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I am a healthy woman of 35 years of age and married for 7 years. We have been trying to conceive for years now and have undergone all the diagnosis for infertility. I have regular periods but with terrible pain. My HSG was clear, AMH pretty good, uterus clear and all hormonal blood work fine except for hypothyroidism for which I take Thyronorm mcg daily. My husband has had semen analysis done, with normal count and 60% motility. I have also undergone 3 failed IUI’s using Clomiphene. Adding to this all, I had laparoscopic surgery 3 years ago and the surgeon noted endometriosis with endometriomas in both the ovaries.

How should we proceed now? Is IVF the only treatment left? If yes, then what else we can do to make it a success?

In my opinion, the cause for your infertility is probably endometriosis. In this condition the uterine lining grows on pelvic structures outside the uterine cavity. This condition causes a toxic pelvic environment with compromised eggs, reducing their ability to successfully fertilize. In your case, endometriosis has created pelvic adhesions sufficient enough to distort the normal pelvic anatomy and interfere with fertilization and embryo transportation mechanism. Endometriomas activate the ovarian connective tissue to secrete excess testosterone (male hormone) which severely compromises egg production and quality.

Also both endometriosis and thyroid disease are often associated with NK cell activation which leads to immunological implantation dysfunction.

ONLY IVF, in which the eggs are extracted before they are released into the toxic peritoneal environment, can circumvent this problem. Since many endometriotic lesions are non- pigmented, thus invisible, cannot be removed through surgery, result in multiple IUI failures. Also, approximately 30% of women who have endometriosis, regardless of severity, show increased NK cell activation in their endometrial lining. I would suggest you to proceed to IVF treatment with the administration of intravenous intralipid therapy and have a successful pregnancy.



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