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This section is written in partnership with UR Vistahermosa experts from Spain.

Endometriosis

The disease that can compromise female fertility

Endometriosis is a benign but chronic problem. Endometriosis is when the endometrium, which is the layer of tissue that covers the uterine cavity, appears and grows outside the uterus, which affects the female reproductive capacity. It is the innermost tissue and it should only and exclusively be located in the uterus. Although it is most frequently found in the ovaries, it can also adhere to the fallopian tubes, even the bladder or the intestines. This unusual growth might lead to the irritation of the surrounding structures, which causes pain and adherences that cause scar tissue in them.

The therapeutic approach and management of endometriosis affecting women is significantly different depending on whether the objective of the treatment is to alleviate the pain or deal with infertility problems. Hormone therapy and radical surgery might be a good option to treat pain, although these strategies often make it more difficult to conceive, seeing as fertility treatments are based on the maximum preservation of the ovarian function, which is frequently an obstacle for pain treatment.

Women who suspect they have endometriosis or have been diagnosed with it, should seek advice from their gynecologist about the implicit risks of this disease with regards to their current or future desires to be become mothers. The clinical symptoms of this disease can vary a lot, some women are asymptomatic, and others require surgical intervention to remove the endometrial tissue and peritoneal adhesions. Moreover, there are four stages of the disease, the first is minimal and the fourth is severe.

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Assisted reproduction techniques to conceive

At the moment, in reproductive medicine, there is no consensus on how to deal with infertility in women who are affected by this disease. In general, if the disease is in the minimum or mild stage (stage I or even II) and the patient is young, artificial insemination or simply ovarian stimulation can be used. However, when the disease is more invasive and affects the fallopian tubes, the most suitable technique that has the highest chances of conceiving, is in vitro fertilization.

When the endometriosis is very severe (III or IV) and access to the ovaries by ovarian puncture is impossible due to multiple adherences, or if the ovarian reserve is very low, ova from a donor will have to be used to conceive, therefore egg donation fertility treatment is required.

For all these reasons, if you have this disease it is best to visit a specialist to address each case personally and assess what sort of intervention is more favorable to achieve pregnancy depending on the state of the endometriosis, the patient’s symptoms and her age. Laparoscopic surgery is an appropriate option for severe endometriosis, since it offers great possibilities of pregnancy in these patients.

Article source:
This article has been published in Creando Familias magazine by UR Vistahermosa clinic from Spain.

Dr. Valeria Sotelo
Dr. Valeria Sotelo
Gynecologist, UR HLA Vistahermosa

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