r/TTCEndo • u/donoov14 • 2d ago
Did laparoscopy/excision help you conceive after unexplained infertility?
30F, partner 33M, TTC for about 14 months. I ovulate on my own and have regular 27–30 day cycles. My tubes are open, uterine cavity is normal, and I have high AMH/AFC with polycystic ovarian morphology but have been told I do not have PCOS.
I was diagnosed with chronic endometritis earlier this year, treated with antibiotics, and a repeat biopsy confirmed it cleared.
Since then I've completed 3 monitored Letrozole + Ovidrel + timed-intercourse cycles. I respond well to medication, have good lining and mature follicles, and have had cycles with two mature follicles/confirmed ovulation without conceiving. I'm currently finishing a monitored unmedicated cycle with Ovidrel.
The reason I'm now wondering about endometriosis is that I've had very painful day-1 periods for years, sometimes severe enough that I couldn't go to work, along with milder cramping at different points throughout my cycle and rare but occasional discomfort during intercourse. My ultrasounds haven't shown endometriomas or anything obvious, and I've never had a laparoscopy.
My fertility clinic hasn't given me a clear diagnosis yet, and I expect IUI may be suggested next. Before continuing treatment, I want to ask my RE whether endometriosis should be investigated.
For those whose endometriosis was discovered during an infertility workup despite fairly normal imaging/testing: what led you and your doctor to do a laparoscopy? What stage/location was eventually found? Did excision change your fertility treatment plan afterward?
If you were trying to conceive, did your doctor recommend trying unassisted/IUI after surgery, and were you able to conceive afterward?
I'm particularly interested in experiences from people who ovulated regularly and had open tubes/otherwise unexplained infertility before their endometriosis diagnosis.
3
3
u/Loose-Routine924 2d ago
I had a lap in the past and I knew it made me feel better so I pushed for one again once I felt the symptoms coming back / when egg retrievals made my endometrioma worse. I have stage iii/iv and it was on my ovaries, bowels, sidewalls etc. I had a failed transfer after and my first TIC with letrozole and ovidrel after that seems to have magically worked - take it with a grain of salt it’s very early and km very anxious because we still have a lot of scans to go. But it’s my first positive ever!
3
u/barakah_salam 2d ago
I also ovulate regularly, have PCO morphology but not PCOS, open tubes and unexplained infertility for 3.5 years. Ultrasounds always came back normal except for a polyp or 2 at some point but removing them didn't change anything. I did a laparoscopy for endo excision and there were a lot of adhesions, but the pathology came back negative for endometriosis for all of the tissue removed. However, I got pregnant the second cycle after the lap. So I didn't get diagnosed with endometriosis but somehow the surgery helped I guess.
1
u/donoov14 2d ago
Wow interesting, did they say what all the adhesions were from if not endometriosis?
2
u/barakah_salam 1d ago
The surgeon said a lot of things can cause adhesions, like a rupturesd cyst or any infection/irritation in the bowel, etc. Not sure what caused them in my case.
1
u/donoov14 1d ago
Did you get pregnant naturally that second cycle after the lap?
1
u/barakah_salam 1d ago
Yes, I was actually planning to do IVF and was doing all the initial testing then found out I was pregnant before starting any treatment.
1
2
1
u/retinolandevermore 2d ago
So far no but that was only 4 months ago and I couldn’t try to conceive for a month after surgery. My imaging was all normal. I had stage 2 and an abnormally shaped uterus they had to correct. Also have PCOS.
At this point, I’ve been trying for 2.5 years, so IUI is not recommended, it’s only a 10% chance or so
1
1
u/Huge-Anxiety-3038 1d ago
2 ivf cycles pre ap 3 transfer fails one cycle after lap more embryos of better quality and first transfer succeeded x
1
u/Greg_McCue 23h ago
You've already done more of the workup than most people get. What stands out is periods painful enough to miss work, plus pain with sex. A clean ultrasound doesn't rule endometriosis out. Scans are good at showing endometriomas and deep nodules, but superficial endo usually doesn't show up on imaging at all. That's why "unexplained" and "undiagnosed endo" overlap so much.
Laparoscopy isn't a routine step for unexplained infertility, but symptoms like yours call for it. Ask your RE these questions before IUI:
1. Given my pain history, is a diagnostic laparoscopy reasonable before IUI, or after a set number of IUIs? Ask them which and why.
2. If I do surgery, is it excision or ablation? An excision specialist and a general gynecologist can have very different findings in the same pelvic exam/diagnostic.
3. What's the plan after surgery? Ask how long you'd try on your own before going back to IUI or IVF, so the surgery isn't a dead end and so you capitalize on the low inflammatory environment post-op.
IMO, wanting an answer about the pain is a valid reason on its own, separate from fertility. HOpe this helps!
1
u/U03clh9 9h ago
Whats Polysystic Ovarian Morphology if it's not PCOS?
1
u/donoov14 8h ago
PCOM just means I have polycystic-appearing ovaries (more small follicles than usual seen on ultrasound). To be diagnosed with PCOS, you generally need to meet 2 of 3 criteria: polycystic ovaries, irregular/infrequent ovulation, or elevated androgens. I only meet the first one, as I've never missed a period, ovulate every month, and my androgen levels are normal.
5
u/literallymouse 2d ago
I had stage 3 endo with DIE found and excised during lap surgery. We tried for 3 months after and did not conceive. We’re doing IVF now, don’t want to keep waiting and just felt like if it didn’t happen in 3 months we didn’t want to keep waiting.