Impact Of Endometriosis On Fertility


Today, Will talk on a very common topic that is a global problem, which is endometriosis and its impact on fertility. Now, endometriosis is every gynaecologist’s dilemma because it has a diagnostic dilemma. This is a progressive disease, reoccurring in nature, and no permanent cure to it. Talking about endometriosis will take hours but here I am going to simplify my topic, so as to give you a basic understanding of how and when does endometriosis affect your fertility.

So, I will be covering a few topics like what exactly is endometriosis, how common is this problem in our population, are there any risk factors associated with it, what are the symptoms, how will you diagnose the problem, why and when endometriosis will affect your fertility, how can you manage that, and what to do if you come across recurrence. So to start with, let’s understand what endometriosis is. In a simple language, this is the presence of endometrial like tissue outside the uterus cavity and the most common site is ovaries where they commonly known as ovarian cysts. Unfortunately, this has become a very common problem across the globe and about 15-20% of the females are affected by this disease. The most common age group in which endometriosis is seen is the fully reproductive years, from 20-29 years of age.

Are there any risk factors which can contribute or increase your chances of endometriosis – Yes, either your mother or your sister or both having history of endometriosis, early age of onset of menarche, delayed marriages and thereby delay in pregnancy attempt, any previous surgeries or medications.

There are certain myths to the use of tampons, OC pills and IUDs, with regards to endometriosis; however, no relation has been seen with the use of either of them and endometriosis.

Now, what are the symptoms if you are suspecting an endometriosis? A female will experience painful periods which is increasing in intensity, progressively over a couple of weeks. This might be associated with painful intercourse and/or chronically low, dull back pain or lower abdominal pain. The symptoms can range from mild to severe. So how do I come to my diagnosis? If you have any of these symptoms, the very history and the examination done by a gynaecologist gives the probable diagnosis of endometriosis. Ultrasound with or without MRI can aid the diagnosis. However, a direct inspection of the pelvic organs with the help of laparoscopy will remain the gold standard to establish the diagnosis.

Now, next very important question that comes in our mind, how is endometriosis related to fertility and how does it affect us? Well, Endometriosis affects the entire pelvic anatomy by forming certain cysts, certain adhesions, eventually leading to distortion and subsequently acting as a roadblock to the normal fertilization. Also, it has been seen to affect the oocyte quality that is the egg, and therefore, affects the embryo quality and the implantation that is the attachment of the embryo to the uterus.

Now, what can be done for this? Well, the management will depend on multitude of factors, like the age of the female, the duration of infertility, any other factor which is also attributing to infertility, what is the stage of endometriosis, is this the first time that she has been diagnosed with endometriosis or it is a recurrent phenomena. A surgical approach in the form of laparoscopy as the management for fertility due to endometriosis should be considered only if you have large cysts along with severe pain. If you are asymptomatic and fertility is the only concern then assisted-reproductive technologies with either IUIs that is intrauterine insemination or IVF that is in vitro fertilization will be offered. Whether you fit into the subset of IUI or IVF would again be ascertained with the factors that I have talked about earlier.

To make things simple, a female less than 35 years, shorter duration of infertility, first episode of endometriosis, no other factor of infertility, a good ovarian reserve can be offered good 3-4 cycles of ovulation induction with IUI. However, IVF would remain the first choice of treatment if the age is more than 38, there is a low ovarian reserve, any other factor contributing to infertility, like male factor, tubes, severe endometriosis that is stage 3 or 4, recurrent endometriosis.

Now, as I said, endometriosis is a diagnostic dilemma, a disease which is progressive in nature, and unfortunately with no permanent cure. What do I do if I come across recurrence? Unfortunately, recurrence has been reported in about 20-21% of the cases within 2 weeks, whereas about 40-50% of the females will be having a recurrent episode within 5 years. Now, again, your treatment would depend on what exactly are we looking it for. With the family completed, recurrences However, if fertility is still the question then we proceed directly with an in vitro fertilization.

So with all this, I have tried to explain what exactly is endometriosis, what are the symptoms where you can think of having endometriosis; if you have not been able to conceive, with an history of endometriosis, what are the treatment modalities that can be taken care of.

So to end my talk, I would like to bring in a nice quotation, “From the outside looking in, it is difficult to understand, and from looking inside out, it is difficult to explain.” So, endometriosis is a complex condition which can be simplified by meeting your doctors at the right time.

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