Learn about endometriosis as a common pregnancy related issue and ways to overcome its effects

Endometriosis is very complex disease which creates difficulties in pregnancy, but it doesn’t mean that it is reason not to have the child.

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What is Endometriosis?
Endometriosis is an abnormal growth pattern of endometrial tissue similar to which lines in the interior of the uterus, but in a location outside of the uterus of the women. Endometrial tissue is shed every month during menstruation cycles. Areas of endometrial tissue found in ectopic locations are called endometrial implants. These are most commonly found on the ovaries, the fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity (i.e. the peritoneum). They are less commonly found in the vagina, cervix, and bladder. Rarely, endometriosis can occur outside the pelvis. Endometriosis has been also reported in the liver, brain, lung, and old surgical scars. Endometrial implants, while they may become problematic, are usually benign (i.e. non-cancerous).

This disease is unlike any other. With it, a tissue almost identical to the endometrium, appears in a place not typical for itself. Note that the only typical place for the endometrium is the uterine cavity.
The most widely known variety of endometriosis is the external genital.With it, this malignant endometrioid tissue is located in the small pelvis on the peritoneum, on the intestine, on the ligaments, on the ovaries, well, in general, on everything that is in the small pelvis. It can be found only through laparoscopy, it is possible to suspect, in neglected cases, on ultrasound. Sometimes it can be a main cause of infertility.

Another, less well known, endometriosis is internal.With it, the above tissue is located inside the uterine muscle (not inside the uterus, but permeates the wall of the uterus). And the wall of the uterus becomes like a sponge, the cells of which are endometrioid heterotopia. It is called internal endometriosis, in another way, adenomyosis. It can also be the cause of infertility, but only in much neglected cases and more often in combination with a thin endometrium. Here adenomyosis is already quite clearly visible on ultrasound, but for the final confirmation of the diagnosis a hysteroscopy is necessary.

No kind of endometriosis is a contraindication to IVF.
What to do with it? It depends on your plans. I'll explain better by examples. If you have suffered infertility for 2 years and you are young and after laparoscopy, external genital endometriosis and endometrioid cyst are confirmed, then you need: first option - burn foci, remove cyst and try to become pregnant during at least 6 months in the natural way and if pregnancy does not occur then proceed with IVF.

The second option is to cauterize the foci and be treated with buserelin (or another GnRH agonist) for 4-6 months, then try to get pregnant during at least 6 months. If pregnancy does not occur, do IVF.

If you are 35 years old, then the second option is unacceptable. If pregnancy does not interest you, but you are concerned about pain and profuse menstruation you can treat endometriosis with hormonal medications. Treatment options for infertility associated with endometriosis vary from case to case but most fertility specialists believe that surgery is preferable to pharmacological treatment for endometriosis.

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Written by;
Dr. Nataly Yakovleva
Pons Medical Research