Endometriosis/Luteal Phase Defect

Courtney

0 Posts
Reply Endometriosis/Luteal Phase Defect Posted on: Dec 22, 2010 at 4:39am
Dr. Braverman,

I am 35 and my husband is 31. We have been trying sence July of 09. I have been using OPK's and charting my ovulation. My FSH as of 11/09 was 5.1. I am active, healthy and a good weight. My husband had some testing that was good except for a slightly high morphology--they did not think that the morphology was affecting our chances of getting pregnant. I had an HSG that revieled nothing too concerning, a few small polyps, but my tubes were open. In June I was put on Clomid to hopefully lengthen my cycle, I was consistantly around 25 days. After 4 months with no luck, she preformed an endometrial biopsy. I do not have my exact results from that, just that she felt I had a possible Luteal Phase Defect. I was then put on a progesterone suppository and started 100mg B6. After 3 months and no luck I was refered to a Fertility Center.
They did an ultrasound and found a cyst on my right ovary. They feel that it is an endometrial cyst, and they would like to remove it and do a hysteroscopy at that time as well. I was told to start birth control to give my ovaries a rest. I just did another FSH and I was at a 12, (I am considering taking melatonin, CoQ10 and wheatgrass). My new doctor feels that this is high and that IUI is no longer an option and that IVF is something that I should do after my procedure.

I am feeling confused at this point. I asked my new physician a few questions the other day.
Frist: If my cyst is and endometrial cyst, then do I have Endometriosis? And how wold I treat it.
Second: If my cycle is short and I have a Luteal Phase Defect, how do I treat that?

His response was that it did not matter because IVF (and the medications that go along with IVF) would bypass all of those issues. I feel that if something is wrong I want to figure out what I can do to fix it, not bypass over it.

Thank you very much for you time. Happy Holidays.
Courtney

Dr. Braverman

2026 Posts
Re: Endometriosis/Luteal Phase Defect Posted on: Dec 25, 2010 at 3:18am
Hi Courtney , sorry for the delay in your answer I was away. I do agree that you should confirm the diagnosis of endometriosis as this could be affecting your FSH level(the high TNF from endometriosis cuases oxidative stress to the follicles, sometimes debulking or ablating the endometriosis gives the eggs a chance to recover and we see better resutls with both IUIs and IVF after these surgeries. Also as endometriosis is an auto immune syndrome you would need to get an immune workup prior to starting any treatment cycles to be sure no other treatments are necesssary. Luteal phase defects are the easiest to treat but are also the least likely cuase of your issues, but I do agree with progesterone supplementation regardless of what your other treatments and diagnosis are.
Feel free to call me and Ill be happy to give you a full plan and workup to figure out exactly what you should do. Ask for Kim when you call.
I hope I can be of service to you , and also I do beleive that morphology can play a signifiant role in your difficulties , when we talk please have all your lab data available.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Dec 31, 2010 at 3:18pm
Thank you for your reply. I have been gathering all of my test results, and will call your office for a phone consultation. In the meantime, do you recommend my taking Melatonin, CoQ10 and wheatgrass for my FSH levels?

Thank you again & Happy New Year!
Courtney

Dr. Braverman

2026 Posts
Re: Endometriosis/Luteal Phase Defect Posted on: Dec 31, 2010 at 4:11pm
Yes I recommend them to all my patients with elevated FSH. There are studies that show an increased level of melatonin in follicular fluid with better egg quality, and the antioxidants have been found to improve egg quality when started after a poor IVF cycle and also when added to the culture medium that the eggs are cultured in the lab. All chlorophyll containing supplements also improve egg quality and I have seen them lower the FSH levels so stay on all.
Speak to you soon.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Mar 17, 2011 at 8:35pm
Dr. Braverman,

After we last spoke I had my procedure. It turned out to be slightly more complex. When they began to look around they noticed that I had a septum in my uterus. They removed it as well as several pollups, the large endometrial cyst, and endometriosis that was located on my bladder and adhesions in my uterus. My doctor feels that my endometriosis is mild to moderate. He also said that my ovaries looked great. Based on these findings, do you feel that this could be immune related. Do you think I could be treating this by taking prednisone? I am scheduled to begin Lupron injections and start the IVF process next week. I am still on all my suppliments, and I as well as my husband have also included Pine Bark per our conversation.

When doing a transfer, does your office typically do a 3 or 5 day transfer. I believe that my doctor does a 3 day transfer. Also, because of my husbands slight morphology issue, he feels that we should do ICSI. What are your thoughts? Thank you Dr. Braverman.

Best,
Courtney

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Mar 18, 2011 at 7:12pm
Dr. Braverman,

After we last spoke, I had my procedure. It turned out to be slightly more complex. When they began to look around they noticed I had a septum in my uterus. They removed it as well as several polups, the large endometrial cyst on my ovary, endometriosis that was located on my bladder and adhesions in my uterus. My doctor feels that my endometriosis is mild to moderate. He also said that my ovaries looked great. Based on these findings, do you feel that this could be immune related? If so, do you think that I could be empiracally treating this with Prednisone? I am scheduled to begin Lupron injections and start the IVF process process next week. I am still on all of the supplements and I as well, as my husband, have also included Pine Bark per our conversation.

I also wanted to ask you opinion on a day 3 or day 5 transfer? I believe that my doctor does a 3 day transfer. Also, because of my husband's slight morphology issue he feels that we should ICSI. What are your thoughts?

Sorry if you get this post twice!

Thank you Dr. Braverman.

Sincerely,

Courtney

Dr. Braverman

2026 Posts
Re: Endometriosis/Luteal Phase Defect Posted on: Mar 22, 2011 at 1:34pm
Yes this is most certainly immune related, you need a full immune panel to decide on the best treatment and among those treatments is prednisone, but intralipids, IVIG, clexane, neupogen, all possibilites and based on the testing. You should not treat without testing as this could cause as much harm to implantation as good. Feel free to call me to arrange for the testing then I woudl be happy to recommend a protocol for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Apr 9, 2011 at 7:08pm
Dr. Braverman,

When we talked a few weeks ago I was just about to begin my first IVF cycle. I started 10 units of Lupron on March 23rd of last month's cycle. On CD 2 I started 150 iu of Menopur, 300 iu of Gonal-f and the Lupron was decreased to only 5 units. My estrogen was tested on CD 7 and it was only 202. The dr said this should be between 400-600 so the Gonal-f was increased to 375 iu. This morning I went in to have my estrogen checked again and for an u/s. The dr saw 11 follicles - 8 small follicles and 3 maturing follicles at 11mm, 13mm and 16mm. I don't have my estrogen result back yet. The dr also said the large endometrioal cyst that was removed from my right ovary in Janurary has grown back. She also saw another smaller one on that same ovary . She said the endometriosis was overtaking over my right ovary...there was only one follicle on it. I go back on Monday for more bloodwork and another u/s. The dr said she would do the egg retrival if she can get 2-3 eggs. So my questions are do you think more of my follicles will mature now that the Gonal-f is increased? Do you think I should be on a different IVF protocol because of my endometriosis?

Thanks again for your time!

Sincerely,

Courtney

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Apr 9, 2011 at 7:15pm
Dr. Braverman,

When we talked a few weeks ago I was just about to begin my first IVF cycle. I started 10 units of Lupron on March 23rd of last month's cycle. On CD 2 I started 150 iu of Menopur, 300 iu of Gonal-f and the Lupron was decreased to only 5 units. My estrogen was tested on CD 7 and it was only 202. The dr said this should be between 400-600 so the Gonal-f was increased to 375 iu. This morning I went in to have my estrogen checked again and for an u/s. The dr saw 11 follicles - 8 small follicles and 3 maturing follicles at 11mm, 13mm and 16mm. I don't have my estrogen result back yet. The dr also said the large endometrioal cyst that was removed from my right ovary in Janurary has grown back. She also saw another smaller one on that same ovary . She said the endometriosis was overtaking over my right ovary...there was only one follicle on it. I go back on Monday for more bloodwork and another u/s. The dr said she would do the egg retrival if she can get 2-3 eggs. Do you think more of my follicles will mature now that the Gonal-f has been increased? Do you think I should be on a different IVF protocol because of my endometriosis?

Thanks again for your time!

Sincerely,

Courtney

Courtney

0 Posts
Reply Re: Endometriosis/Luteal Phase Defect Posted on: Apr 10, 2011 at 1:14am
To follow-up to my post earlier today...I found out my estrogen today was 619. Today was CD9.