Post-Lupron & Trying To Conceive

Hello,

I am 24 years old and my husband and I are trying to conceive.   I was diagnosed with endometriosis after a lap on Dec 15, 2007. I have been on two separate treatment cycles of Lupron Depo. The first cycle was in 2011 for 11 months (monthly injection). I was then put on Aygestin. My menstrual cycles were semi normal for about 4 months while on BC. I had a span of about 6 months (starting in of constant menstruating with only about 3-5 days of not bleeding that came rarely. I was put back on the Lupron injections (3 month shot) in May 2013 and received my last 3 month injection in August 2013. The 3 month shot should have started wearing off in November.

It is now January 21, 2014 and I have yet to start my menstrual cycle. I am not able to track and chart when I should be ovulating due to no cycle. I am very anxious to get pregnant and went through the 6 months of Lupron to “start fresh” as my doctor said this will help. I have not had any pain/cramps, but I have had a fluttering or bubbling feeling in my lower abdomen. I read that many pregnant women got this feeling at the beginning of their pregnancy, but the tests I’ve taken are negative.

Any advice is GREATLY appreciated,

Fearful in Fairfield, CA

Answer:

Hello B. from the U.S. (California),

Considering that you have a significant amount of endometriosis, based on the amount of lupron you have received, then it is imperative that you get pregnant as soon as possible. By the way, I have never heard of anyone taking lupron for 11 months.  In fact, it is NOT recommended to take Lupron for more than 6 months because of the risk of causing osteoporosis.

Now, I would recommend that you no longer wait for your cycles to start again.  I would recommend that that you go see a competent doctor who can do ovulation induction cycles.  That is, you should be placed on fertility medications to get your ovaries to ovulate.  You will NOT be able to use Clomid or Femara because they work by increasing the pituitary output of FSH.  The lupron works by blocking the hypothalamus and pituitary so if there are any Lupron effects still present, those drugs will not work.  You will need to use FSH, which are injectable medications such as Follistim, Gonal-f, Menopur, Repronex, Pergonal, etc.  I would use Menopur or Repronex.  These medications need to be given by a doctor with knowledge and experience in using them, AND you need to be monitored for your response to make sure that #1 you don’t form too many ovulatory follicles, #2 to know when to trigger ovulation with HCG and #3 to know when to start intercourse.  This should be a fairly easy treatment if you see the right doctor.  I would recommend that you screen by simply asking the doctor if they do IVF, since those are the specialists that use these injectable drugs the most.

Having just been treated with Lupron, you have about 6 months to 1 year before the endometriosis returns so pursue your pregnancy desires aggressively.

Good Luck,

Edward J. Ramirez, MD FACOG