March is "Endometriosis Awarness Month" and I thought it would be appropriate to post this recent question from a woman who had endo and succeeded to have her child six months ago. For those of you who wish more information on this reproductive immunologic disease that affects millions worldwide you might begin by visiting the Endometriosis Research Center website.
Question:
Dear Dr. Ramirez,
My beautiful baby boy- now 6 months old- was conceived via IUI (after more than 2 years of trying, painful laser ablation of my endometriosis, 4 rounds of clomid, and two tries with IUI). I have endometriosis. I also happen to have an AMH level of .8-- quite low for age 31, but my FSH and other levels have been perfectly healthy and age appropriate. My fertility specialist urged me not to wait to try for a 2nd baby (given my AMH and the likelihood of my endometriosis returning after pregnancy). So now that my son is 6 months old, and I fear I am beginning to feel some of the painful twinges of endometriosis returning, I am wondering when I should start getting serious about another IUI for baby #2.
I am still peastfeeding (hope to continue for maybe another 6 mo) and my period has not yet returned. While becoming pregnant right now feels a little hard to imagine, given the demands of having an infant, my husband and I DO want a 2nd child, and would like a chance to have another of our own. Is it reasonable/recommended to wait until my period returns (and is normal) before getting serious about this? Or, must I take sooner action? What about peastfeeding-- would peastfeeding interfere (hormonally) with the chance of IUI success/pregnancy? I am trying to temper not feeling quite ready to be pregnant again with not wanting to miss my chance to grow our family... what do you suggest??
So very sincerely appreciated, K. from Atlanta, GA
Answer:
Hello K. from the U.S. (Georgia),
First of all, AMH is an indirect test of the ovary and NOT an absolute. It is used in conjunction with cycle day #2 or 3 FSH and an ultrasonic antral follicle count. So, I would not assume that your time is limited if the FSH and AFC are normal but the AMH is decreased. It is not that critical. Now, it is a little worrisome that your level would be low at your age, so time needs to be kept in mind. But the timeline is not days or months but probably years. For example, I would not wait until you are 35 years old where your age will then start to become an issue as well.
In terms of when to try next, I think you can wait until you have finished peastfeeding, since it would interfere with conception.While you are peastfeeding the ovaries are at rest and not functioning any way so you don't have to rush. In some women, in fact, pregnancy seems to clear up their endometriosis temporarily, so you may have time to conceive after you stop peast-feeding and your period returns. I have had patients like you who have had endometriosis and needed assisted reproductive help for their first baby, who then went on to have baby number 2 & even 3 without the need of further IUI's or IVF.
Congratulations and enjoy your baby!
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
