#1 Cost efficient IVF service and education in U.S. Outpatient based IVF. Complete facilities include ultrasound suite,endocrine and andrology labs, and all IVF facilities. Located at new outpatient therapy center offering the latest in laparoscopy and hysteroscopy. Accomodations for visitors are nearby, safe, and inexpensive.

Endometriosis Therapy- GnRH Analogs and Estrogen Replacement
Title: Add-back therapy and gonadotropin releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached?
Author: E. Surrey and the Add-Back Consensus Working Group
Address: Beverly Hills, California
Source: Fertility and Sterility 71: 420-424(March)1999
Summary: Using retrospective and prospective studies (referenced via MEDLINE) a working group of 31 gynecologic surgeons and reproductive endocrinologists attempts to reach a consensus about add-back therapy and gonadotropin releasing hormone agonists in the treatment of patients with endometriosis. Patients with endometriosis who were candidates for GnRH-a therapy over a treatment course of 6-12 months were studied. When using add-back therapy for 6 months, both 2.5 mg norethindrone and 0.625 mg of conjugated equine estrogens with 5 mg/d of medroxyprogesterone acetate were shown to alleviate painful symptoms and vasomotor symptoms, but bone mineral loss occurs. With 12 months of therapy, bone mineral loss is eliminated effectively. After reviewing the literature, the consensus working group agreed that prolonged use of add-back GnRH therapy is the best course to follow because the efficacy of the GnRH agonists are prolonged, hypoestrogenic side effects lessened, and bone mineral density maintained.
Comment: In my experience, progestins must be used. Estrogen alone often results in failure to improve pain symptoms. Amenorrhea must be maintained for full therapeutic benefit. I wish this therapy was not so expensive. Cost is the biggest barrier to more widespread use.