Infertility treatment for endometriosis

Endometriosis is a common disease in women of reproductive age. In this pathology, the inner layer of the uterus (endometrium) grows outside the uterus. Endometrioid foci can be located in any organs and tissues: fallopian tubes, on the surface of the peritoneum, in the ovaries, and in rare cases even in the nasal mucosa. Endometrioid tissue may look like flat foci, thickened nodules, or cysts (cysts form in the ovaries) called endometriomas.

It is almost impossible to predict how the disease will progress. Sometimes there are only a few small foci of endometriosis that do not increase in size throughout life, and in some cases the disease can develop and progress rapidly.

CAUSES OF ENDOMETRIOSIS

The most common cause of endometriosis is considered to be retrograde menstruation. This is a phenomenon in which menstrual blood with endometrial cells is thrown into the abdominal cavity, fallopian tubes and other organs during menstruation. There, endometrial cells can take root and function like the lining of the uterus.

Another reason for the development of endometriosis is a genetic predisposition. According to doctors, the disease is more often detected in women whose mothers or sisters also suffered or are suffering from this disease.

Endometriosis can result from the transfer of endometrial cells through blood and lymphatic vessels.

The risk of pathology increases after any operations on the uterus: abortions, diagnostic curettage, cauterization of erosion, etc., as well as after childbirth.

SYMPTOMS OF ENDOMETRIOSIS

In most cases, there are no signs of pathology or they appear very weakly. Often, pathology is first diagnosed during surgery for another disease.

However, in some women, endometriosis can cause:

• Severe pain during menstruation (dysmenorrhea). The level of pain is not an indicator of the spread of the disease.

• Pain during sexual intercourse (dyspareunia).

• Spotting that is not associated with menstruation. Endometriosis of the uterine body (adenomyosis) can be manifested by prolonged menstruation and the appearance of dark spotting before and after the end of menstruation.

DIAGNOSIS OF ENDOMETRIOSIS

To make a definitive diagnosis, a doctor may prescribe to a woman:

• Ultrasound of the pelvis.  On ultrasound, a gynecologist may suspect endometrioid cysts, severe adenomyosis, etc.

• Гистероскопию. Examination of the walls of the uterine cavity using a hysteroscope. If there is adenomyosis, then the endometrioid passages are clearly visible on the walls of the uterus.

• Laparoscopy. It is prescribed by a gynecologist if an accurate diagnosis has not been made after previous diagnostic procedures. Using a laparoscope, the doctor sees the outer surface of the fallopian tubes, ovaries, and uterus and determines the extent of the endometrioid process. During the manipulation, the doctor can take a small piece of tissue for further laboratory examination and eliminate the foci of external genital endometriosis.  If endometrioid cysts are detected, they are removed, preserving healthy ovarian tissue.

ENDOMETRIOSIS TREATMENT METHODS

Pathology is usually treated with medication. But there are cases when drug therapy is ineffective. Then gynecologists resort to gentle surgical intervention.

Medical treatment of endometriosis

Therapy is aimed at temporarily shutting down menstrual function. Those medications are considered the most effective when used for 4-8 months without menstruation completely. Gonadotropin-releasing hormone agonists are used. After stopping the intake, menstruation is restored. 

Before conducting such therapy, you need to understand the risks. If a woman has a severely reduced ovarian reserve (HR), then the patient may not get out of this condition. However, EMC patients may not worry about this. In our clinic, if desired, a woman receives eggs before treatment, followed by fertilization with her husband's or partner's sperm. The resulting embryos are frozen until the uterus and the hormonal background of the woman return to their normal state.

Surgical treatment of endometriosis

Conservative treatment does not help with the formation of endometrioid cysts and pronounced adhesions. Then the EMC gynecologists perform surgical treatment of endometriosis.

During laparoscopy, it is possible to eliminate foci of endometriosis, dissect adhesions that prevent pregnancy, and remove cysts. In the future, a woman may become pregnant on her own.

But, as in the case of drug therapy, it is necessary to assess the risks. After surgery, there is a small chance of a decrease in HR. If the patient's ovarian reserve is low even before surgery, IVF is recommended: pre-collection and fertilization of eggs, followed by freezing and embryo transfer after the woman's recovery.

ENDOMETRIOSIS AND PREGNANCY: IS IT POSSIBLE

If adhesions form against the background of endometriosis, this can prevent the onset of pregnancy. In such cases, laparoscopy with dissection of adhesions usually helps to restore reproductive function.

Infertility in endometriosis can be triggered by a violation of immunological processes. This can affect the quality of oocytes or the further development of embryos. 

In addition, the disease can be accompanied by hormonal imbalance, which also negatively affects a woman's fertility.

Despite all these factors, pregnancy with endometriosis is possible, especially with mild forms of external genital endometriosis or adenomyosis. It all depends on the extent of the process and its complications (for example, the formation of adhesions or ovarian cysts).

If an unplanned pregnancy has occurred with this disease or the diagnosis has already been made during pregnancy, patients should be regularly monitored by a doctor.

EMC specialists have extensive experience in managing pregnancies with endometriosis of varying degrees of prevalence, IVF and other types of ART in patients with endometriosis.

ADVANTAGES OF CONTACTING THE EMC

• Doctors with experience in leading clinics in Europe. Modern international protocols for the diagnosis and treatment of infertility and other diseases of the reproductive sphere.

• Multidisciplinary approach. We will organize a consultation with the participation of all necessary specialists (gynecologist-reproductologist, endocrinologist, oncologist, etc.).

• Own cryobank of oocytes, embryos and sperm.