Endometriosis

The number of infertile couples today is a lot more than ever before. Why is infertility at an all-time high? This is a question that confounds researchers and the medical industry. Statistics state that one out of every 5 couples are unable to conceive and needs to seek medical assistance to conceive. These couples might be facing infertility due to some medical issues or the sedentary lifestyles that might prevent them from conceiving.

There are many issues that plague women and prevent them from conceiving naturally. There are a variety of treatment options to provide solutions for different kinds of fertility problems. The uterus is a very important organ when it comes to pregnancy. Any kind of problem with the uterus can hinder pregnancy or its ability to carry a baby to full term. And Endometriosis is a disease related to the uterus which can become painful and sometimes affect pregnancy.

Endometriosis is abnormal tissue growth and is a disease which is related to the uterus. In some cases, it can cause infertility by affecting the surrounding reproductive organs and impeding their ability to function normally.

When the tissue which makes up the uterine lining grows outside the uterus and onto the surrounding organs like the ovaries and the Fallopian tubes it is referred to as endometriosis. The endometrium tissue forms a lining inside the uterus after ovulation in preparation for implantation and pregnancy. If this tissue grows outside the uterus, then it is considered as a disease.

At times this tissue also grows onto other organs and hampers their proper functioning. When the endometriosis affects the functioning of other reproductive organs like the Fallopian tubes and the ovaries, it can affect fertility in a disastrous way.

SYMPTOMS OF ENDOMETRIOSIS

The most common symptom of endometriosis is pelvic pain. This is a reoccurring pain and can vary from mild pain to severe pain. The pain occurs in the pelvic area, the lower back and even travels down the legs in some cases. The severity of the pain depends on the extent of the endometriosis. Some women also experience a cramping sensation in their pelvic region. The symptoms are summarised below:

  • Painful periods
  • Pain in the lower abdomen, lower back
  • Intestinal and pelvic pain
  • Heavy menstrual bleeding, or spotting or bleeding in between periods
  • Discomfort during bowel movement
  • Painful sexual intercourse
  • Infertility

CAUSES OF ENDOMETRIOSIS

The actual cause of endometriosis is not known. However, possible reasons can be due to:

  • Problems with the menstrual flow: Instead of the menstrual blood leaving the body during the time of periods it enters the fallopian tubes and the pelvis something which is known as retrograde menstruation.
  • Embryonic cell growth: It is said that at times, the embryonic cells that line the abdomen and the pelvis develops into endometrial tissue within those cavities.
  • Fetal development: Research shows that the condition of endometriosis is present in the developing fetus, and during the time of puberty, the estrogen levels are said to trigger the symptoms.
  • Scarring during surgery: It is believed that endometrial cells can move out during the procedure of hysteroscopy or c-section.
  • A family history of Endometriosis: Genetics may play a part, a woman, whose close family member has endometriosis is more likely to have endometriosis herself.
  • Hormonal imbalance: Research indicates that many women with endometriosis are said to have a hormonal imbalance, especially the dominance of the estrogen hormone.
  • Immune system: It is also said that any problem with the immune system can prevent the destruction of the extrauterine endometrial tissue, thus giving rise to the condition of endometriosis.

RISK FACTORS ASSOCIATED WITH ENDOMETRIOSIS

2-10% of women of the childbearing age are affected with endometriosis. The condition is painful, but if one understands the risk factors that might lead to this condition then it can be managed properly, and the woman can be sure enough if she is susceptible to the condition or not.

  • Age: Endometriosis usually affects women between the ages of 25-40 years (the childbearing age), but the thing is that the symptoms can start to show from puberty.
  • Family history: It is always advisable to talk to a doctor if you have a family history of endometriosis because then you are at a higher risk of developing this condition.
  • Menstruation history: If you face any problem in your periods then it is advisable to talk to a doctor. Keep track of your cycles, whether you have a shorter cycle, heavier or longer period cycle or if you started menstruating early. These factors may put you at a high risk of developing endometriosis.
  • Pregnancy history: It is said that pregnancy can protect women against endometriosis from developing. If you haven’t had children, then you might be encouraged to conceive. But saying that it doesn’t mean that endometriosis won’t affect women who have had children, women with children may also be affected. The hormones affect the development and progress of the condition. Pregnancy may not cure the condition but may make the symptoms of endometriosis less afterwards.

DIAGNOSING ENDOMETRIOSIS

Endometriosis is a disease caused by the extra growth of tissue. A pelvic examination which is often conducted by doctors to check for cysts and abnormal growth in the reproductive organ does not reveal the endometriosis. In some cases, if cysts have developed due to endometriosis, it may be felt as an abnormality, and hence your doctor will suspect that there is some abnormality which needs further investigations through tests.

An ultrasound with a transducer pressed against your abdominal area as well as a transvaginal ultrasound probe together may give imaging of the reproductive organs but does not give a clear indication about the presence of endometriosis. If there are cysts on the endometriosis, they will show up on the ultrasound. The presence of cysts may lead to doctor’s suspect that there is an endometrial tissue growth outside the uterus.

Laparoscopy is the best and most definitive way to diagnose endometriosis. It is a surgical procedure in which a camera (laparoscope) is inserted into the abdominal cavity through a small incision. This procedure is carried out while the patient is under anaesthesia. The doctors may also take a small tissue sample to conduct further tests. The laparoscopy procedure reveals information about the size of the endometriosis and the extent to which it has spread.

It is important to understand how much the endometriosis has spread and the areas or internal organs that it has affected if any. The endometriosis treatment is determined based on this vital information. The endometriosis can affect the normal working of the organs that it spreads to and lead to an organ shift in severe cases.

MILD ENDOMETRIOSIS

Most of the endometriosis cases are quite mild. Mild endometriosis usually does not show any symptoms and women have been able to successfully conceive and have a fertile reproductive life. Very rarely, a woman with a case of mild endometriosis has been found to be infertile. Infertility with mild endometriosis is defined as a case of unexplained infertility.

SEVERE ENDOMETRIOSIS

In conditions of severe endometriosis, it can affect the pelvic anatomy and distort it by displacing the organs or binding them together with the tissue growth. This causes some of the internal organs in the abdominal cavity to shift position. Severe endometriosis also causes pelvic scarring. In most cases of severe endometriosis, the fallopian tubes are badly affected and get blocked or severely damaged, causing infertility. The ovaries develop cysts due to the endometriosis and get attached to the uterus or the sidewall of the pelvic region.

Severe endometriosis can affect ovarian reserve and well as lead to the damage of the eggs. Many women with severe endometriosis have been found to have poor quality eggs, and a decreased ovarian reserve. In most cases, severe endometriosis results in infertility. Women with severe endometriosis will have to seek fertility treatment to conceive.

ENDOMETRIOSIS SUCCESS STORY

Saloni 32 years

Saloni was unable to get pregnant after trying for nearly 2 years. She was 32 years old and had a regular ovulation cycle. Her husband Deepak had a sperm analysis test to check if there was a problem with his sperm that was preventing Saloni from getting pregnant. The semen analysis report was all good, and a pelvic exam conducted by her doctor revealed that all was clear with Saloni too, hence their case was labelled as unexplained infertility. After a friend recommended the couple to seek fertility treatment, they decided to visit one. Recently Deepak (Saloni’s husband) had gone through an advertisement in the newspaper about Medicover Fertility. A European leader in IVF and going through their USP’s (advanced technology, transparency, patient-centric and ethical treatment) they decided to visit it.

In the meanwhile, Saloni had begun experiencing some occasional pain in the pelvic area. At Medicover Fertility Clinic, the Fertility Consultant suspected endometriosis. They did a laparoscopic examination and found that indeed she had endometrial tissue which had spread over her fallopian tubes and that was hindering her from getting pregnant. The endometriosis had caused scar tissue and adhesions on her fallopian tubes. Since Saloni and Deepak were very keen on having a baby, they decided to have IVF treatment. Before her IVF treatment, she had to take medication to retard the growth of the endometriosis.

DOCTOR’S SUGGESTION ON ENDOMETRIOSIS

Medicover Fertility IVF Consultant says, “Endometriosis is not always easy to diagnose, and sometimes patients have no symptoms at all. Very often, infertility due to endometriosis is mistaken as a case of unexplained infertility. If the endometriosis is detected while it is in the milder stages, then treatment is easier. Doctors need to keep a lookout for endometriosis as it is not as uncommon as one thinks.”

EFFECT OF ENDOMETRIOSIS ON FERTILITY

Up to 10% of women have endometriosis, but among these women, only a certain percentage of them face problems with getting pregnant and infertility.

Endometriosis can sometimes cause fertility problems. Around 40% of the women with endometriosis are infertile and unable to conceive.

Infertility with endometriosis is caused by blockage of the Fallopian tubes due to the endometrial tissue over it or a malfunction of the ovaries due to the growth of the endometrial tissue. Sometimes endometriosis prevents implantation as well.

Some researchers believe that delayed pregnancy can lead to the development of endometriosis rather than it being the other way around and endometriosis causing infertility.

TREATMENT FOR ENDOMETRIOSIS

The treatment for endometriosis depends on the severity of the tissue growth and the regions it has spread to. For milder cases of endometriosis, a doctor may prescribe medication to retard the growth of the endometriosis. More severe cases where the endometriosis has covered other organs and is causing a problem, then the recommendation is surgery to remove the endometriosis growth. Most doctors prefer to keep surgery as a last resort.

  • Pain reliever: Medication is prescribed to contain the pain that the patient may be experiencing due to the endometriosis. The pain medication is usually an over the counter drug and a simple presc.ription.
  • Hormone supplements: The endometrial tissue thickens during each ovulation cycle, and then it breaks down and is expelled by the body. These changes are prompted by the release of certain hormones in the body. Giving the patient hormonal medication could lead to a reduction in endometrial tissue formation. Taking hormone supplement is not a permanent cure for endometriosis, but less tissue growth is experienced during the ovulation cycle. The endometriosis and its symptoms may return after the hormone medication has been stopped. Some of the hormonal medication used for containing endometriosis are:
    • Contraceptives: Birth control tools such as pregnancy control pills or vaginal rings etc. could reduce the release of the hormones that encourage the growth of the endometrial tissue. Hormone birth control pills have been found to get rid of the pain caused due to the endometriosis too.
    • Gonadotropin-releasing hormone (Gn-RH): The agonists and antagonists stop the release of the hormones that stimulate the ovaries. This will prevent ovulation and lower oestrogen hormone levels. The idea is to create artificial menopause. This results in the endometriosis shrinking in size. The patient may begin to experience some of the menopausal symptoms like hot flushes and vaginal dryness, but by taking a low dosage of progestin along with the Gn-RH will reduce the menopausal side effects. Once the Gn-RH is stopped, the patient will begin getting her periods again and will be able to conceive normally as before.
    • Progestin: A contraceptive implant like an intrauterine device or taking a contraceptive injection can help to reduce the endometriosis growth and eliminate the symptoms and pain caused by the endometriosis.
  • Conservative Surgery: If the endometriosis has spread over the ovaries and the fallopian tubes and the patient is keen to get pregnant, doctors may recommend surgery for endometriosis removal. This surgical procedure is used to remove as much of the endometriosis tissue as they can. This conservative surgery is performed with a specific intent to preserve the reproductive organs like the ovaries and uterus and prevent any damage to them. This surgery may be performed as a regular abdominal surgery or as a laparoscopic procedure. Even though a large portion of the endometriosis is removed the probability of it growing back and the symptoms returning still exists. This is not a permanent cure but will help for conception and during pregnancy.

WHAT IS THE BEST TREATMENT OF ENDOMETRIOSIS?

The key to a successful endometriosis treatment is the individualisation of the patient’s care, based on their symptoms and accurate diagnosis. Once the state of endometriosis is known, the treatment involves either medical or surgical procedures or a combination of both, depending upon person-to-person.

Some of the treatment options recommended by doctors are:

  • Pain management medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), or naproxen sodium (Aleve) to ease menstrual cramps.
  • Hormone therapy, in combination with pain medications in case of patients who are not trying to conceive.
  • Surgical treatment for the removal or destruction of endometrial tissue.
  • Removal of adhesions or scar tissue.
  • Removal of drainage or cysts.

A woman diagnosed with endometriosis might also suffer from infertility. According to research, 25 – 50% of the women suffering from infertility are affected with endometriosis. However, with the right treatment, the chances of getting pregnant with endometriosis can be considerably enhanced.

At first, the doctor surgically removes the endometrial tissues through laparoscopy, or other similar procedures, and then accordingly, the infertility treatment options are suggested to patients facing infertility. The treatment options vary from person-to-person depending upon the type of infertility and their level of endometriosis.

Some of the common treatments include:

  1. IUI: Mild endometriosis can often be treated with laparoscopy followed by Intrauterine Insemination (IUI), to help a woman conceive. It is the type of fertility treatment in which the sperm is directly injected inside the uterus to assist in fertilization and improve the chances of conception.
  2. IUI with Controlled Ovarian Hyperstimulation: Sometimes, stimulation medications are given to patients, to help ovaries in producing more eggs and then it is followed by IUI for the successful conception of pregnancy.
  3. IVF: In cases of severe endometriosis with advanced infertility issues, laparoscopy followed by IVF or in-vitro fertilisation, increases a woman’s conception chances. IVF is a procedure in which eggs and sperm are fertilized outside the body. Once the embryo is formed, it is transferred back to the uterus to implant.

Above all the treatment procedures, IVF treatment, after removal of the endometrial tissues by laparoscopy or similar other procedures, is considered to be the best treatment of endometriosis, to conceive a pregnancy. 

ASSISTED REPRODUCTIVE TECHNOLOGY TO CONCEIVE WITH ENDOMETRIOSIS

Women who are not able to get pregnant and have been diagnosed with endometriosis are usually advised to consider some form of Assisted Reproductive Technique to conceive. There are many different variations of IVF treatment, which can be used by women who have endometriosis to have a baby. IVF is the most popular type of assisted reproductive technique around the world.

The Assisted Reproductive Technique commonly prescribed for patients suffering from endometriosis is In vitro fertilisation. In this treatment, the female egg is made to fertilise with the male sperm in a petri dish, and this procedure takes place in a lab. An embryologist supervises the fertilisation of the egg and sperm. The egg is extracted from the female partner by giving her some hormonal injections to stimulate her ovaries to grow mature eggs. These eggs are then aspirated through a special egg retrieval process. The semen sample is given by the male partner and is required to produce on the same day as the egg retrieval.

Once the embryos have formed in the lab, they are kept in an incubator for 2 to 3 days and then transferred to the female partner’s uterus. The next stage after fertilisation is the transfer of the embryo to the uterus and wait for its implantation. The embryo has to hatch from its outer covering and embed itself in the endometrial lining inside the uterus which is known as implantation. Women with more severe cases of endometriosis may find it more difficult to conceive as the embryo does not implant easily. Fertility drugs are given to the patients to improve the chances of implantation and help the uterus to become receptive to the embryo.

In some cases, the embryo is kept in the lab till the blastocyst stage and then transferred on the 5th or 6th day. Doctors believe that blastocysts have a higher implantation success rate, and the uterus is more receptive on the 6th day than on the 3rd day.

Women who have undergone hysterectomy with their ovaries intact can have a child through a surrogate mother using their own eggs. Those women whose ovaries have also been removed can opt for donor egg IVF and then go with surrogacy where the donor egg is fertilised by the husband’s sperm and transferred to the uterus of the surrogate.

FERTILITY TREATMENT AT MEDICOVER

Medicover Fertility Clinic is one of the leading fertility clinics now in India. Medicover has state of the art infrastructure and lab facilities. We follow international standards in keeping with our European brand name. Medicover provides specialised patient care. We believe that each patient is unique, and each case is different, so the treatment plan is tailored according to individual patient needs.

At Medicover Fertility, fertility consultants are assigned to couples who can understand their case and work closely with them at each step throughout their fertility treatment. The couple can clear their doubts and present their queries to their attending consultants. Every couple needs to feel that they matter and we at Medicover Fertility exactly make them feel so so that they feel at home and are comfortable.

RELATED QUESTIONS ON ENDOMETRIOSIS:

Q: I have been suffering from pain in the pelvic area for the last few months. The pain reoccurs at frequent intervals and is becoming more severe. Could I have endometriosis?
A: It is advisable to consult with a doctor rather than jumping to conclusions with a self-diagnosis. Pain in the pelvic area is one of the symptoms of endometriosis, but you could also have some other minor problem that is causing you pain.

Q: I have been diagnosed with endometriosis and now we are planning a baby. What is the best course of action?
A: The safest way to have a baby when you have endometriosis is through IVF.

Q: Can I conceive naturally after being diagnosed with endometriosis?
A: You can conceive naturally even if you have endometriosis. 60% of the women with endometriosis are able to conceive naturally without any problem in their pregnancy. If you have a condition of infertility caused due to the endometriosis, then IVF is the best choice.

Q – What are the first signs of endometriosis?

A – Although, endometriosis is usually asymptomatic; however, some of the common symptoms include, pelvic pain, pain before or during periods, infertility, pain during intercourse, abnormal bleeding, etc.

Q – What happens when you have endometriosis?

A – In the case of endometriosis, the endometrium grows outside the uterus. The misplaced tissue continues to thicken, shed and bleed with every menstrual cycle. Since the blood and tissues shed outside the body, do not find a way to flow out of the body, they lead to inflammation and pain.

Q – Can you have a baby with endometriosis?

A – Yes! It is generally believed that about 60 – 70% of the woman with endometriosis are fertile. Moreover, half of the women facing trouble conceiving, eventually become pregnant, with or without the treatment.

Q – How does a person get endometriosis?

A – Endometriosis is usually a result of retrograde menstruation. Although the exact cause of endometriosis is unknown, it may also be caused due to genetic factors.