SPONSORED FEATURE
Endometriosis and Infertility
By : Dr . Sharifah Halimah Jaafar , MD , M . Med O & G ( Mal ) AM ( Mal ), Consultant Gynaecologist , Advanced MIS & Endometriosis Specialist , Gleneagles Hospital Medini Johor .
Endometriosis is a common cause of infertility , affecting 10-15 % of women of reproductive age . It is a condition in which the tissue that lines the uterus grows outside the uterus , usually in the pelvic area , and causes chronic pain , and infertility .
According to the literature , almost 35 % – 50 % of women with pain , infertility , or both have endometriosis . The lesion of endometriosis can be found on the peritoneal surfaces , and on the ovary as well as deeply infiltrating the surrounding organs like the rectum , the bladder , and the ureters . Some studies have reported that almost 40 % of women living with endometriosis have an ovarian endometriotic cyst , which is a cyst formation on one side or both sides of the ovaries that contained old blood collection . Approximately about 50 % of those with the cyst have concomitant deeply infiltrating endometriosis .
How endometriosis affects the reproductive potential There are several ways by which endometriosis can affect fertility . Besides painful intercourse that might reduce the frequency of coitus , adhesion , and fibrosis resulting from the chronic inflammation may distort the pelvic anatomical structure . This mechanical disruption might impair egg release from the ovary and its pickup by the fallopian tubes , and increase the contraction of the uterine muscle which would eventually fail fertilization and implantation to happen . Furthermore , the inflammatory response triggered by the endometriosis lesions releases some chemical mediators , creating a hostile environment in the pelvis which slows down and kills the sperm and embryo . In the case of ovarian endometriosis , the effect of stretching by the cyst wall upon the ovary tissue could damage its cortex and the follicles , altering ovulation and in the long term it reducing egg production by the ovary .
The options of treatment for endometriosis with infertility Women who have endometriosis with infertility and wish to get pregnant have few options for treatment depending on their age , the severity of the endometriosis , duration of infertility , and previous surgery if any . If she is ready to get pregnant anytime soon , she will be highly recommended to undergo medically assisted conception and invitro-fertilization ( IVF ). Several studies in the literature have reported that IVF improves the pregnancy rates in women with endometriosis by 30-40 %. The earlier they decide to get pregnant , the better because endometriosis can progressively affect the ovarian reserve and the quality of eggs as long as the disease is still active .
Another option the patient can consider is a surgical intervention especially if she has large ovarian cysts or deeply infiltrating endometriosis . Minimally invasive surgery or laparoscopy has become a standard surgical approach to endometriosis as it not only causes a minimal scar on the abdomen , less painful wound , and shorter recovery time but most importantly it improves surgical visualization , better staging , and clearance of the disease with minimal adhesion as compared to the conventional approach . It has been reported that almost 50 % of women who have had surgery for endometriosis conceive naturally and for those who had IVF soon after the surgery about 40 % of them successfully conceived . However , this surgery has to be done by a fully-trained laparoscopic surgeon for a better outcome .
Currently , there is a technology that supports fertility preservation . If the facility is available in the hospital , for older women with endometrioma who want to postpone their pregnancy to the future , there is an option for ovarian tissue or egg preservation . This will allow her to get proper treatment for endometriosis and stabilize the disease without affecting her future chances to have a baby .
Endometriosis is an enigmatic disease that affects young women and their reproductive capacity . Fortunately , the availability of advanced technology and endometriosis specialist have significantly improved the reproductive outcome for women who are severely affected by endometriosis .
The availability of advanced technology and endometriosis specialist have significantly improved the reproductive outcome for women who are severely affected by endometriosis .
GlobalHealthAsiaPacific . com ISSUE 1 | 2023
31