Infertility/Fertility/adenomyosis question


I am in a tricky situation. I am 45 years of age and have a number of frozen embryos created when I was younger.
I am wanting to use these embryos, but have learned that I have adenomyosis (diffuse). I have had past laparoscopies for Endo (Stage III) - my last one was in 2011 and was all clear.
I do not have (touch wood) severe symptoms of adenomyosis - some light pain at period, two days of bleeding, a little spotting till day 5. My estradiol levels etc are ok for a natural cycle I'm told, which is about 24-26 days long, with luteal phase normally 14 days long.
I am wondering if I would be giving these embryos the best possible chance by down regulating with something like GnRH for several months (I have read a min of 3) before doing an FET, but I don't know if this will mean I will have problems getting back into regular cycles. I have read that down reg is not wise with low AMH - and I am sure my AMH will be in the dungeon at my age.
I am due to have an MRI to look at the adenomyosis next week, but on the ultrasound could see a cyst (about 4mm) and light/white spots which my gyn said were adenomyosis. An MRI earlier this year showed the junctional zone was 12mm.
My gyn says he doesn't treat adenomyosis. It doesn't sit 100% comfortably with me, given what I have read about people with adenomyosis falling pregnant after downregulating.
What would you recommend I do? I will do anything to give these embryos their best shot.
thanks so much, any advice is greatly appreciated.
kind regards

Hello Sye from Australia,

Whether or not adenomyosis impedes with or impairs fertility at the uterine level is not known, and certainly controversial in terms of whether or not to treat.  I believe that women can get pregnant with adenomyosis in place, and therefore do not necessarily treat it ahead of time.  However, the theory about why endometriosis and/or adenomyosis might impair fertility is because of the production of a chronic inflammatory state.  So, with that in consideration, some do advocate pre-treating with a GnRH agonist to "down regulate" the disease and possibly reduce the inflammation.  So, if you want to do everything that you can do, then it might be a good idea to pre-treat.  You would use Lupron, or a similar drug, for three to six months prior to the embryo transfer date.  That is something that should be managed by the reproductive endocrinologist/infertility specialist and not your gynecologist (that is, it should be the doctor that will be doing the FET).

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at 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


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.


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.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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

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

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