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Chelsea Fertility NYC Blog

Endometriosis Explained

by Chelsea Fertility NYCPosted in InfertilityMay 17th, 2023

Women’s Health Focus on Endometriosis and Fertility: Mechanisms, Options, Choices, and Outcomes

Endometriosis is a disease that has plagued women for centuries. It can only be diagnosed visually by observation in situ (e.g., during surgery). Biopsies of implants can confirm the tissue as being similar to that found in the lining of the uterus. The problem is that this tissue is not in its normal place, i.e., the uterine lining but outside the uterus. It can scar tubes, ovaries, and other pelvic organs, leading to symptoms of severe menstrual cramps, daily pelvic pain, pain during sexual intercourse, and conception delay; it’s even associated with a mild increase in miscarriages.

Treatment Options for Endometriosis

There are two basic approaches to treating endometriosis: medications akin to chemotherapy, or surgery.

For women who don’t immediately want to conceive, you can stop endometriosis from spreading and even have it shrink. Depending on stage and location this can be very effective. It can take months to have an effect and the medications used will stop the normal menstrual cycle, creating what is called a “pseudo-menopause,” which is reversible. Endometriosis is a chronic disease, so it is expected to return and need treatment again. If this doesn’t work well or one decides to be more aggressive, both traditional and laparoscopic surgery are good options. Recovery can be weeks to months and the medications are still recommended post-operatively.

Endometriosis and IVF

For women who are currently trying to conceive or want to get pregnant, it’s best to go directly to in vitro fertilization (IVF). Artificial insemination is generally not comprehensive enough; plus, IVF makes it possible for the embryos to be tested for chromosomal integrity before transfer, thus eliminating other confounding issues that would disrupt pregnancy. The inflammation of endometriosis can be dampened using steroids and baby aspirin to augment possible implantation woes.

IVF also bypasses the need for fallopian tubes in the process of conceiving, which is a known target of endometriosis and its effect on fertility potential. In uncommon cases, one has to pre-treat to eradicate the endometriosis in part with medication or surgery before the IVF attempt. At Chelsea Fertility NYC, this is not our recommendation as a first-line approach. It delays the first attempt which can work and recovery can be long. Also, aggressive surgery can damage the blood supply to the female organs and lead to even more conception problems. So, it is not considered a first step in our clinic. We have forty years of experience in handling these cases and have several strategies that have worked.

Age, Endometriosis, and Fertility Care: What to Consider

A major concern is age. When treating infertility, one is always racing against the clock. Menopause occurs naturally not by depletion of the number of eggs but by the change in quality and performance. A woman is born with her eggs and doesn’t make any more. Over decades they are kept in a dormant state and released only during menstrual cycles after puberty. A fraction of eggs is released over decades and a woman enters menopause still with tens of thousands of eggs in the ovary. Menopause occurs not due to the depletion of egg quantity, but because of changes to the chromosomes therein due to entropy and time, leading to aging effects (telomere shortening) that don’t allow the DNA to function. There is no known treatment for this.

We include the impact of age because this is the ultimate driver in deciding strategy to treat infertility of any kind; whether related or not to endometriosis. Since pre-treatment of endometriosis can take months before IVF can be attempted, this can eliminate one’s chances if it pushes them beyond their fertile window. Having to wait months or longer to start IVF would potentially backfire against using one’s own eggs. You cannot predict this window and therefore must be aggressive. The fight against infertility, age, and endometriosis requires experience and a comprehensive strategy, which we can provide.

For more information, contact Chelsea Fertility NYC or book your free consultation.

Paul R. Gindoff, MD

Chelsea Fertility NYC