March 3, 2022, marks the beginning of endometriosis awareness week. A week during which we should all be informed and educated about that common but often unrecognized condition. In this article, we will shed some light on the causes, implications, and on how endometriosis affects fertility levels and possible pregnancies.
What is endometriosis? Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy. It is primarily found in young women, but its occurrence is not related to ethnic or social group distinctions. Patients with endometriosis mainly complain of pelvic pain, dysmenorrhea, and dyspareunia.
It is a very common condition with 6 to 10% of the world population suffering from it, and the percentage rises up to 50% in women with pain and infertility problems. About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile, so there is a clear connection between those two conditions.
Symptoms of endometriosis: Most common symptoms appear to be dysmenorrhea, chronic pelvic pain, deep dyspareunia, severe menstrual pain and irregular flow. Others might be nausea, lethargy, and chronic fatigue. The severity of the symptoms increases with the woman’s age.
It basically 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.
If endometriosis is found at the time of surgery, the doctor will surgically remove the scar tissue. This treatment will restore the normal anatomy and will allow the reproductive organs to function more normally.
The best way to tell for certain if you have endometriosis is through a surgical procedure called laparoscopy.
In general, when women are younger (below the age of 35) it is reasonable to remove any visible endometriosis to increase chances of pregnancy. If women are 35 or older, other fertility treatments are recommended instead of laparoscopy. If Stage III or IV endometriosis is present, pregnancy rates are higher after surgery is performed to remove scar tissue or large endometriotic cysts. If pregnancy does not occur within 6 months after surgical treatment of endometriosis, other fertility treatments should be discussed, such as IVF.
According to a research study, the correct management of infertile women with endometriosis is a combination of surgery and, in the absence of a spontaneous post-surgery pregnancy, IVF-ET. This integrated approach (surgery-IVF-ET) produced a pregnancy rate of 56.1% compared to a significantly lower pregnancy rate of only 37.4% after surgery alone.
It is a two-part assisted reproductive technology procedure. It requires the female partner to receive a series of injections of potent fertility drugs, which induce ovulation. These fertility medications cause her ovaries to produce several mature eggs (oocytes) at the same time as opposed to just one in a normal, unmedicated menstrual cycle. This gives the woman an increased chance of conceiving, and the ability to select the most viable embryos. Egg retrieval proceeds by removing the oocytes from the ovaries under light sedation using an intravaginal aspiration process that takes just a few minutes to perform. A semen specimen is obtained from the male partner, and eggs and sperm are combined in the IVF laboratory. Within three to six days, embryos developing from this process are evaluated, and some are selected for embryo transfer (ET).
So, if you have endometriosis and want to get pregnant, the doctor will evaluate your situation using the endometriosis fertility index (EFI). The EFI is a 10-point scale that can tell a doctor how likely a person is to get pregnant without medical intervention. Some of the scale considers factors are
Although one size doesn’t fit all, a 2021 study concluded that people with a score of 5 or higher might be able to try conceiving naturally for 24 months before medical intervention. The authors said that those with scores of 4 or lower should be referred for artificial reproductive treatments more quickly.
Interesting scientific facts you may need to keep in mind, is that if you have endometriosis the risk of a miscarriage rises to 1 in 4, when for healthy women is 1 in 5. Also, although ectopic pregnancies are less common than miscarriages, with around 1 in 80 to 100 pregnancies ending up as ectopic, but research has shown that in those with endometriosis, the risk is more than doubled.
Bottom line is that although endometriosis will most likely cause infertility issues, that is not the end of your story! Trust your body and science, give time, and hope for the best. Assisted reproductive technology does wonders nowadays, but there is also a chance of you conceiving naturally if you treat endometriosis at an early stage.
And because we are on the endometriosis awareness week, there are a few associations worth visiting”!
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