Description
Endometriosis, a condition where endometrial-like tissue grows outside the uterus, can significantly impact fertility. It causes inflammation, scarring, and adhesions that may distort pelvic anatomy, block fallopian tubes, and impair ovarian function. Endometriosis is also linked to hormonal imbalances and poor egg quality, reducing the chances of conception. Symptoms like chronic pelvic pain and painful intercourse further complicate fertility. Diagnosis often requires laparoscopy, while management includes pain relief, hormonal therapy, and assisted reproductive techniques like IVF. Early intervention with medical or surgical treatment can improve reproductive outcomes, but severe cases may necessitate advanced fertility treatments for conception.
Summary Listen
- Endometriosis, a chronic estrogen-dependent inflammatory condition, involves the growth of endometrial-like tissue outside the uterus. This can affect organs like the ovaries, fallopian tubes, bladder, and even distant sites like the lungs or brain. The condition is characterized by pain, inflammation, and bleeding during menstruation, impacting a significant portion of women in their reproductive years. Diagnosis is often delayed due to normal imaging results and the primary symptom being pain.
- The delay in diagnosis and treatment can significantly impact fertility. Endometriosis can cause adhesions, scar tissue, and anatomical distortions in the pelvic region, hindering conception. The inflammatory environment and hormonal imbalances associated with endometriosis can also affect oocyte quality, implantation, and tubal transport, contributing to infertility.
- Management of endometriosis involves both medical and surgical approaches. Medical treatments, such as pain killers, combined oral contraceptive pills, progestins, and GnRH analogs, aim to manage pain and suppress endometrial tissue growth. However, medical treatments do not improve fertility and are not suitable for women actively trying to conceive.
- Laparoscopic surgery is the gold standard for diagnosis and can improve fertility by removing endometrial implants, adhesions, and cysts, thereby restoring normal anatomy. However, repeated surgeries should be avoided to preserve ovarian reserve. Complete removal of all endometriotic implants during the initial surgery is crucial to prevent recurrence.
- For women with endometriosis and infertility, assisted reproductive technologies (ART), such as IUI and IVF, are often recommended. IUI can be considered for stage 1 or 2 endometriosis after surgical restoration of anatomy, while IVF is often recommended for more severe cases (stage 3 or 4), particularly when ovarian reserve is compromised or tubal damage is present. The choice between surgery and ART depends on factors such as age, ovarian reserve, size and location of endometriomas, and presence of symptoms.
- In cases of endometriomas, surgery before ART is considered only if there is a single large cyst or suspicious radiological and clinical features and when ovarian reserve is intact or you have already collected the oocyte and the patient has symptoms. GNRH agonists can be used to improve IVF success rates, but hormonal therapy does not improve natural conception rates.
- A multidisciplinary approach involving gynecologists, urologists, and surgeons may be required for complex cases of endometriosis, especially when deep infiltrating endometriosis affects the bowel or bladder. Early diagnosis, tailored treatment plans, and timely referral to fertility specialists are essential to optimize reproductive outcomes for women with endometriosis.
- In conclusion, the key to managing endometriosis-related infertility lies in a comprehensive understanding of the disease, early suspicion and diagnosis, individualized treatment strategies, and a collaborative approach involving medical and surgical interventions, as well as assisted reproductive technologies.
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About the Speakers
Dr. Priyanka Mehta
Specialist Gynaecologist, Canadian Specialist Hospital, Dubai,UAE
Financial Disclosure
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