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Infertility/Fertility/Adenomyosis/Painful menstrual cramps/infertility


Hi from VA!  After years of excruciating menstrual cramps and heavy bleeding and clots, I was just diagnosed as having adenomyosis.  My options were to take ibuprofen for the pain, birth control pills, or a hysterectomy.  Hubby and I have been TTC for about four years now.  (Several failed IUI cycles, no IVF.) Hysterectomy seems a bit extreme right now.  The ibuprofen isn't really helping much for the pain (I'm averaging 1600 mg a day, which is the max and I'm still hurting.)  As we're TTC, I didn't think BCP would be more of a hindrance than a help, and I've read that once you stop taking them, the pain and everything comes back.  I guess my question is is the adenomyosis the reason that we have not been able to conceive?  After the many ultrasounds I've had since we've been TTC how could all of the doctors have missed it?  Would IVF even work since it seems like a pregnancy would not be viable in my uterus because of the adenomyosis?

Hello Denita from the U.S.(Virginia),

You don't mention having a laparoscopy.  Was one done?  Adenomyosis is a diagnosis of exclusion, meanining it is only given once everything else is ruled out.  That is because it can't be made without a hysterectomy.  Yes, it is found once the uterus is removed and the pathologist examines it microscopically.  Although this can cause pelvic cramping/uterine cramping, the most common diagnosis is endometriosis which is in the pelvis (adenomyosis is in the muscle of the uterus).  Endometriosis also can cause infertility and the treatment often ends up requiring IVF (this is the only treatment that bypasses the pelvis).  With minimal or mild disease, often this can be treated with the laparoscopy and then a short course of Lupron which can then make pregnancy possible by natural means or some assistance.  Adenomyosis is not associated with infertility.  It does not interfere with getting pregnant by IVF.

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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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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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