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Endometriosis is a common gynecological disease for women, which may cause infertility. Despite it’s frequency, diagnosis is often delayed and the disease is usually found  only at an infertility clinic.

Endometriosis is a common disease for fertile women, with approximately 10-15 % prevalence. A typical symptom of the disease is lower abdominal pain before and after the period. Pain may also occur during urination, defecation, or intercourse. Additionally, menstrual cycle disturbances are possible. The symptoms, their intensity, and where the pain occurs, vary from patient to patient. Some patients have no symptoms at all.

The pain and other symptoms of endometriosis are due to uterine mucosal like tissue in places where it should not be present. The tissue can typically be found in the Fallopian tubes, ovaries or on the surface of the rectum or bladder. The more prevalent the endometriosis and the deeper the tissue is ingrained, the more complicated the symptoms usually are.

– During the period the tissue behaves like the endometrium of the uterus typically behaves. The uterine mucosa thickens as it gets ready for a possible pregnancy. If fertilization of an egg or further implantation of an embryo does not take place, the mucous membrane exits the body as menstrual blood, says Nova Vita`s infertility doctor Liisa Viirmaa.

– However, in case of endometriosis, the blood does not get out, which causes chronic inflammation of the tissues next to the endometriosis. This may lead to scarring and adhesion.

The reason for endometriosis is not fully understood. It is estimated that mucosal cells travel through the Fallopian tubes to other parts of the body and attach themselves therein. This leads to the formation of the tissue. It is also possible that the formation of the tissue is facilitated by a poorly functioning immunal defense, in which case the defense system fails to remove the excess tissue. However, there is no certainty regarding  the role of the immunal defense system in causing the disease.

Women with a severe form of the disease often need infertility treatments to get pregnant

Endometriosis can cause infertility in many different ways. Scarring and adhesion may, for example block the Fallopian tubes, in which case the fertilization of an egg, which normally takes place in one of the tubes, does not occur. Endometriosis in ovaries, in turn, block normal ovulation. Inflammatory molecules are also known to interfere with functioning of both sperm and ova.

– The more severe the disease, the more likely it is that there will be difficulties in getting pregnant. While pregnancy is possible, at least women with severe endometriosis often need infertility treatments. Women suffering from less severe forms of the disease can also get pregnant spontaneously.

Dr Viirmaa says that the diagnosis for endometriosis is, unfortunately, often delayed and that the disease is usually found at an infertility clinic. One reason for this is that many women think dysmenorrhoea are a normal part of a woman’s life, and it does not occur to them that the pain might actually be caused by a disease. Viirmaa emphasizes that severe pain should never be considered normal. If a woman struggles with menstrual pains or any other unusual symptoms, she should always book an appointment for a gynecologist. The cause of the symptoms must further be thoroughly examined.

-With the help of an early diagnosis and subsequent treatment, it is possible to slow down the progression of endometriosis, thereby increasing the likelihood of pregnancy (please correct if this is wrong information!!). A timely diagnosis can also help in family planning.

What kind of help is available?

Women with endometriosis and infertility problems can receive help via several different infertility treatments. At Nova Vita infertility clinic, each patient’s specific treatment needs are always reviewed individually.

– As a matter of fact, all treatment methods from ovulation induction to IVF, ICSI and donated gametes may come into question, depending on the patient and her unique situation. Ovulation induction combined with insemination often brings good results for women with mild endometriosis, according to Dr Viirmaa.

– In more severe cases laparoscopy may be needed. During the procedure, the endometriosis is removed, which increases the likelihood of pregnancy. Usually the pains will also ease. Unfortunately, endometriosis quite often recurs after the surgery, Dr Viirmaasays.

According to the latest research, the IVF treatment results of patients who have endometriosis do not differ from those of other infertility patients (please correct if this is wrong information!!). In the end, many women with endometriosis will have the baby they have hoped for.

If you suffer from dysmenorrhoea or have some other abnormal gynecological symptoms, book an appointment with one of our experienced gynecologist. At Nova Vita infertility clinic, your situation will be examined thoroughly, and if endometriosis is suspected, you will be directed to further examinations and proper treatments if needed. If you are not planning to have a baby at the time of diagnosis, social egg freezing might be a suitable option for you. According to your wishes, a Fertility Check-Up may also be added to your gynecological examination. The Check-Up enables us to give an even better evaluation of the state of your fertility.

If you are hoping for a baby and receive an endometriosis diagnosis, infertility treatments can be started immediately, should the pregnancy not start spontaneously. On the other hand, if you or you and your partner, have tried to get pregnant already for some time without success, treatment can be started right away. Please do not hesitate to contact us either by calling +372 6 059 609 or by email novavita@novavita.ee . We are happy to help.

 

Text by: Anna-Maija Kakkonen

Keywords: endometriosis, infertility, IVF, getting pregnant.

Sources:

Endometrioosiyhdistys. Mitä endometrioosi on? (http://www.endometrioosiyhdistys.fi/fi/tietoaendometrioosista). Luettu 29.3.2019.

Härkki Päivi, Heikinheimo Oskari, Tiitinen Aila. 2015. Endometrioosi ei tarkoita lapsettomuutta. Potilaan Lääkärilehti.

Härkki Päivi, Heikkinen Anna-Mari, Setälä Marjaleena. 2011. Endometrioosin nykyhoito. Lääketieteellinen aikakauskirja Duodecim 2011;127(17):1837-47.

Tiitinen Aila. 2018. Endometrioosi. Lääkärikirja Duodecim.

WebMD Medical Reference. Endometriosis. Reviewed by Nivin Todd, MD on Feb 12, 2019.