TTC Advice with Bilateral Endo
Hello! I am 30yo, found out I had endometriosis last year after struggling TTC for 2 years prior. Delayed with diagnosis and starting up the treatment plan than I would have hoped (my obgyn, who I won't be going back to, told me after 1 year of trying that "you're young and healthy, try for another year I'm sure you will get pregnant"). While my periods were always heavy, I never had "significant" pain after day 1 of my period to make me suspect I had endometriosis. I have bilateral endometriomas (so assuming I am at least stage 3) and have been seeing a RE for the past year or so, who has had me on letrozole for about 9-ish cycles (took a 2 month break somewhere in that timespan to mentally decompress from all this). I have gone through workup already, HSG good, AMH good, both ovaries good and ovulating each cycle, spouse semen good. The bilateral endometriomas are about 3cm in size. I honestly am conflicted with what the next best step is. While my ovarian reserve is good, my RE is concerned that with moving forward with surgery we'd be putting risk to my ovaries. Surgery does make me anxious if I am being completely honest, although it makes me wonder if this is a logical next step with all the good outcomes I've seen on reddit for others who had surgery TTC. I know that research supports IVF as an optimal strategy for those with endometriosis, but I'm conflicted on what to do given insurance coverage (doesn't cover it). I also have a lot on my plate right now so I know that the journey of IVF can be taxing in some ways and I'm not sure that I can go through that right now (I should also mention that I am the bread winner right now (spouse in school) and have some deal of stress that I try my absolute best to control knowing it can affect fertility). I try to stay active and take my supplements, eating healthy.
I was hoping I could get some insight and thoughts from others who have maybe gone down this path, and any advice / particular thing you may have done that made things successful with TTC. I am thinking to probably stay trying on letrozole for another few cycles before considering IVF, but really just wanting to talk to someone about what to do because I'm completely lost. Thank you so much for any feedback, endo community 🤍