Endometriosis is a mysterious condition caused by hormonal and immunological abnormalities. It is diagnosed among girls and women of childbearing age. The term ‘endometriosis’ comes from the Latin word ‘endometrium,’ used to name a mucosal tissue inside the uterus. Endometriosis is diagnosed when endometrial cells appear outside the uterus in the abdominal cavity and grow into cysts, tumors, and implants. They may cause pain, infertility, and other issues. Endometriosis is seen in around 10% of women of childbearing age and 50% of women struggling with infertility.
How to diagnose endometriosis?
Due to the complexity of symptoms, it is not easy to diagnose endometriosis. However, the progress in medical imaging (US, MRI) laparoscopy remains a gold standard in endometriosis diagnosis.
Laparoscopy is a surgical procedure performed under general anesthesia. The abdominal cavity is filled with carbon dioxide, and through the small cut on the belly, the laparoscope is brought inside. The laparoscope is a tube with light that allows:
- visualization of the abnormalities and cutting them out
- collecting tissue for histopathological testing
- diagnosis and evaluation of the endometriosis
- testing fallopian tubes patency.
Endometriosis - symptoms
Endometrial cysts outside of the uterus react to hormones secreted during the menstrual cycle. Under the influence of hormones, new endometrium grows and causes bleeding. However, unlike in the uterus, blood is not excreted from the body. It leads to internal bleeding inside the pelvic cavity and neighboring organs, degradation of blood and tissue, inflammation of organs, creation of scar tissue and adhesions.
The most common symptoms of endometriosis:
- painful menstruations
- irregular menstrual cycle
- pain during or after sexual intercourse pain in the loins
- ovulatory pain
- pelvic and abdominal pain
- flatulence, nausea, vomiting
- pain in urinary bladder, painful urination
Why does endometriosis make it difficult to get pregnant?
Infertility affects 30-40% of women with diagnosed endometriosis and is a common symptom of the condition’s progress. Depending on where the cysts are located and how advanced the condition is, endometriosis may cause difficulties with getting pregnant in different ways:
- negatively affects the quality of oocytes
- blocks the fallopian tubes
- decreases ovarian reserve
- impacts implantation
- leads to different anatomical changes in the pelvis
- due to the pain, sexual intercourse may be less frequent
An appropriate diagnostic approach and individually tailored treatment are a starting point for overcoming difficulties with getting pregnant.
The treatment consists of:
- pharmacotherapy – hormonal therapy and symptom-based treatment. The most common hormonal medications are contraceptive pills, gestagen, testosterone-related hormones, GnRH antagonists, and analogs. Painkillers and non-steroid anti-inflammation medicines.
- surgical – minor or radical, depending on the patient’s needs
Endometriosis and pregnancy - what can be done?
Endometriosis treatment is individual due to huge differences between patients’ general conditions: advancement of endometriosis, woman’s age, ovarian reserve, fallopian tube dysfunction, partner’s semen quality. Endometriosis rarely makes pregnancy impossible. Many couples succeed despite this condition. Still, it is important to mention that the more endometriosis is advanced, the fewer chances the couple has.
- ovarian functions abnormalities, e.g., lack of ovulation
- oocytes issues
- fallopian tube blockage or disfunction
- Inflammatory semen damage
- embryo implantation dysfunction (e.g., due to high interleukin level)
In the most advanced cases of endometriosis (3rd or 4th grade) and when the treatment is long-term, IVF is recommended if the ovarian reserve is still normal. The success rate for IVF is similar to the fallopian tube factor. Embryos can always be vitrified and transferred at a more convenient time. During the ovulation stimulation, all the IVF protocols can be used in patients with endometriosis.
Adenomyosis is a separate medical condition but related to endometriosis. The endometrium infiltrates the uterine wall, causing fertility problems.
- profuse menstrual bleeding
- abnormal uterine bleeding
- pain during the intercourse and pain associated with the cycle phase
The main diagnostic method is pelvic US Treatment is mostly surgical: hysteroscopy and laparoscopy. It is also possible to prescribe hormonal therapy to slow down the progress of the disease.
- Sono-HSG fallopian tube patency test (SIS, salpingohydrosonography, HyCoSy)
- Ultrasound scan
- Pre-gestational testing PGS/PGD
- In Vitro Activation (IVA)
- Medical consultation
- Psychological consultation
- Hormonal tests
- Consultation with an infertility treatment specialist