
Whilst I am always reluctant to suggest IVF treatment unless it is really necessary, I do feel that in your case this is quite likely to be the best option even though you have conceived before. One of the issues might be that you have some degree of adenomyosis in the uterus, and this should probably be checked. Either and HSG or an MRI are ideal in cases of adenomyosis because they give some indication of uterine involvement and therefore the chance of an embryo implanting successfully and proceeding to term. However, most people with adenomyosis have pelvic pain and very irregular periods, as well sometimes bleeding between the periods. It seems that you have none of these symptoms so I think investigation of your uterus is not essential.
One advantage of doing IVF will also be that the surveillance of your ovaries during stimulation may help to see how effectively your ovaries are working. Also it will confirm that you do not have cysts in either ovary which need treatment. The other thing of course is that if you do get pregnant your endometriosis is likely to continue to be suppressed. Clearly a good thing.