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What Is Endometriosis?
Endometriosis is a relatively common gynecological problem affecting up to 10 percent of women in the US. It has different grades, depending on how severe it is. According to the American Fertility Society Revised Classification of Endometriosis score, it can be minimal, mild, moderate, or severe.
Endometriosis symptoms include heavy menstrual cycles, pain during and after intercourse, bloating, cramping before and during the menstrual cycle, and fatigue. Since many of these symptoms are shared among other conditions, it is common for patients to have undiagnosed endometriosis.
Every person's journey to starting a family is different depending on their unique health situation. If a woman is struggling to get pregnant, endometriosis may be a contributing factor. If this is the case, getting tested for endometriosis is important because it can determine the best fertility treatment for you.
How Does Endometriosis Affect My Fertility?
Endometriosis causes the formation of adhesions inside the uterus. Adhesions are clumps of thick scar tissue that form inside the body in response to injuries or inflammation. With endometriosis, the tissue lining the uterus begins to grow in other places and bleeds in response to the hormonal cycle. In response to this bleeding, adhesions form.
As a result, scar tissue grows on the fallopian tubes, ovaries, and other reproductive organs, limiting how effectively they function. The adhesions distort the pelvic anatomy, making conception harder.
As endometriosis gets more severe, the amount of scar tissue increases. Women with minimal to mild endometriosis may have little difficulty conceiving naturally. However, women with moderate to severe endometriosis will have more trouble. As a woman's age increases, complications from endometriosis compound their lowering fertility rates.
How Does IVF Help?
In vitro fertilization helps women whose anatomy has been damaged or blocked by the progression of endometriosis. Compared to other fertility treatments, this method has a higher success rate.
When performing IVF for patients with endometriosis, it is essential to avoid aspirating the endometrioma cysts during the eff retrieval procedure to minimize chance of infection.
At times, endometriosis can produce chemicals in the lining of the uterus which blocks implantation of the embryo. If this is the case, your doctor can run certain tests and biopsies to check. This process will also help guide the treatment plan as it will check for the presence of the BCL6.
Patients who have a history of implantation failure after one to two embryo transfers with good quality embryos (especially if the embryos have been genetically tested and found normal) should be tested for BCL6.
Should I Have My Ovarian Cyst Removed Before My IVF?
Cysts that are less than five centimeters — and are not growing rapidly — can be left alone unless there is pain or severe discomfort. Removing cysts has its own down sides, especially endometriosis cyst: at times surgery to remove cyst can lead to scar tissue formation, loss of one or both ovaries or decreased (diminished) ovarian reserve because the surgery may move part of the ovary with the cyst which in turn may cause your egg count to go down and decrease chances of pregnancy.
Therefore, it is important to discuss ovarian cysts with your fertility physician and decide if they should be removed based on symptom size and other parameters, such as suspicion for cancer.
Why Should I Get Evaluated for Endometriosis?
Gonadotropin-releasing hormone agonists (GnRHa) have the effect of removing your body's natural ovarian cycle. This lowers the number of canceled cycles in your body and prevents premature egg ovulation. The combination of IVF with the administration of GnRHa increases the pregnancy rates for women with endometriosis-related infertility substantially. The additional treatment usually lasts 60 days and is done right before the IVF procedure. Thus, using special treatments, your doctor can tailor your treatment for the best possible results if you have endometriosis.
Getting evaluated for endometriosis before your fertility treatment is important because it can help you improve your chances of success. By addressing all the potential obstacles before your first IVF, your entire fertility treatment experience will be smoother.