I had one miscarriage two years ago. I was diagnosed with endometriosis nine months ago, after a laparoscopy. My doctor was unable to remove any of it because he said it was everywhere, and he felt that treating it with Lupron would work better. I had six months of the therapy. Now I'm wondering what my chances are of conceiving and staying pregnant. I was also wondering if it is beneficial to do a repeat lap after treatment with Lupron, just to make sure it worked effectively and that there aren't any places that could now be removed surgically.

B.R.

It is unfortunate that your physician did not remove all the disease that was present at your previous laparoscopy. While the temporary use of Lupron can suppress endometriosis, it is likely of little value in your situation. First, the endometriosis comes back as soon as the medication is stopped. And you cannot conceive while you are on Lupron unless you are also using ovulation induction medications.

There is no evidence that treating endometriosis with Lupron will improve pregnancy rates or reduce the risk of future miscarriages. However, it's quite likely that the endometriosis had nothing to do with your miscarriage.

You asked if another laparoscopy would be beneficial. This is a tough question. I don't know how bad things were and whether there was scar tissue involving the tubes and ovaries. If your doctor noted adhesions, then a repeat surgery by a trained endometriosis surgeon who can excise (cut out rather than vaporize) all the evident disease is worth considering. A repeat surgery might also be a good idea if you are having pain. If the tubes and ovaries were not stuck down at the first surgery, I don't think another surgery would be of benefit. As there is no evidence to suggest that Lupron helps to promote fertility, doing a laparoscopy to see if it has been effective is of little or no value.

Your chance to conceive again depend on your age, the duration of your infertility and the degree of anatomical abnormalities seen at the first surgery. It sounds like a second opinion from a fellowship trained infertility specialist would be a good idea.