Endometriosis is a condition that affects millions of reproductive age women. It is associated not only with infertility, pain, and other complications, but also with recurrent early pregnancy loss (RPL). Below is a series of comments and my responses to a woman with endometriosis and a recent cervical pregnancy. I hope this may provide some insight and information of general interest to women with RPL and endometriosis.
fryerfairy said... I have endometriosis and had a cervical pregnancy. I was in the hospital for 3 weeks and I was treated with Methotrexate. I think it was 3 shots. I had this 6 months ago. I was told that I might not be able to carry a baby full term. Since having this 6 months on I am still in a lot of pain and am losing big clots at each period. I can no longer cope with the pain and the worry that I may never be a Mum I am only 23. Do you think I will go on to have a baby? Sun Nov 04, 11:03:00 PM 2007
Kenneth F. Trofatter, Jr., MD, PhD said... To fryerfairy: I wish I had my crystal ball for you. Let me ask a few questions: Did you have pain prior to the cervical pregnancy? Is this pain all the time or just at certain times of your menstrual cycle? Did they have to do any surgery in addition to the methotrexate? How do your doctors know that you have endometriosis? Have you had any treatment for your endometriosis to date? Are you having regular periods every month? Did you have any trouble conceiving the pregnancy that you lost? Do you have any other medical problems? Let me know and I will do the best to give you my thoughts. Dr T Tue Nov 06, 12:18:00 PM 2007
fryerfairy said... I have had 2 laparoscopies in which the endometriosis was first diagnosed and burnt away the second one I had they checked my tubes and ovaries and removed a lot of endometriosis from my pelvis. I had a miscarriage 6 months before falling pregnant again which resulted in the cervical pregnancy. I do suffer with a lot of pain and I can not remember the last time I was pain free. My doctor said that there is a lot of scarring and a lot of growths. Could this be the reason that the baby implanted in my cervix. I was due to begin IVF treatment as my husband and I have been trying for over 3 years when I fell pregnant. My cycles are regular but are odd and I do occasionally get spotting throughout the month. I don’t have any other medical problems. When I went to the hospital for an early scan they admitted me straight away but they did not know how to handle the situation due to it being so rare. I felt like a guinea pig having tests done Tue Nov 06, 01:13:00 PM 2007
Kenneth F. Trofatter, Jr., MD, PhD said... To fryerfairy Nov 6: By your history and symptoms, it could be that you have not only endometriosis, but ADENOMYOSIS as well. Adenomyosis is endometriosis in the muscle wall (myometrium) of the uterus itself. It can cause pain, anytime throughout your cycle, but especially with menstruation - if you can imagine bleeding into a muscle - by the irritation and inflammation that results. I am not an expert in Reproductive Endocrinology and Infertility (REI), but when very young women have severe endometriosis/adenomyosis they can have a great deal of difficulty conceiving and getting through first trimester and may have other underlying risk factors (autoimmune, hormonal, thrombophilic, and anatomical) that further increase their risk for recurrent early pregnancy loss. Some will have defects in the production of cell surface structures called 'integrins' as well. Integrins help the early embryo attach to and implant in the endometrium. Indeed, implantation defects seem to be a big problem in women with endometriosis that have recurrent early pregnancy losses (and, to answer one of your questions, in your case, perhaps, the embryo did not find a good place to implant until it reached your cervix).
Treatment varies but, it is my understanding, the first step is to surgically ablate as much of the endometriosis as possible. Many REI doctors will then place their patients on a course of Lupron (leuprolide acetate) for about 6 months to suppress the hormonal production that supports the endometriosis. This basically puts you into a reversible state of ‘menopause.’ (Yes, and I am afraid the symptoms of ‘going through the change of life’ are side-effects of the drug). You are a young woman and should consider this if you have not already had it. Then, controlled ovulation induction, sometimes with the use of Femara (letrozole – an aromatase inhibitor used to treat breast cancer and now found to be effective in ovulation induction and perhaps implantation under these circumstances), and even IVF may improve your chances for successful implantation and 'survival' through first trimester.
We used to say that getting through a pregnancy is the best 'cure' for endometriosis. I don't know if that still holds, but I have had many women with a history of endometriosis return within a year of a successful pregnancy having then conceived again spontaneously! In your case, one thing in closing...if you do succeed in getting through first trimester, because of the cervical pregnancy, you should be evaluated by ultrasound in second trimester to look for the possibility of cervical incompetence. Indeed, if there was significant damage done to your cervix by that pregnancy, your doctors might even consider placing a cerclage, prophylactically, at the end of first trimester. So, good luck and thanks for reading. Dr T Wed Nov 07, 05:43:00 AM 2007