April 8, 2020

Endometriosis and cancer

Author Name: Dr. Rakshita Mentor Name: Dr. Satish Londhe on April 08, 2020

One out of six couples is infertile in urban areas of india and current infertility rate is as high as 14% (according to the Indian Society of Assisted Reproduction).

The very first step in evaluation of an infertile couple is full history and clinical examination of both partners.
First visit :

  • complete blood count
  • vaginal wet mount with appropriate culture
  • liquid based cytology, rubella serology
  • Hepatitis B and C, HIV serology
  • thyroid, prolactin
  • semen analysis
  • AMH
  • Transvaginal ultrasonography.

AMH helps in prediction of ovarian reserve irrespective of the day of menses and thus has made patient visits very comfortable according to their time schedule.

We use 3D and 4D tvs probes to detect causes of infertility and any pelvic pathology (sensitivity 95%)

  • uterine masses and abnormalities
  • ovarian masses
  • tubal patency (Saline infused sonography is a very painless substitute to HSG)
  • AFC to predict ovarian reserve (the pool of eggs present in the ovaries at any given time).

The use of hysteroscopy and laproscopy for diagnosis of pathology is done in cases of suspected pathologies or diagnosis made by 3d and 4d ultrasound. Chromosomal karyotyping is for suspected genetic disorders like Turner’s syndrome.

There are three main types of fertility treatment: medical treatment (such as ovulation induction therapy); surgical treatment (such as laparoscopy and hysteroscopy); and the different assisted reproduction techniques like IUI, IVF, ICSI and IMSI.

Choice of infertility treatment depends on the duration of their infertility, which partner is affected, the age of the female partner and if any has a previous children or not and the underlying pathological cause and also on efficacy, cost and ease of use or administration.

The single most important determinant of couple’s fertility is the age of female partner. A treatment protocol is formulated based upon the age and the duration of married life.

If duration of infertility is 1-3 years and no obvious cause is found then treatment starts with counselling for timed intercourse and lifestyle changes like giving up smoking, drinking alcohol or any addictive drugs and losing weight if BMI is >29. Folic acid 0.4 mg is given as a daily supplement to prevent neural tube defect (5.0 mg advised for women who have previously affected child or on medication for epilepsy).
For women with ovulatory dysfunctions or in whom the counselling doesn’t work we do ovulation induction with medicines or gonadotropin injections. Intra-uterine Insemination (IUI) could be used for unexplained infertility (with duration of marriage less than 5 years) and female cases with minimal endometriosis.

In certain situations ivf is done directly.

ART involves hormone stimulation to make the ovaries produce 10–15 eggs. When the eggs are ‘ready’ they are retrieved by an ultrasound-guided procedure. The collected eggs are then mixed with sperm from the male partner or a donor, and in the case of ICSI each egg is injected with a single sperm. Two to five days later the embryos formed are assessed and frozen for future use. They are tansferred to the woman’s uterus using a thin tube that is inserted through the cervix.

Certain surgeries like mentioned below are performed for specific diseases before ART. Laproscopic myomectomy (to remove any fibroid affecting the fertility) , salphingectomy or delinking to removing infected tubes or adhesiolysis are performed. Hysteroscopic adhesiolysis, septal resection, polypectomy are some procedures which require minimum hospital stay and have fast recovery.

So hurry up and meet an infertility expert since most treatments have higher success rates in younger age.

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