Monday, August 30, 2010

A reason to believe

WheelbarrowRider's comment on my last post was very timely.  She asked why I was opposed to laparoscopy. Well, what a difference 48 hours makes.  I went searching for research studies on unexplained infertility and the prevalence of endometriosis in infertility patients and I found something very interesting.  A study completed in 2009 titled:

High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners

Uh oh.  


OBJECTIVE: To determine the prevalence of histologically proven endometriosis in a subset of infertile women.
DESIGN: Retrospective case series with electronic file search and multivariable logistic regression analysis.
SETTING: Tertiary academic fertility center.
PATIENT(S): Two hundred twenty-one infertile women without previous surgical diagnosis for infertility with regular cycles (variation, 21-35 days) whose partners have a normal semen analysis.
INTERVENTION(S): Diagnostic laparoscopy and, if necessary, operative laparoscopy with CO(2) laser excision. MAIN OUTCOME MEASUREMENT(S): The prevalence of endometriosis and of fertility-reducing nonendometriotic tubal and/or uterine pathology.
RESULT(S): The prevalence of endometriosis was 47% (104/221), including stage I (39%, 41/104), stage II (24%, 25/104), stage III (14%, 15/104), and stage IV (23%, 23/104) endometriosis, and was comparable in patients with (54%, 61/113) and without (40%, 43/108) pelvic pain. The prevalence of fertility-reducing nonendometriotic tubal and/or uterine pathology was 29% in all patients (15% in women with and 40% in women without endometriosis). A multivariate logistic regression model including pain, ultrasound data, age, duration of infertility, and type of fertility was not or not sufficiently reliable for the prediction of endometriosis according to the revised American Fertility Society (rAFS) classifications I-II and rAFS III-IV, respectively.
CONCLUSION(S): Reproductive surgery is indicated in infertile women belonging to the study population, regardless of pain symptoms or transvaginal ultrasound results, since half of them have endometriosis and 40% of those without endometriosis have fertility-reducing pelvic pathology.
I'm not sure if you can call a 21 day cycle "normal" but the results of this study were telling.  Before this weekend, I was thoroughly unconvinced that a woman without painful periods or other pelvic pain could have endometriosis severe enough to prevent conception.  I'm still a tiny bit unconvinced but that's not stopping me from calling Dr. St.igen to schedule the surgery.  Trixie, I'm waiting for a return call.  I'll give her until 11am before I bang down her door. ;)
I'm also not sure I want to do the surgery with her but I'll at least schedule it hopefully for the first week in November to keep her on the hook.  


  1. Very interesting! Thanks for the highlights...I get a little blurry-eyed with med-talk.

    I have horrendous cramps and have had two laps- Feb 07 and Feb 08- then 9 months of Lupron to no avail. Sigh... I know Dr,. H is a lot more aggressive in his laps than my doctor was. Perhaps that will be the answer for us?

  2. :) I just know with endo you can have symptoms and have none of the complete reverse can be true. It just seems you never know until you look, not to mention other things can be discovered just by looking. I found ours so enlightening-I have non-symptomatic PCOS that was discovered, an infection that was found during the culture that occurred during the lap, endo that was addition Dr. Hilgers did a selective hsg and hystero (shoot what is the word?) during the lap so it was nice to knock it all out. As far as surgeries go, laps are pretty non-invasive. The more they do the more sore you are recovering, but in general I just didn't mind it. Plus insurance tends to cover....Anyway, that is why I was curious. I didn't want to knock your opinion, just to understand it better, since some folks are going off misinformation or fear. Glad you found the article, looks like a good one!
    Oh, Lauren, my lap by my previous doc was not very effective and I did six months of lupron (evil stuff)! Dr. H is so the way to go if at all a possibility-he does a lot at once (see above) and there is much less scar tissue etc. He says you are good for min of 18 months after, where as other docs say 12 or less. And we got preg after without problem (with meds), which always helps with endo I have been told. Mine was in 2006 and I haven't had to go back.

  3. Lauren, Dr. Stig.en did a fellowship at PPVI so I'm pretty confident she has a handle on the Hilgers lap technique. I'm lucky to be near L..A.. so there's likely lots of good surgeons out there, I just don't have one in mind and would have to do a bit of searching to find one. It's essentially a 50/50 chance I have endometriosis or not and I'm willing to take the gamble at this point.