For those ttcian, should read this..

One couple that I will remember forever.

I first met this couple about 7 or 8 years back. They came to me because couldn't get pregnant for about 3 years. We did several tests :

Ovulation was good
Sperm test was good
Fallopian tube also good
Ultrasound scan was good

The next test that I advised was laparoscopy. The reason was that I suspected endometriosis. There's always a reason for not getting pregnant. And, early endometriosis cannot see on ultrasound.

But because they were not convinced and, laparoscopy was a surgery, they decided not to do it. They went to see alternative treatment - Traditional Chinese Physician. They also went to another doctor and did IUI twice. Basically, they didn't see me for the next few years. midi wedding dress with long sleeves

They re-appeared at my clinic 3 years later. This time, ultrasound scan revealed 2 big endometriotic cyst. They came to me for the laparoscopy. A laparoscopic surgery was performed and she had stage 3 endometriosis.

She got pregnant after the surgery and had a normal birth and breastfed her baby. And, when she least expected, she got pregnant again.

What can we learn from this case ?

There's always a reason for not getting pregnant.
When all tests are normal, think endometriosis.
Early stages of endometriosis cannot see on ultrasound scan.
Endometriosis can cause difficulty in getting pregnant.
With endometriosis, IUI will not work.
Don't go for IUI or IVF blindly if you do not know the reason why you are not pregnant.
Laparoscopy is the only way to detect early endometriosis.
Laparoscopy can cure endometriosis.
Pregnancy and breastfeeding cure endometriosis.

What would be the difference if she had the laparoscopy earlier?

The endometriosis would be only stage 1 or 2. Early stage endometriosis would be easier to treat and good chance of total clearance on laparoscopy and very low chance of coming back.

But, because it was already stage 3, the chances of recurrent endometriosis is high. She will need to use a Mirena after she completed her family. She also need close monitoring and occasional Visanne if necessary.

She would have been pregnant earlier if she had done the laparoscopy 3 years earlier.

Luckily, it was only stage 3. If it was stage 4, surgery may not even get her pregnant. That's why early laparoscopy is very important to improve pregnancy chances and reduce recurrence.