An Overview of Endometriosis and its effect on Fertility with Dr.Gautam Allahbabdia

by Dr Gautam Allahbadia IVF, Infertility Specialists,IVF Clinic

Endometriosis is a disease that affects women of reproductive age and that may be associated with both pelvic pain and infertility. Scientific advances have improved our understanding of this benign (non-cancerous) but sometimes debilitating condition. And modern medicine now offers women with endometriosis many treatment options for relief of both pain and infertility.

According to medical statistics it is estimated that infertility can affect around 40% of women with endometriosis. Infertility can be one of the consequences of endometriosis. Interestingly it has been found that 30-40 % of women undergoing laparoscopy as part of infertility evaluation are found to have endometriosis.

What is endometriosis?

When the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.” Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. Rarely, endometrial tissue may spread beyond your pelvic region. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.

How women will know that she has endometriosis?

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Though many woman experience cramping during their menstrual period, women with endometriosis typically describe their menstrual pain that's far worse than the usual. They also tend to report that the pain has increased over time. Common signs and symptoms of endometriosis may include:

1. Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
2. Pain with intercourse. Pain during sex or after sex is common in endometriosis.
3. Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
4. Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
5. Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
6. Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The cause of endometriosis is not known, although it often runs in families. Numerous biochemical and immunological changes have been identified in association with endometriosis, but it is unclear which may contribute to endometriosis and which simply result from it.

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Does endometriosis lead to infertility?

If you have endometriosis, it may be more difficult for you to become pregnant. Up to 30% to 50% of women with endometriosis may experience infertility. Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy and altered egg quality.
At the time of surgery, your doctor may evaluate the amount, location, and depth of endometriosis and tell you whether it is minimal, mild, moderate or severe. Different stages relates with pregnancy success. Women with severe endometriosis, which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty becoming pregnant and often require advanced fertility treatment.

Test and Diagnosis

To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Tests to check for physical clues of endometriosis include Pelvic exam, Ultrasound and Laparoscopy. Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.

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Options available for Endometriosis Treatment

Endometriosis needs the female hormone estrogen to develop and grow. Birth control pills and other drugs that lower or block estrogen can be effective in improving pain symptoms. For patients who wish to become pregnant, medical therapy may be considered prior to attempts at conception, but this treatment usually does not improve pregnancy rates.

If endometriosis is seen at the time of surgery, your doctor will surgically destroy or remove the endometriosis and remove the scar tissue. This treatment will restore your normal anatomy and will allow your reproductive organs to function more normally. Your chances of becoming pregnant are improved after surgical treatment, especially if your endometriosis is in the moderate or severe range. The combination of surgical and medical therapy may be beneficial in patients attempting to conceive through in vitro fertilization (IVF). Overall, treatment is highly individualized for each patient. IVF is appropriate treatment especially if there are coexisting causes of infertility and/or other treatments have failed, but IVF pregnancy rates are lower in women with endometriosis than in those with tubal infertility.

What can be done to maximise future fertility when diagnosed with Endometriosis?

The birth control pill is commonly prescribed to reduce menstrual cramping and help prevent endometriosis recurrence. Preventing endometriosis can help preserve fertility, so the pill is an excellent treatment option following endometriosis surgery if you are not yet ready to become pregnant. Women with endometriosis should also strongly consider consulting with a fertility specialist, (a specialist in Reproductive Endocrinology/Infertility), even if they are not yet ready to try to conceive. This is particularly important if you are over 30 or if you have “decreased ovarian reserve.” Fertility in women decreases with age. In addition to age, “ovarian reserve” also helps predict your ability to conceive. Surgery to remove or destroy endometriosis involving the ovaries may also reduce ovarian reserve and thus lower a woman’s chances for pregnancy even with fertility treatment such as IVF. Women with moderate to severe endometriosis may have scarring that can prevent the egg from entering the fallopian tube. Mild and minimal endometriosis are also associated with infertility, so all women with endometriosis need to consider the impact endometriosis may have on their fertility. A newer option is for women to freeze eggs for possible future use in the event they experience infertility. Though egg freezing is costly and is usually not covered by insurance it is always better to opt for this option.

Many women believe endometriosis will prevent them from having children. This is a myth. Although some does experience infertility, about 70 percent of women with endometriosis do not. There are no preventive measures to avoid the condition. A woman can manage the symptoms only if she is diagnosed.

Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may also want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes. About 70 percent of women with endometriosis do not experience infertility.

Dr.Gautam N. Allahbadia, MD is the Medical Director of Rotunda – The Center for Human Reproduction, the world-renowned infertility clinic at Bandra, Mumbai, India. The fertility experts along with Dr. Gautam offers services including basic work-up of the infertile Couple, One Stop Fertility Diagnostic Services including hormonal testing, Diagnostic Laparoscopy & Hysteroscopy, Recurrent Pregnancy Loss Clinic, Reproductive Endoscopic Surgery including Fallopian Tube Recanalization, Minimally Invasive Ultrasound Guided Procedures, Uterine Cavity Assessment (Sonocontrast hysterography), Artificial Insemination, Semen Cryopreservation, Semen processing, Ovulation Induction & Monitoring, Evaluation of male patient, Intrauterine insemination, Gonadotropin Cycles, Fallopian Tube Sperm per fusion, GIFT, ZIFT, In Vitro Fertilization (IVF), Embryo Freezing, BET, Oocyte Donor Program, Surrogacy, Assisted Hatching, Surgical Sperm Retrieval (PESA/MESA/TESA/TESE), & Intracytoplasmic Sperm Injection (ICSI). Dr. Allahbadia and his world-class team of Reproductive endocrinologists, embryologists, anthologists and infertility specialists have helped hundreds of couples have babies through Assisted Reproduction.

You can contact Dr Gautam Allahbadia at http://www.gautamallahbadia.com/ or fix up an appointment over phone at +91 22 2655 2000