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Question
Posted by: Annie | 2010-09-15

HSG and Zoladex for Endo

I have two questions:

I recently had a HSG x-ray done. Both of my fallopian tubes are still open. Is this the only thing that can be seen with the HSG? The reason I ask is because I think my endometriosis is growing again. How do I know if it is growing in the uterus? I have been diagnosed with stage 4 endo 4 years ago and they had to remove part of my colon due to the endo. My gyne said I have three options available for the treatment of the endo: Zoladex, Depo Provera or sugery for the treatment of the endo as Ladazol is not available any more. I would also like to know if I treat the Endo with Zoladex, what influence this will have on my fertility as I already have one child and would like to get pregnant again. It seems to me that Zoladex is my best option - am I wrong to think this?

We also already did 7 AI and would like to go for IVF now. Do I first treat the Endo or do I first do the IVF one or two times and then treat the Endo?

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Our expert says:
Expert ImageFertility expert

Dear Annie

HSG assess the patency of the fallopian tubes. However one can also see other things such as sub-mucosal fibroids, endometrial cavity adhesions and uterine abnormalities on a HSG. However an HSG does not diagnose endometriosis nor would it tell you if endometriosis has recurred and to what extend. One would suspect endometriosis recurrence if symptoms of painful periods are present again or if there is any suggestion on ultrasound or the presence of fluid in the abdomen and endometriomas. The best way to diagnosis if endometriosis has recurred is by doing a Laparoscopy. If you are planning to go for IVF, so it is better to first clear as much endometriosis as possible before starting IVF. This would give you a better chance to achieve a pregnancy. The best treatment would be surgically removal of as much endometriosis as possible and follow that with IVF or if your doctor thinks it’s necessary then after surgical removal go on a 3-month course of Zoladex followed immediately with IVF.

Answered by: Dr Y.M. Dasoo

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2
Our users say:
Posted by: Fertility expert | 2010-09-21

Dear Annie

HSG assess the patency of the fallopian tubes. However one can also see other things such as sub-mucosal fibroids, endometrial cavity adhesions and uterine abnormalities on a HSG. However an HSG does not diagnose endometriosis nor would it tell you if endometriosis has recurred and to what extend. One would suspect endometriosis recurrence if symptoms of painful periods are present again or if there is any suggestion on ultrasound or the presence of fluid in the abdomen and endometriomas. The best way to diagnosis if endometriosis has recurred is by doing a Laparoscopy. If you are planning to go for IVF, so it is better to first clear as much endometriosis as possible before starting IVF. This would give you a better chance to achieve a pregnancy. The best treatment would be surgically removal of as much endometriosis as possible and follow that with IVF or if your doctor thinks it’s necessary then after surgical removal go on a 3-month course of Zoladex followed immediately with IVF.

Answered by: Dr Y.M. Dasoo

Reply to Fertility expert
Posted by: Dee | 2010-09-16

Treat the endo first definitely. Endo makes you very acidic and could possibly create implantation issues for a fragile embryo.

Reply to Dee

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