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Overcoming infertility with endometriosis

According to ESHRE about 50% of infertile women of reproductive age suffer from endometriosis.

This disease is one of the top three along with inflammatory diseases and uterine fibroids, leading to:

 

  • significant reproductive disorders
  • persistent pain syndrome
  • infertility

Endometriosis is the presence of endometrial cells outside the uterus that causes a chronic inflammatory response.

According to the results of a study by the International Association of Endometriosis, in which 4000 sick women took part, 50% of respondents showed the first signs of the disease before the age of 24 years, in 21% – before 15 years, in 17% – between 15 and 19 years.

In some cases, the first and only symptom of endometriosis is infertility .

Probable causes of subfertility in endometriosis:

  • tubal infertility (organic and functional)
  • peritoneal infertility
  • endocrine infertility
  • immunological infertility (violation of the implantation process, damage to spermatozoa by activated macrophages)

There are many theories of the disease, but none of them has been proven.

The background can be:

  • frequent infectious diseases
  • hormonal disorders
  • inflammation of the appendages
  • abortion or diagnostic curettage
  • genetic factors

Diagnostic methods

  • Anamnesis
  • Physical examination
  • Laboratory methods (biomarkers)
  • Ultrasound of the pelvic organs
  • MRI
  • Hysteroscopy
  • Laparoscopy
  • Anamnesis
  • Physical examination
  • Laboratory methods (biomarkers)
  • Ultrasound of the pelvic organs
  • MRI
  • Hysteroscopy
  • Laparoscopy

Treatment methods

  • medicated (conservative)
  • surgical
  • combined
  • IVF is recommended for infertility within 1 year during therapy.
  • to patients over 38 years old IVF should be prescribed immediately , regardless of the form and severity of endometriosis.

Medication for endometriosis.  The main drugs with proven effect for the treatment of confirmed endometriosis are:

  • Progesterone drugs
  • Monophasic COCs
  • Aromatase inhibitors as antiestrogenic agents
  • Danazol
  • Gonadotropin releasing hormone (GnRH) agonists

Surgical treatments for endometriosis

  • When conservative treatment is ineffective
  • Recommended in the presence of “chocolate” ovarian cysts, to eliminate adhesions in the pelvic area
  • Selection Method – LAPAROSCOPY
  • In 12% of women over 40, the disease is not treatable. A radical operation to remove the uterus and ovaries was recommended.

Is hormone therapy effective for endometriosis-related infertility?

  • Suppression of ovarian function (with hormonal contraceptives, progestogens, GnRH agonists, or danazol) to improve feltillism in mild to moderate endometriosis is ineffective and should not be used solely for this purpose.
  • Women with endometriosis who are infertile do not need hormonal treatment to suppress ovarian function to improve fertility (Hughes et al., 2007).
  • Increased estrogen levels in endometriosis can also provoke hyperprolactinemia.

Is endometriosis-related infertility surgery effective?

When referring to surgery, not all doctors (unfortunately) take care of a woman’s reproductive potential. But several operations on the ovaries may well lead to the fact that at the age of 30 a woman has menopause.

! That is why it is very important to consult a fertility specialist before the operation, who can “preserve” eggs for use in the IVF program (if necessary).

  • In severe endometriosis, in vitro fertilization (IVF) procedure is recommended .

 

In the IVF program for endometriosis, protocols with GnRH agonists are recommended, which help to simultaneously reduce the intensity of the disease, as well as obtain a larger number of eggs, thereby increasing the chance of successful fertilization and subsequent implantation of the embryo in the uterus.

 

At the risk of developing OHSS, the clinic conducts protocols with GnRH antagonists in women with minimal and moderate endometriosis or endometrioma.

  • ESHRE recommends the use of ART in the treatment of infertility associated with endometriosis, especially in case of impaired function of the fallopian tubes, male factor infertility and / or other factors of treatment failure.

 

  • Infertile women with endometriosis should be treated with ART after surgery because the cumulative incidence of endometriosis recurrence does not increase after controlled ovarian stimulation with IVF / ICSI (Coccia et al., 2010 Benaglia; et al., 2011).

 

  • We recommend that doctors advise women with ovarian endometrioma regarding the risk of decreased ovarian function after surgery and possible loss of the ovary.
  • If a woman has previously undergone ovarian surgery, the decision to have a second surgery before IVF should be carefully considered

The best endometriosis treatment is pregnancy!

 

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Клиника репродуктивного здоровья "Лада"
ул. Среднефонтанская, 19В, ЖК «Чудо-город» 65039 Украина, г.Одесса
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