An abnormal condition where endometrial tissue (inner lining of uterus) starts growing in places outside of the uterus. This abnormal growth of endometrium outside the uterus is also responsive to female sex hormones and this leads to a local bleeding at the time of normal menstruation. This results in an increase in symptoms at the time of menstruation like pain and fatigue. Although usually the endometrial tissue is non-malignant it behaves like a local ‘tumour’ often developing into an ovarian cyst.
Being the finest IVF clinic in Delhi, we know that the most common and serious problem of Endometriosis is Infertility or inability to conceive. This results from the damage caused to the organs where Endometriosis exists like ovaries and fallopian tubes. Apart from direct injury there are several other mechanisms by which Endometriosis causes Infertility. Janini IVF the best IVF Centre in Delhi offers effective, safe and result-oriented approaches to treat Infertility associated with Endometriosis. A firm proponent of evidence-based medicine, renowned and gold medalist FNB Dr. Dalal believes in incorporating latest technology and experience generated over a decade to give you the benefit of advanced reproductive capabilities of IVF and ICSI. Indeed, most if not all patients with Endometriosis will take a baby home for sure.
Endometriosis is quite common - seen in almost 10% of ALL women and almost 30-40% females attending OPD of IVF clinics. Endometriosis is believed to have multi-factorial origin so it requires both some genes and right environmental conditions for it to develop. It has no relation with education, economic status or blood groups. You must have heard of many celebrities like Hillary Clinton or Celina Jaitley or Katrina Kaif also having Endometriosis. Nobody knows the exact cause of Endometriosis, in spite of varied theories formed on its causation, it is called “The enigmatic disease of Gynaecology”.
There are many ways by which this disease impairs fertility potential :
No unfortunately there is no permanent cure but the disease can be kept in control by either surgery or medicines. In surgery we remove all endometriotic patches and disease tissue. If there is an ovarian cyst even that could be removed or aspirated. Medicines that can help include a wide variety like Danazol, Dienogest, Medroxy Progesterone Acetate, DMPA injections, GnRH analogues like Injection Triptorelin, Combined Oral Contraceptive pills and Mirena or Intra-uterine LNG device. Pain killers like NSAIDs are given for controlling pain.
All these medicines only help in controlling the disease, they do not help in conceiving. Indeed, if the primary concern is fertility, then rather than medical treatment one should go for Assisted conception methods like IUI or IVF. What is the most noteworthy fact is that pregnancy itself is a good temporary cure of the disease. For the entire duration of 9 months of pregnancy and also few months of lactation, Endometriosis keeps in control due to the elevated Progesterone hormone in pregnancy. Thus, even though endometriosis causes infertility, once we achieve a pregnancy the endometriosis will subside.
Staging of Endometriosis is done as per the revised AFS (American Fertility Society) classification into 4 stages:
There has been a lot many published articles of good quality in impactful International journals and the evidence is pretty clear in what is advised. For minimal to mild stage of disease with infertility, various treatment models can be recommended depending on the age of the woman, duration of infertility, ovarian reserve and semen parameters. If everything is favourable one can go for IUI in a stimulated cycle. If one comes across mild disease in a laparoscopic procedure it is best recommended to treat the disease in the same sitting.
For moderate and severe disease the best approach is IVF. IVF has far higher success rates than IUI or performing laparoscopy for cyst removal. Even if the cyst is as large as 5-6 cm latest evidence is very strong in advocating that the cyst should be left alone and the couple should go for IVF or ICSI directly WITHOUT GOING FOR A CYST REMOVAL SURGERY.
Dr. Dalal, the best infertility doctor in Delhi, in his extensive experience spanning more than a decade has come across and treated many cases of Endometriosis from India and abroad. He believes that patients of Endometriosis are very commonly advocated to go for surgery unnecessarily and wrongly. Surgery is not only unnecessary it can also be harmful because while removing the cyst some part of ovary is also removed, no matter how good the surgeon is. By doing so there is a further reduction in the egg reserve and ultimately patient has to go for IVF with egg donation treatment. To prevent that from happening, one should consult the right fertility doctor and weigh the pros and cons in determining the best decision for themselves.
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