Trying To Conceive After Surgery For Cysts & Endometriosis: Do A Clomid Induction Cycle?

Question:

Hi from Wisconsin!

My husband and I have been trying to conceive our third child. My youngest will be turning three in a couple of months. They were conceived quickly with no issues. About a year ago, I was advised to have surgery to remove what looked liked a "complex ovarian cyst" that was causing intense pain. I was on birth control pills at the time. I was told everything else looked good at the time of surgery and I experienced heavy bleeding afterwards for about a week. A year later I was still having pain in that area, so a different MD did surgery and removed an adhesion between my tube and ovary, a small amount of endometroisis, and paratubular cysts everything was located on the same side as my surgery. My tubes were open.

I am about 3 months from the surgery and on our fifth month of ttc and have been having really light periods (which I have always had, so I was surprised by the endo) that start/stop and have pownish spotting in the beginning. I was told it means I am not ovulating. I am doing a progesterone test later this week to see if I am. I did get a positive OPK on day 14 this month and my periods are pretty regular occurring every 28-30 days. Clomid was suggested for my next cycle, which I am nervous about trying. I am 33 and my husband has a normal semen analysis (one of the motility numbers was lower 37% but they said because his total motile sperm number was above 57 million they said it was fine).

Do the light periods have anything do to with not getting pregnant? I also get a lot of white sticky discharge after the egg white mucus and a few days after the OPK positive, is this also a sign something is not working? Will Clomid help me? If I am ovulating will it just increase the number of available eggs? For the next cycle an ultrasound and HCG trigger were also suggested. This is all so frustrating! When asked my MD told me I had a reasonably good chance of getting pregnant on my own but I am worried about being on a time crunch, especially since no endo was seen a year before.

Thank you for your advise. S. from Wisconsin.

Answer:

Hello S. from the U.S. (Wisconsin),

Usually the amount of flow with a period is proportional to the amount of endometrial lining produced. The endometrial lining is produced or grown with increasing amounts of estrogen that occurs in the first two weeks of the cycle. This is called the "proliferative phase" for proliferation/growth of the endometrium. As a targeted follicle grows, it produces more and more estrogen. So, the fact that your periods are very light is a little worrisome in terms of the possibility that there is inadequate estrogen production. If you are ovulating then adequate estrogen should be produced, so maybe there is an ovarian dysfunction going on. I cannot be sure without additional information or testing. Clomid may help this by inducing the ovary to function more normally and increase the estrogen production by increasing the number of follicles that progress to ovulation. Clomid increases pregnancy rates by increasing the number of eggs ovulate in women that are already ovulating normally. This treatment is called "superovulation.".

With clomid ovulation induction cycles, I am a strong advocate of ultrasound surveillance or monitoring. This allows us to evaluate how you are responding to a particular dosage of medication, since there are varying dosages that can be used and people respond differently, how many follicles are being developed, so that you don't ovulate too many eggs and significantly increase your chances of a super-multiple gestation, when the follicle is at the appropriate size to trigger ovulation with HCG and to time intercourse or IUI so that it is at the closest time to ovulation (ovulation cannot be predicted completely).

You are correct about the timeline for your endometriosis. I tell my patients that they basically have a 6 month window of opportunity after their endometriosis treatment. With each cycle, new endometriosis is being produced and some endometriosis that was at a microscopic stage is growing. Eventually, you will return to the pre-surgery state which may be preventing pregnancy. For that reason, I too recommend a more aggressive timeline and aggressive approach to treatment such as superovulation with timed intercourse or IUI.

Good Luck,

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.