Endometriosis is an illness that, apart from causing great discomfort to the sufferers, is one of the main causes of infertility during reproductive age.
It is estimated that it is suffered by 14 million women in the EU and by 176 million women all over the world.
We asked IVF Spain to explain in detail about how this illness works, how it affects female fertility, and what options are available to women who suffer from it and want to become a parent.
How does endometriosis work and how does it affect women who suffer from it?
The endometrium is a layer of cells that, during each menstrual cycle, lines the uterus in order to hold the embryo in case of pregnancy. If a pregnancy is not produced, this layer detaches giving way to menstruation.
In women with endometriosis, endometrial tissue is found outside of its normal location, that is, outside of the uterus. It can be found in the ovaries, fallopian tubes, bladder and even in the intestines.
Most women who suffer from endometriosis are not even aware of it as their main symptoms – pelvic or abdominal pain and heavy periods – are considered normal. For this reason it’s also known as “the silent illness”.
This illness affects the quality of life of the patient in various forms. This can be from crippling pains during menstruation, or discomfort during sexual intercourse, to difficulties achieving a natural pregnancy.
What affect does endometriosis have on female fertility?
Infertility and endometriosis go together on many occasions. It is calculated that it reduces by half the chances of achieving pregnancy of a woman in fertile age and that approximately a third of the patients presenting infertility have endometriosis. Depending on the sequels, the location and the degree of the disease, it can affect female fertility in different ways. Scarring of the fallopian tubes or ovaries, toxicity of the sperm or egg cells, endometrial alterations that affect the embryo’s implantation, hormonal imbalances that decrease the egg quality.
Due to all of the above it is fundamental to get an early diagnosis to prevent women from engaging in such emotional and financial upset in their pursuit to become pregnant.
What options does a woman with endometriosis have to become pregnant?
There are different approaches to fertility treatment after this diagnosis. In many cases, a standard hormonal protocol is applied, ignoring the patient’s endometriosis, followed by consecutive embryo transfers (since the statistic probability of achieving pregnancy increases with every transfer).
At IVF Spain we advise against this practice, and firmly believe in the development of carefully planned, personalised and patient-adapted strategy.
With this we make use of cutting edge technology in assisted reproduction to diagnose and, if necessary, treat all the factors that can have an impact on fertility and that may hinder the wished-for pregnancy, so that the patient needs the minimum possible amount of embryo transfers to achieve it.
Additionally, we perform two studies on the patient – an endometrial immunology test, that allows us to modulate the immune response should it interfere with the embryo, and an endometrial receptivity test, with the aim of transferring the embryo exactly when the uterus is most receptive. These practices contribute to placing us among the best fertility clinics in the world.
Is there a treatment for or a vaccine against this illness?
Unfortunately, it is not curable. It is a chronic disease although, with proper treatment, some of its worst effects, such as infertility and awful pain, can be avoided or mitigated.
The medical approach and handling of patients with endometriosis is radically different if the aim is to treat pain or to address infertility. For pain treatment, hormonal therapies and surgery can be a good option, but the downside is that these strategies usually hinder the achievement of pregnancy. On the other hand, fertility treatments are based on the maximum possible conservation of the ovarian function, and thus it is frequently an obstacle for the treatment of endometriosis.
What is your advice to all those women that suffer from endometriosis and wish to become pregnant?
First and foremost is to have a correct diagnosis of the disease, because very few advances have been made in the past decades on the knowledge about its origin and causes.
Endometriosis is a very frequent but ignored illness
As the problem is inside the body, many women suffer from it but remain unaware. The diagnosis is complicated because it normally requires a surgical procedure to visualise the ectopic endometrial tissue.
Nowadays the diagnosis for endometriosis has improved though. In the past, pelvic lesions were sometimes diagnosed as the cause of issues with endometriosis not even considered, however, we now know that these lesions in fact can indeed be caused by the disease. There has also been a great technological improvement that allows us to observe, under the microscope, the tissues extracted during surgery. From this we can find typical endometriosis lesions that would go unnoticed to the naked eye.
It’s great news that reproductive medicine can now help women suffering from endometriosis, offering high success rates in resolving this fertility issue.
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