Endometriosis - IVF? Surgery?
Endometriosis is a disease that causes infertility and pain. The classic definition of this disease: Uterus is the presence of endometrium (the tissue in which the baby is implanted) tissue outside the uterus. Infertility About 50% of women diagnosed with infertility have endometriosis. Medication can reduce post menopausal symptoms, but it does not help infertility. it is not effective in reducing post-menopausal symptoms, but it does not help infertility. Surgical or assisted reproductive treatments are used in the treatment of infertility due to endometriosis.
In the first 12-18 months after the surgical operation, regardless of the level of the disease, the chance of pregnancy with natural ways increases. Surgery is not considered if assisted reproductive treatments (such as IVF treatment) are planned. Today, assisted reproductive treatments are preferred instead of surgical treatment in women diagnosed with infertility due to endometriosis. Surgery should not be the first choice especially if the ovarian reserve is decreased and the woman's age is over 35.
Endometriosis can cause infertility by three mechanisms. Firstly, it causes an inflammatory reaction in the abdomen and prevents the sperm and egg from joining naturally. The second mechanism disrupts the natural anatomy with intra-abdominal adhesions and makes it difficult for the egg to be retained by the tubes. Thirdly, it can form chocolate cysts in the ovaries and surgery to remove the cyst reduces the ovarian reserve. Even if it does not form cysts, it reduces the chance of pregnancy by decreasing egg quality. Apart from these basic mechanisms, LUF cysts can cause infertility by leading to progesterone resistance, luteal phase defects, adverse effects on sperm, anti-endometrial antibodies and impaired tubal movement.
Women under 35 with endometriosis have a 50% higher infertility rate. Although the exact cause of the disease is still unclear, the most likely cause is menstrual bleeding from the tubes into the intra-abdominal cavity (retrograde menstruation).
The diagnosis of this disease is made through surgical biopsy of the lesions. Diagnostic laparoscopy operations are not routinely performed today simply to make a diagnosis. Persistent severe pain in the groin during menstrual periods and during sexual intercourse leads one to suspect the disease.
The severity of the disease may vary. It can progress from intra-abdominal punctate lesions to extremely dense adhesions surrounding the entire pelvic region (frozen pelvis). As the level of disease progresses, spontaneous pregnancy rates decrease, but there is no clear relationship between the level of disease and infertility rates. About 50% of women with mild to moderate disease can conceive naturally. About 25% of women with moderate disease can conceive naturally, while a small number of patients can conceive naturally despite severe disease.
Interestingly, superficial clefts on the abdominal membranes are associated with infertility more often than choracic cysts and deep-seated endometriosis. If egg quality is affected by endometriosis, this can be resolved by egg donation treatment. Very low egg quality due to endometriosis may prevent the patient from conceiving with her own eggs. The success of pregnancy in IVF treatments with egg donation in Cyprus is not different from the treatments applied for other causes of infertility. Current research on donor eggs worldwide has shown that the use of donor eggs solves the issue of implantation in patients with endometriosis and that the disease does not significantly affect the uterine wall.