Laparoscopy before IVF and low AMH

[YellowTack]

Hello everyone,

I have suspected endometriosis because I have one blocked tube and awful period pain, and am finally at the top of the list for a laparoscopy, which could happen early next year.

I have just done my first cycle of IVF which was successful but ended in a miscarriage.

I am 34 with low AMH (4,14 pmol/L), so time is running out, and I would like to start another IVF cycle as soon as my body has recovered from the miscarriage.

I am not sure if proceeding with the laparoscopy now is a good idea, as I have read that it can lower AMH (at least temporarily), and I would need to wait a few months after the surgery to do another IVF cycle.

As anyone with a low AMH had a laparoscopy? Would you recommend going ahead with the laparoscopy or starting another IVF cycle instead?

Hi! I have endometriosis and low AMH. It was 5 last time I checked, when I was 25 years old. I expect it's much lower now as I'm 28.

Anyway I had IVF before the lap because the wait for the lap was so long and my AMH was already really low. I had four embryos frozen as a result in March 23 (none transferred yet!) and then the lap in Nov 23. Unfortunately the surgery for endo hasn't helped me conceive m so I'm going to move onto a FET in about six months if no luck by then.

Personally I would do the IVF cycle before the lap in case your AMH drops further, but I also didn't find the lap helpful in terms of fertility or pain so I'm biased in that respect 😕

Good luck whichever you decide! X

Your time isn't running out. Your AMH may well stay static for years and you are still in your early 30s. It's perfectly possible to conceive naturally with a low AMH, it just often takes longer. AMH is a hormone level and is one indicator of ovarian reserve, it doesn't have an effect on it, and I can't see how a laparoscopy would affect your ovarian reserve itself but may be wrong. It will just mean taking a break from further transfers from a time perspective while you recover from surgery.

If the surgery is important and has been recommended I'd personally go ahead with it. Declining may mean you aren't offered the opportunity again for a while. The endometriosis could be affecting your ability to conceive anyway so having it treated may inadvertently help your cause. If you're uncertain I'd discuss with your consultant for their view.

@Nessie2395 thank you for sharing your experience, and sorry to hear that your surgery hasn’t helped.
At the moment my priority is to have a baby or freeze embryos, and I am not sure I want to delay the process given that I don’t know if the laparoscopy would help my fertility at all. I don’t even know if I really have endometriosis.
We also have MFI so we would have to go to IVF again anyways, and there is a good chance that they would not be able to unblock my tube during the lap.

The ideal situation would be to do the laparoscopy after having a baby but of course that’s not really something I can control.

@SErunner thank you very much for your perspective, it’s completely true that I don’t know if my AMH would drop or stay stable for years! I would like to discuss this with my NHS consultant as well but I have just literally received appointments for the pre-op and surgery out of nowhere after months on the waiting list. No discussion with my consultant is planned as I have apparently been discharged since they have approved my IVF referral. I will see what my fertility clinic says as well but would like to gather as much information as possible before that. I they do recommend the surgery and think it could help with my fertility in general I will be happy to go ahead.

I have read a few scientific articles that showed decreased AMH after laparoscopies, which is why I was worried. One of the potential reason is that they might have to operate around the ovaries and it could lead to damages/scarring that could take time to recover.

It’s really difficult with endometriosis as we can’t have a diagnosis without the laparoscopy, maybe I don’t even have it. I have been raising my concerns for years and years, but it was only taken seriously once I was diagnosed with a blocked tube.
It’s also unfortunately not our only issue as we also have MFI, so even with the surgery we would still have to go through IVF, but if there is even a slight chance of improved outcomes it is definitely worth considering.

@YellowTack I had suspected endometriosis and have had a laparoscopy to remove a large endometrioma. It's true that is can decrease your AMH. The reason being is that if they may damage the ovaries during the op for example if they need to remove endometriomas.

I thankfully didn't have endometriosis it was simply a large blood filled cyst, they also removed what they thought was endometriosis (without my consent but that's another matter). I don't know if my amh was affected as I didn't know my amh prior to op but it's now 11 at 38 so very average. However the ovary they operated on produces half as many follicles as the other.

Also (as now 4 cysts have grown back) I asked whether I should have more surgery before IVF and my consultant said she would strongly advise not to have surgery on ovaries prior to IVF as it reduces ovarian reserve which in turn reduces the number of eggs they are likely to retrieve. I'm having the cysts aspirated during IVF instead as it's less likely to affect ovarian reserve.

@Confusedddddddd thank you so much for sharing your experience and feedback from your consultant. I am sorry that your cysts have grown back.
I think it’s similar with endometriosis as even if they remove everything, it will eventually come back.

I am worried they would have to operate on my ovary as one of my scan revealed that one of my ovaries was not mobile.
I really don’t want to risk producing even less follicles as I had only 5 during my recent IVF cycle, so even a slight decrease could have a massive impact on our chances of success.

@YellowTack it might be worth calling your clinic for advice. I had a quick call with a consultant to ask what to do about mine which was free.

I was in the same place as you and for a long refused the op because I was worried about its effect on future fertility especially as research literature seems mixed as to whether the ovaries ever regain some of their reserve . In the end I was convinced to agree to it before an emergency op for a ruptured ectopic.

I think endo surgery can be worth it if you're not planning IVF, but IVF bypasses the disease anyway.

@YellowTack I was going to have a laparoscopy as well as my doctor thought it might help with fertility. But before going through with it, she wanted my partner to have a semen analysis as if he had any issues we'd have to do IVF anyway so the laparoscopy wouldn't be worth it. As it happened my partner does have MFI so we then went straight to IVF/ICSI. I asked my IVF consultant about the laparoscopy and he advised against it as well, as it could reduce my ovarian reserve (I have endometriomas).
So I would say if you need to do IVF anyway because of MFI, they will probably advise against the laparoscopy, but as others say best to ask your doctor/ivf clinic.

@Confusedddddddd thank you, I will try to talk to my clinic and see what they advise.

In retrospect I should have had the laparoscopy years ago but at the time I was not really taken seriously.

I think I will continue trying with IVF for now and keep the surgery for after (fingers crossed) I have children.

@bubu24 thank you for sharing, that’s interesting as we are in the same situation with MFI. I would be really worried to risk decreasing my ovarian reserve even further but I will ask my consultant what they think.
I am a little worried that my consultant appears a little “old school” as during our initial conversation all they were talking about was my potential endometriosis even though our main reason for IVF is MFI.