Painful menses, cramps, and heavy bleeding are common stories for many women and they may have a dozen different causes. They remain a puzzle to understand, diagnose & treat because not only are women reluctant to come to the doctor with these issues but they are brought up on the firm belief that these monthly periods have to be lived with. However, Endometriosis is a different ball game altogether. The pain can destroy your personal life, it lasts well beyond the menstrual cycle and is immune to medication. It may also delay pregnancy, make it more complicated and can progress toward infertility.
In fact, you can consider yourself lucky that you have been actually diagnosed as having Endometriosis because the only definitive diagnostic test is Diagnostic Laparoscopy.
Can you imagine, a diagnostic surgery simply to confirm the presence of endometriosis? Yes, there is no other test for a definitive diagnosis and it is up to the expertise of the Gynaecologist to recognise the symptoms and recommend a diagnostic Laparoscopy. It is quite another issue that most patients may reject this recommendation outright unless the suffering is too severe to bear.
No wonder, 30-50 % of the patients diagnosed with endometriosis often have had a struggling journey of infertility. This condition often remains underdiagnosed unless a couple faces issues in getting pregnant.
The real concern is that the couple is trying desperately for pregnancy and visits the gynaecologist only to find out that the cause is an incurable condition called ‘endometriosis’.
Endometriosis is a condition wherein the cells of the linings of the uterus are found outside the uterus, on other organs like the ovaries, fallopian tubes, or elsewhere in the body like the kidney, bladder or intestine.
How long does endometriosis last?
Endometriosis feeds on estrogen, so endometriosis starts as early as the 1st period, lasting beyond menopause in severe cases, in about 30% of the cases. The only indication is failure to conceive. Silent or milder endometriosis has no symptoms. The control over the symptoms is one part and controlling the endometriosis is another side of the story and that’s why there are foundations of endometriosis in the world to address this concern.
How much is the burden of endometriosis for Pregnancy?
Let’s understand first, that endometriosis is inflammation of the endometrium, the lining of uterine cells. Inflammation is reddening, ballooning& swelling of linings, due to which, eggs may have a problem travelling from ovaries through fallopian tubes to the uterus.
There is scarring of tissues as the lining is disturbed. Eggs may get lodged and may not move. Fertility issues with endometriosis, often start with ovaries & fallopian tubes. While passing these barriers to fertilisation, women with endometriosis have potentially higher rates of miscarriage Preterm deliveries, Pre-eclampsia, and Caesarean deliveries.
So, what to treat first? Endometriosis or fertility issues
The simple answer is, that it depends on the severity of the conditions, health records of the women, age, etc. It is highly patient-specific & getting consultation from the experts is a must, as surgical removal through laparoscopy is a super speciality surgery and a lot can depend on the skills & expertise of the operating gynaecological.
Endometriosis diagnosis is the key to treatment,
Timely treatment of endometriosis not only improves the success rate of IVF but also helps in natural conception.
The cell growth as well as lesions (scarring of tubes) often leads to the delay or difficulty in travelling or implantation of embryos. The severity of endometriosis matters the most in the success of IVF. The gold standard investigation for endometriosis is surgical laparoscopy and biopsy. If pain is not controlled with simple analgesia or the diagnosis is suspected in a woman who is actively trying to conceive, referral should be considered. Early referral should be considered in women with abnormal examination findings,
A Myth attached to this situation is, that pregnancy can cure endometriosis.
Simple answer, it is incorrect. No pregnancy can cure endometriosis. The symptoms and severity may decrease due to pregnancy or lactation because of hormonal changes, but the scarring and pregnancy may further cause problems in the journey of parenthood.
Can IVF be successful with endometriosis?
If you have been diagnosed with endometriosis and want to start a family, IVF is a good option & the best solution too.
IVF success depends on women’s age, quality of eggs & sperms, medical history of the couple, lifestyle & stress, and Severity of Endometriosis etc. A special precautionary measure, if taken can increase the success of IVF. There are instances, seen & studied which say, the impact of endometriosis on IVF Success is on various stages with Poor implantation, low egg retrieval, quality of eggs etc.
Let’s know the facts about endometriosis & fertility.
Endometriosis is a common Gynaecological concern, which does not cause necessarily infertility or pain. Mild endometriosis is common & one will not have any problem in natural conception. As the severity increases, adhesions are the main concern & chances of natural conception are lowered.
What, if you decide to be silent on silent endometriosis?
The simple answer is, delay in diagnosis is because of symptoms which may be mild or seen as normal period pain. You can maintain the silence but silent endometriosis may not. It worsens over time & the growth of such unwanted cells multiply and can cause future complications.
Does medical treatment endometriosis?
Drug treatment for endometriosis does not improve fertility either during or after the treatment. It is documented for pain relief or preparation for surgery. It does offer symptomatic relief to the patient.
Does surgical treatment for endometriosis improve the chances of pregnancy?
It is well known & documented fact that surgical removal of such unwanted tissues with precision & accuracy, definitely improves fertility & reduces pain. The Surgical treatment is more valuable than diagnostic laparoscopy (look & see).
Laparoscopic Surgery is often hailed as the gold standard in case of endometriosis and expertise in doing so, is a branch of super speciality. We @Pearl Women’s Hospital & Yash IVF have excellence in endometriosis treatment and is situated at the central location of Deccan, Pune.
Dr. Chaitanya Ganapule is an expert in Laparoscopic surgery Removal of such tissues or fibroids or Polyps, is his forte and he is considered one of the top Gynaecologists for this procedure.
A reputed Laparoscopic and Hysteroscopic surgeon, Dr. Chaitanya Ganapule has been trained at some of the best centers in France and Germany. He has a diploma in Pelvic Endoscopy from Kiel University, Germany, and A Diploma in Gynec Endoscopy from the University of Clermont – Ferrand, France. He has recently attended & completed the “Indian Workshop of the Franco-European Multidisciplinary Endometriosis Institute in France, in 2022. We are happy to offer our special ’EndometrioCEASE’ solutions to patients who wish to get rid of pain, restrictions and infertility.