ENDOMETRIOSIS

Endometriosis is extremely common. It affects 1 in 9 Australian women and is even more common in women suffering infertility.

Some women with endometriosis suffer crippling pain with their periods, but for others it can be silent. Nobody yet understands why this is the case – not even the experts – but for some women, the presenting symptom of endometriosis can be infertility.

Yes, as not all women with endometriosis suffer primary infertility. Endometriosis is a condition that worsens over time and can be a cause of secondary infertility (the inability to conceive a child naturally after having had a baby before).

Endometriosis is an inflammatory condition where abnormal tissue that looks and behaves like the endometrium (lining of the womb) grows inappropriately elsewhere around the body.

Endometriosis most commonly affects the peritoneum (inner soft lining of the internal pelvis) but can also cause surface disease and chocolate cysts on the ovaries (endometriomas). It can also result in hard, scar-like nodules on the bladder, rectum and bowel, pelvic ligaments and even on distant tissues like the diaphragm muscle and pleura (lining of the lungs).

This is why some women with endometriosis can suffer chest pain when they have their period.

Yes. Recognising and gently treating endometriosis through her fertility focused and delicate approach to keyhole (laparoscopic) surgery not only allows our team to achieve improved IVF treatment outcomes, but critically it also allows many of our patients to go on to conceive naturally. At the same procedure to excise endometriosis, fallopian tubal flushing is performed to optimise a woman’s chance of achieving natural fertility.

The short answer is – we don’t really know. Experts have studied endometriosis for a long time and have come up with several theories, but ultimately we still don’t know why it happens

Yes, having a relative with endometriosis is a strong risk factor. In fact, if your mother or sister had endometriosis, your risk is seven times greater than the average woman. This fact indicates that our genes play an important role.

Having your first baby later in life increases your risk of developing endometriosis. Experiencing menstrual cycles over and over is a risk factor that can stir up endometriosis and allow disease to progress. That’s why if you have proven endometriosis (found at laparoscopy), or your doctor suspects it based on your symptoms, the oral contraceptive pill might be suggested if you are not actively trying to conceive.

It can, as aggressive surgical management of endometriosis involving the ovary can seriously diminish a woman’s ovarian reserve. If fertility is a current or future priority for you and you’re concerned that you may have endometriosis, seeking care at a CREI Fertility Specialist lead clinic like WHM, lead by Dr Raelia Lew is likely to give you your best outcome.

If you are not trying to have a baby now, “turning off” your menstrual cycle using hormonal medications may be the best way to ensure that your endometriosis does not get worse with time. You may also consider freezing your eggs. If you have serious endometriosis that puts your future fertility at risk, you may be eligible for Medicare subsidised treatment to freeze your eggs

The hormones used in ovarian stimulation for egg freezing (otherwise known as oocyte cryopreservation) can stir up your endometriosis. However if individualised care is provided by a CREI subspecialist, your practitioner will know how to manage the situation both in the short and long-term to optimise your fertility outcomes.

It depends. Where a woman’s anatomy has been surgically normalised and fallopian tubes are working well, we would generally advise women to continue to try conceiving naturally following laparoscopic excision of endometriosis.

If your fallopian tubes are blocked, if you are older (above 35 years), if you have a very low egg count (ovarian reserve) or if there is also a serious and irreversible sperm problem, proceeding directly to IVF may be your best option.

If you have been trying to conceive for 12 months without success, have open (clear) fallopian tubes, normal hormonal blood tests and your partner has a normal sperm test, there is over an 80 per cent chance of diagnosing (and being able to helpfully treat) endometriosis at a laparoscopy assessment.

Having a normal pelvic ultrasound means you probably don’t have stage 3 or 4 endometriosis (a very severe disease causing scarring, nodules, cysts and associated distortion of normal pelvic anatomy). Unfortunately, stage 1 and stage 2 endometriosis are unable to be diagnosed by ultrasound but can still cause infertility.

Endometriosis is a spectrum and symptoms can often be fairly subjective. A challenge to doctors is that some women with endometriosis have a lot of pain with their periods, sex, ovulation and even with normal bladder and bowel function during a period. However other women carry the burden of endometriosis silently and first present for help when they suffer with infertility.

Women whose endometriosis causes pain paradoxically may have better fertility outcomes, as they are more likely to seek help at an earlier stage of their disease.

Many women with endometriosis have been managed on the oral contraceptive pill for a long time, but cease this treatment to try to have a baby. Period pain that worsens progressively over several months of trying is highly suspicious for active endometriosis.

Endometriosis can cause infertility in multiple ways:

● Causing scarring/blockage of the fallopian tubes

● Causing pelvic adhesions which prevent normal ovarian and fallopian tube interaction

● Causing inflammation in the pelvis which can be toxic to eggs, sperm and embryos

● Causing sex to be painful

It is okay to use ibuprofen and paracetamol during your period, but after ovulation, non steroidal anti-inflammatory painkillers should be avoided. This is because they may increase your risk of having a miscarriage.

Maybe not. Studies have demonstrated that specific techniques of ovarian stimulation and embryo transfer achieve the best outcomes for women with endometriosis. Surgical management of endometriosis before IVF and techniques of ultra-long central GnRH agonist down regulation therapy before ovarian stimulation and before embryo transfer may achieve your best chance of success. These techniques require individualisation of care, and are best performed with the involved oversight of your care by a CREI fertility expert like Raelia.