Stages of Endometriosis and Infertility
Endometriosis is associated with an increased risk of pregnancy complications, or infertility. Studies have shown that the number of endometriosis seen during laparoscopy is linked to future births.
There is a stage plan to diagnose endometriosis:
- Stage I endometriosis: There are a few small incisions in endometriosis, with no red tissue visible.
- Stage II endometriosis (malignant disease): There are many implants of endometriosis, but they are involved less than 2 inches in the abdomen and no red tissue.
- Stage III endometriosis (moderate disease): There is very little endometriosis in the abdomen that can be deep and can cause packets of endometriotic fluid (chocolate cysts, or endometriomas) in the ovaries. There may be red tissue around the tubes or eggs.
- Stage IV endometriosis: Multiple endometriotic tumors, possibly large endometriotic cyst in the ovaries, potential red tissue between the uterus and rectum (lower intestine), and around the ovaries
Surgical Treatment of Endometriosis and Infertility
Women with Stage I and II endometriosis can become pregnant on their own, however, medical studies show that if laparoscopy is performed on pregnant women, they are more likely to have endometriosis than pregnant women without complications. There is some evidence that pregnancy rates may improve if Phase I or II endometriosis is surgically removed, but other data suggest that this is not helpful. Generally, when women are young (under 35 years of age) it makes sense to remove any visible endometriosis to see if a pregnancy can occur. If women are 35 years of age or older, alternative therapies are recommended instead of laparoscopy (see below). If Stage III or IV endometriosis is present, elevated pregnancy rates after surgery are performed to remove red tissue or large endometriotic cyst. If pregnancy does not occur within six months after surgical treatment of endometriosis, other treatment options should be discussed.
Unfortunately, some women with endometriosis may have recurrent cysts. If the cysts are removed too often, this can cause loss of eggs in the ovaries, and can make it harder to conceive.
Endometriosis Infertility Treatment
Before starting any fertility treatment a thorough birth test is performed. This could include hormone and other blood tests and testing the sperm count of partners. Treatment depends on the patient’s endometriosis stage:
STATEMENT I-II ENDOMETRIOSIS CLOMIPHENE IUI TREATMENT
To improve the chances of pregnancy clomiphene citrate, a fertility drug, is given 5 days after the onset of menstruation. When an egg is released from the ovary (ovulation), the male partner produces a sample of sperm by masturbating in a sterile cup. Sperm is brought to a laboratory and processed. The woman then entered the office at the time of which she released the eggs so that the sperm could be inserted into her uterus through a small tube. This was done during the speculum test and it sounds similar to a Pap test. The chances of having a baby with a single treatment for clomiphene / IUI are about 10% for women under 40 years of age.
If this treatment is unsuccessful after three months or more, the next step is 1) the use of IUDI-free placebo, or 2) in vitro fertilization.
SECTION III-IV ENDOMETRIOSIS
If pregnancy does not occur within 6 to 12 months after surgical treatment of moderate to severe endometriosis, in vitro pregnancy is usually recommended. In some cases the fallopian tubes are found to be blocked, and / or the red tissue is very hard. In some cases your doctor may recommend that you go directly to in vitro fertilization treatment.
IN-VITRO CLOSING (IVF)
Before you start this treatment, your doctor will tell you about the chances of in vitro pregnancy working for you, depending on your age and hormone test.
This treatment requires the woman to take small injections of birth control pills which cause many eggs to grow in the ovaries inside the fluid packs called follicles. These cords are screened for blood tests and ultrasound. When the follicles are of a certain size, the eggs are not ready to be released from the ovaries. This is done under simple sleeping pills (anesthesia). Using an ultrasound-guided needle, and passing through the wall of the vagina to the ovaries, the mature eggs are removed. This process takes about 10 minutes. The eggs are then placed in sperm containers in the reproductive laboratory. Most will fertilize and grow into embryos. A few days after the eggs are removed from the uterus the woman returns to the fertility clinic and implants a few embryos in the uterus through a small tube, in the cervix, during a speculum test. This feeling is similar to Pap testing. The chances of pregnancy from a single in vitro fertilization trial range from 50% or more to women in their 20s, to only 10% to women in their 40s.