Newly married Ms. Chandana Sharma received the disappointing news that she would not be able to conceive naturally. At 33, she is healthy and does not have any history of fertility problems beyond a painful period is one of the leading symptoms. Endometriosis is the leading cause of infertility in women, a fact that drives many to pursue in-vitro fertilization. Research has found that infertility affects around 30–50 percent of women with endometriosis. It is a fact that endometriotic women who have undergone IVF have a lesser success rate as compared to their peers who are undergoing IVF for other indications. But in many cases, they do successfully conceive, carry and deliver a healthy baby.
Endometriosis begins right from a young age and as it is a progressive disease, signs and symptoms keep worsening throughout the women's reproductive life. Besides excruciating pelvic pain and infertility, other symptoms include:
- pain during sex
- pain with ovulation
- frequent urination
- low back pain
- painful bowel movements
- constipation or diarrhea
The link between endometriosis and infertility
As discussed above, infertility is one of the most common symptoms of endometriosis. According to a report published in 2017, endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35–50% . About 25 to 50% of infertile women have endometriosis, and 30% to 50% of women with endometriosis are infertile. However, the awareness towards this condition in India is very low. Unfortunately, some women come to know about it when they experience difficulty getting pregnant. Various researches are still on to find the exact reason behind why women with endometriosis are infertile.
Some unproved theories say:
- Inflammation causes the production of chemicals known as cytokines. These cytokines can inhibit the sperm and egg cells, making fertilization more difficult.
- Scarring and adhesions that occur with endometriosis can block the fallopian tubes or uterus, making it difficult for the sperm to meet the egg.
- Endometrial tissue on the ovaries can inhibit ovulation, preventing the release of an egg.
Is IVF treatment safe for endometriotic woman?
Yes, in experienced hand, IVF treatment is definitely safe for endometriotic women. Some clinicians prefer to take out endometriotic cyst from the ovary prior to taking up for IVF, this could be the double edge sword because the ovarian reserve of the patient can go down after the surgery. Hence most clinicians go ahead with IVF and ICSI(Intracytoplasmic Sperm Injection) without removal of the endometriotic cyst.
Even a 2011 study published in Human Reproduction used ultrasounds and questionnaires from women with endometriosis who received IVF to explore if the procedure had any effect on their disease. The study concluded that IVF does not expose women to a consistent risk of endometriosis-related symptom progression. However, experts suggest that ultrasounds are not the best way to diagnose and track endometriosis. The progression needs to be determined via laparoscopywhichin the present date is a gold standard form of investigation to diagnose endometriosis.
(By Dr.Aswati Nair, Fertility Consultant, Nova IVF)