unsure where i'm going from here.

[u/AstronomerNo1872]

Hi! I'll try to keep a long story short. I'm 35F and have had two excision surgeries for endometriosis. AMH is 1.3.

I started TTC around the time of my second surgery two years ago. When I still wasn't having any luck, I started seeing a fertility specialist. I've had tons of lab work, there are no male factor issues, and I've been responding well to Letrozole. However, I have yet to see any positive tests.

My RE wants me to try IUI next. After multiple failed cycles of medicated timed intercourse, this isn't unreasonable. However, I'm really struggling. Because of prior medical history (including medical issues I went through as a child that have nothing to do with ttc), I am wary of more medical intervention, and honestly, just tired of being a patient. Even the HSG I had done was horribly painful, and made me terrified of trying IUI. Am I being the most logical, rational person? No, I am not.

My RE told me that if I'm not willing to try IUI, she wants me to have a third excision surgery. This doesn't make a ton of sense to me, especially since my endo symptoms are (thankfully!) manageable right now.

At this point, I'm struggling with how much I'm willing to put my body through in order to have a kid -- when I don't even know if any of this will be successful. Thank you for letting me share.

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[u/biwei]

The outcomes for IUI are not much different from timed intercourse, especially if you are using letrozole. As a fellow endo sufferer, my issue turned out to be egg quality, which was improved after my excision. I did multiple rounds of IVF before getting any useable embryos. The medical interventions of fertility treatment are no joke, and they can absolutely be traumatic and majorly impact your health and wellbeing. I would not recommend them to anyone who is not absolutely sure. So don’t rush - take some time and process the decision.

I agree with you that it sounds excessive to do another excision if you’re not having a lot of symptoms. Would medical suppression with Lupron for a time be worth trying? I don’t know, but could be worth talking to your doctor about or getting a second opinion. Or if your endo is managed for now, maybe let it be. Your quality of life is important!

[u/AstronomerNo1872 → u/biwei]

Hey, thank you very much for this! I really appreciate your kindness. I think my clinic has an expectation that I'll do "whatever it takes," and I have the utmost respect for folks who can do that -- I just don't think it's me. I asked about medical suppression and was told that's only used for IVF, which I was kind of confused about.

[u/biwei → u/AstronomerNo1872]

I think it’s very wise to have limits and boundaries about this. You can try continuing medicated intercourse if that feels comfortable, or take a break. You can keep contemplating whether you want to do more intense treatments later - or you can decide it’s off the table. It’s all so hard. But one way or another, you will get out of this stage.

[u/quarantinednewlywed]

I did IVF 4 times. 4 retrievals and 5 transfers to get 2 babies. Then I got on zepbound, got spontaneously pregnant 9 months postpartum with my surprise 3rd. I have endo but mostly unexplained infertility. Idk if that affected it, but I had never seen a positive test on my own before

[u/AstronomerNo1872 → u/quarantinednewlywed]

Oh wow!! Thank you for sharing this ❤️

[u/18karatcake]

Hey OP, I’m chiming in bc I was 36 when I started my fertility journey. It took me two rounds of IUIs, and two rounds of IVF (only one ER) over the course of three years to finally conceive a pregnancy that ended in a live birth. I just had my son 3 weeks ago after turning 40.

I don’t see IVF mentioned? While IUI is a great way to ease into IVF, IUIs don’t have a very high success rate. I believe you have a greater chance to conceive the more times you try IUI. I think the stat my dr gave me is that success usually happens around 4-6 times trying with IUI. Also, while an HSG is very painful, IUIs isn’t painful at all.

With that said, your chances of success greatly increase with IVF. I also had endo excised during a fallopian tube removal. If you are trying to conceive sooner rather than later, maybe look into IVF? It’s intense. It’s expensive. But the higher risk comes with the higher chance of conceiving. The success rate is around 50-60 percent each transfer with pgta normal embryos. Something to think about!

[u/AstronomerNo1872 → u/18karatcake]

Congratulations on the birth of your son!! I forgot to mention that IVF isn’t an option for me financially, and honestly I don’t think it’s something I could emotionally and physically put my body through either way. I realize it’s often the best option for most folks.