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Question
Hello. I am 24 years old and my husband and I are trying to conceive.   I was diagnosed with endo after a lap on Dec 15, 2006. I have been on two seperate treatment cycles of Lupron Depo. The first cycle was in 2010 for 11 months (monthly injection). I was then put on Aygestin. My menstrual cycles were semi normal for about 4 months while on BC. I had a span of about 6 months (starting in of constant menstruating with only about 3-5 days of not bleeding that came rarely. I was put back on the Lupron injections (3 month shot) in May 2012 and received my last 3 month injection in August 2012. The 3 month shot should have started wearing off in November. It is now January 21, 2013 and I have yet to start my menstrual cycle. I am not able to track and chart when I should be ovulating due to no cycle. I  very anxious to get pregnant and went through the 6 months of Lupron to "start fresh" as my doctor said this will help. I have not had any pain/cramps, but I have had a fluttering or bubbling feeling in my lower abdomen. I read that many pregnant women got this feeling at the beginning of their pregnancy, but the tests I've taken are negative.

Any advice is GREATLY appreciated,

Fearful in Fairfield, CA

Answer
Hello Blake from the U.S. (California),

Considering that you have a significant amount of endometriosis, based on the amount of lupron you have received, then it is imperative that you get pregnant as soon as possible. By the way, I have never heard of anyone taking lupron for 11 months.  In fact, it is NOT recommended to take Lupron for more than 6 months because of the risk of causing osteoporosis.

Now, I would recommend that you no longer wait for your cycles to start again.  I would recommend that that you go see a competent doctor who can do ovulation induction cycles.  That is, you should be placed on fertility medications to get your ovaries to ovulate.  You will NOT be able to use Clomid or Femara because they work by increasing the pituitary output of FSH.  The lupron works by blocking the hypothalamus and pituitary so if there are any Lupron effects still present, those drugs will not work.  You will need to use FSH, which are injectable medications such as Follistim, Gonal-f, Menopur, Repronex, Pergonal, etc.  I would use Menopur or Repronex.  These medications need to be given by a doctor with knowledge and experience in using them, AND you need to be monitored for your response to make sure that (1) you don't form too many ovulatory follicles, (2# to know when to trigger ovulation with HCG and #3) to know when to start intercourse.  This should be a fairly easy treatment if you see the right doctor.  I would recommend that you screen by simply asking the doctor if they do IVF, since those are the specialists that use these injectable drugs the most.

Having just been treated with Lupron, you have about 6 months to 1 year before the endometriosis returns so pursue your pregnancy desires aggressively.

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.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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