Endometriosis: An Important Cause of Infertility

WHAT IS ENDOMETRIOSIS:

This is a disease related to inner lining of the uterus know as endometrium.
Each month the endometrial lining grows and is shed off during the menstrual cycle. When this endometrium starts growing abnormally outside the uterus in and around various pelvic organs and in the abdominal cavity then this disease is known as Endometriosis. This abnormally located endometrial tissue keep on growing in and around various pelvic organs to form a cyst called endometriotic cyst depending on the extent of spread and size.

Endometriosis is classified into 4 stages:

STAGE 1: MINIMAL DISEASE
STAGE 2: MILD DISEASE
STAGE 3: MODERATE DISEASE
STAGE 4: SEVERE DISEASE

Almost 20 – 40 % of infertile females suffer from this disease.
Apart from endometriotic cyst this disease causes severe adhesions between the pelvic organs; bowel and uterus, uterus and ovaries.

Endometriosis also called adhesions of fallopian tubes, affects ovulation. Destroys good eggs in the ovaries; resulting in inability to conceive.

Females suffering from endometriosis can also have following symptoms:
1. Painful Periods(Dysmenorrhea)
2. Pan during sexual intercourses (Dyspareunia)
3. Difficulty in passing urine.
4. Constipation and abdominal blooding.

TESTS INNVOLVED IN DIAGOSIS:
• Sonography (Ultrasound) of pelvic and abdomen is one of the most important test to diagnosis endometriosis.
• Laproscopic Surgery done to visualize the pelvic and abdomen.
• Blood test like AMH and CA-125 can also be helpful. AMH tells us the egg producing capacity (ovarian reserve) of the female and CA-125 will guide us about the extent of disease and prognosis.
Chances of infertile female of having pregnancy with disease of endometriosis will depend upon the stage of the disease and its severity at diagnosis.
Females with minimal to mild disease of endometriosis have better chances to conceive that females with severe disease.

TREATMENT OPTIONS OR INFERTILITY IN ENDOMETRIOSIS:

• There can various treatment options depending upon staging and severely of endometriosis. Treatment options while also depend on other factors which determine fertility like tubal patency, age, husband semen analysis reports, etc.
• Females with stage 1 or minimal disease can conceive naturally or with simple help in form of medicines for proper egg formation and ovulation along with timed intercourse.
• Female with stage 2- 3 ie mild to moderate disease would require treatment in form of Intrauterine Insemination (IUI) along with medicines for proper ovulation.
• Female with stage 3 to 4 ie moderate to severe disease would require advanced form of treatment to achieve pregnancy in form of IVF(In Vitro Fertilization or test tube baby)

ROLE OF LAPAROSCOPIC SURGERY IN TREATING INFERTILITY WITH ENDOMETRIOSIS:

Laparoscopy not only can help in diagnosis but simultaneously we can also remove the disease. It can help in removal of endometriotic cyst (drainage or cystectomy), removal of adhesions, checking of tubal patency in pelvic cavity. Endometriosis is a recurrent disease. Infertile females have 40-60% chances of recurrence of this disease within 1 year of its treatment. Due to this high recurrence it is important that these patients treated aggressively with minimum time to achieve pregnancy.
It is advisable to achieve pregnancy within 6 months of diagnosing endometriosis or within 6 months of doing laparoscopic surgery for endometriosis.

MISCONCEPTION:

Myth: – It is a cancer.
Truth: – Not a cancer but a recurrent disease.

Myth: – Something patient did cause endometriosis.
Truth: – Exact cause unknown, but definitely not related to patient activity.

Myth: – Endometriosis means “You can’t get pregnant”
Truth: – Pregnancy can be achieved with various treatment modalities available.

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