Description
Fertility preservation is a crucial consideration for individuals with endometriosis, a condition that can affect reproductive health. Endometriosis can lead to pelvic scarring, ovarian cysts, and fallopian tube damage, impacting fertility potential. Options for fertility preservation include oocyte or embryo cryopreservation before undergoing surgical interventions for endometriosis. Consultation with a reproductive endocrinologist can help individuals with endometriosis explore fertility preservation options tailored to their specific needs and treatment goals. Early detection and intervention for endometriosis, combined with fertility preservation strategies, can optimize chances of achieving parenthood for individuals affected by this condition.
Summary Listen
- Endometriosis, a chronic inflammatory disease affecting about 10% of women in their reproductive years, can significantly reduce fertility rates. The condition affects fertility through pelvic anatomical distortion, adenomyosis, local inflammation, and impaired egg migration. Untreated endometriosis can reduce ovarian reserves, posing a treatment dilemma as surgical intervention risks further damage to the ovaries. Fertility preservation should be considered from the first patient visit.
- Surgical procedures, particularly cystectomies, can damage the ovarian reserve, regardless of the surgeon's meticulousness. Alternatives like CO2 lasers and plasma energy, which cause less damage, are not readily available in India. Sclerotherapy, a cost-effective technique using ethanol, is a newer option being explored, but long-term studies are still needed to assess its efficacy. The goal is always to minimize damage to the ovarian reserve while addressing the disease.
- Oocyte cryopreservation, while popular, has concerns regarding its efficacy, the quality of stored oocytes, and cost-effectiveness. Elective oocyte freezing should be timed appropriately, ideally when the ovarian reserve is still normal and pregnancy isn't immediately desired, as demonstrated by the Kobo study. The optimal age for oocyte cryopreservation is around 35 years, and it should be considered before surgery.
- The decision to pursue fertility preservation should be individualized, considering the patient's age, symptoms, and ovarian reserve. Proper reproductive counseling, involving a reproductive consultant, is essential. If immediate fertility is desired, spontaneous pregnancy or IVF should be considered. If fertility can be delayed, oocyte cryopreservation might be an option.
- Case-by-case evaluation is crucial, as a blanket approach to fertility preservation isn't appropriate. Proper reproductive counseling should start early, considering both fertility goals and pain management. Lifestyle changes such as diet, exercise, and avoiding smoking and alcohol can help improve fertility potential. Newer surgical techniques like sclerotherapy offer alternatives for preserving ovarian reserve.
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About the Speakers
Dr. Sonu Singh
Consultant Endoscopic Surgeon, Vivekanand Institute of Medical Sciences, Lucknow
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