ENDOMETRIOSIS AND INFERTILTY

What is endometriosis?

Endometriosis is a word derived from endometrium which means the lining of uterus. This lining is programmed to naturally grow inside the uterus and shed off if pregnancy does not happen in that cycle. But, if this endometrial tissue starts growing outside the uterus, in the ovaries for example, it fails to find a way from where the tissue can be shed, so it gets trapped and may cause scarring of the tissue where it grows. This creates an environment of swelling or inflammation in these tissues.

It is therefore a chronic inflammatory condition and affects approximately 8-10% of women in the general population and approximately 40% of infertile women.  This enigmatic disease may be associated with pain during menstrual periods, intercourse, defecation, urination and ovulation. It may even cause a long standing pelvic pain and infertility.

What causes endometriosis?

There are many proposed theories behind the etiology of endometriosis, but no clear answers on what actually causes endometriosis.  Theory of retrograde menstruation which says that some of the lining of uterus may move up the tube to be deposited in the pelvis is one such theory. While there is still no known cause of endometriosis, it is very likely that certain genes may predispose women to develop endometriosis, so affected women may have a similar family history in their mother and/or sister(s). It may even have an environmental or lifestyle correlation.

How may endometriosis affect your fertility?

Endometriosis, at any stage of its development can potentially contribute to infertility by one or the other mechanisms. In cases where endometriosis is present in the ovaries, it can cause ovulatory abnormalities by affecting both quality and quantity of eggs causing fall in ovarian reserve. The eggs don’t get a healthy environment to grow as follicular fluid where eggs develop is also abnormal. The free radicals and collected blood cause local inflammatory reaction and produce poor quality eggs.

In severe cases, endometriosis can also cause tubal damage by affecting its motility or due to direct abnormal implants. This may prevent sperms from travelling through the fallopian tube and fertilisation of eggs and sperms fails to happen.

Endometriosis may also affect the uterus and may cause a decrease in endometrial receptivity.

How is endometriosis diagnosed?

1. Many a times, endometriosis goes unnoticed on clinical examination and routine testing. Sometimes, clinician needs to have high levels of suspicion to diagnose it.
2. A good quality ultrasound scan can identify endometriosis, particularly if it causes cysts in the ovaries, also called chocolate cysts. TVS(TRANSVAGINAL SCAN) is a much better tool in identifying the size and characteristic of endometriomas. TVS also gives us a fair estimate of the ovarian reserve in infertility cases.
3. The gold standard investigation is doing a diagnostic laparoscopy. In this, a camera is inserted through the abdomen which allows clinician to look around the pelvis to identify any abnormal endometrial implants. In the same setting, this abnormal tissue can be fulgrated or removed.
4. An AMH test gives us an estimate of ovarian reserve, though this does not tell about the quality of the eggs.

Symptoms of endometriosis: Typical complaints of women with endometriosis are:

1. Painful menstrual periods (dysmenorrhoea)
2. Pain during intercourse
3. Chronic pelvic discomfort or pain
4. Chronic nagging lower back pain
5. Pain during defecation
6. Pain when passing urine
7. Premenstrual symptoms including pain and pelvic congestion few days before periods.
8. Fertility issues may also be the presenting symptom in some women with endometriosis.

Fertility options with endometriosis.

Once a couple understands that there is a problem or delay in achieving fertility due to endometriosis, it is always better to consult a fertility doctor at the earliest as this is a progressive condition.

Although the fertility options available are many, but the treatment has always to be individualised based  on the type and severity of endometriosis. Vansh IVF (AN ADVANCED FERTILIT AND WOMEN WELLNESS CENTRE) is one of  the Best IVF Centre in Jaipur providing a comprehensive and holistic treatment of fertility issues arising due to endometriosis.

Various treatment options available at VANSH IVF JAIPUR are:

1. Ovulation Induction with IUI – Ovulation is induced using medicines.Once the follicle becomes mature, it is made to release with the help of HCG injection. At the time of ovulation, which we monitor with regular TVS ultrasounds, husband sperms are injected inside wife’s uterus using a fine catheter. This is specially beneficial in cases with early endometriosis where tubes are intact.

 

2. Laparoscopy with adhesiolysis: Treatment by laparoscopy increases pregnancy rates as we can break the adhesions around the tubes restoring the natural between tubes and ovaries. Also, surgical removal of endometriosis may help in restoring normal functions of ovary. However, in clear cases for IVF, removal of cysts is not recommended for all.

 

3. IVF (In Vitro Fertilisation): In cases with severe endometriosis or in cases with long standing infertility due to endometriosis, IVF gives the best chances of conception. However, if ovarian reserve has already gone very down or if there are big endometriomas , the chances of success are lower, even with IVF.

Best approach to endometriosis?

1. THE SOONER – THE BETTER. NO TIME TO WASTE.
2. It is very important that you speak to a good fertility specialist to discuss about the various treatment options and find out the best possible option according to your condition.
3. Don’t waste time as endometriosis is a progressive condition. Even if trying naturally, it is better to be under monitoring.
4. IVF-ICSI is the most successful treatment of the condition in infertility cases.

Having diagnosed with endometriosis does not mean that you cannot conceive. In many cases, people may even conceive naturally.  However, if you find that it is taking time to conceive, then get help sooner rather than later. Trying to get pregnant and deliver a healthy baby when you have endometriosis is challenging and requires careful individualised planning with your fertility doctor. To address infertility, your treatment plan will consider your age, duration of infertility, pelvic pain, and the stage of endometriosis along with ovarian reserve and tubal status to maximize your chance of success. In case, you are wondering from where to get the treatment from,  please visit Vansh IVF (AN ADVANCED FERTILIT AND WOMEN WELLNESS CENTRE) which is one of  the Best IVF centre in RAJASTHAN and provides a comprehensive and holistic treatment of fertility issues arising due to endometriosis.  Our fertility consults have a vast experience in dealing with such cases. Also, VANSH IVF JAIPUR provides very good  success rates of IVF in RAJASTHAN.

WE SINCERELY WISH THAT YOU ARE OUR NEXT SUCCESS STORY.