Endometriosis is a disease caused by the presence of the endometrium (the layer that lines the uterus inside and where the embryo must nest), outside its normal location: in the ovaries, pelvis, etc.
The endometrium is responsible for menstrual bleeding (every 28 days, if it is not nested by an embryo, it is expelled with menstruation); but when it is out of its normal location, it produces small bleeds that give rise to the so-called “chocolate cysts” in the ovaries, as well as inflammatory phenomena (pain), when it is in the pelvis or other locations
It is estimated that up to 10% of women have endometriosis, although only half will have more or less intense symptoms; and between 30 and 50% of them, may present problems when looking for children
(Guide to care for women with endometriosis in the spanish National Health System).
Why is this difficulty in having a baby associated with endometriosis?
It is due to various factors, including:
- Anatomical changes in the pelvis, which may affect the tubes, or the possibility that the tubes pick up the egg after the egg is expelled by the ovary during ovulation.
- Inflammatory changes in the ovaries, which can affect the ovulation process and, even more importantly, the quality of the eggs.
- To this we must add the decrease in the ovarian reserve (in the number of ovules) that this woman will have, for two reasons:
o Loss of ovules due to endometriosis itself, which can injure them, before the moment of ovulation.
o Surgical interventions on the ovaries, fundamentally, to remove endometriotic cysts (“chocolate”), in these interventions it is practically impossible not to take eggs together with the cyst.
Therefore, if you suffer from endometriosis, you should take into account two aspects:
- We must try to diagnose the disease early (sometimes it takes years …), which is not easy, because sometimes there are no symptoms that make the patient go to the gynecologist, while on other occasions the only symptom is pain, without that on ultrasound reveals nothing abnormal.
- Patients and gynecologists, we must take into account possible problems when dealing with motherhood and making decisions.
How can I know if I have endometriosis?
It should be suspected due to clinical symptoms, mainly pelvic pain, related or not to menstruation, pain with sexual intercourse, and menstrual alterations.
Even so, only half of the patients will present typical symptoms, and it will not be easy to identify it, so it is up to the gynecologist to look for exploratory or ultrasound signs in all their patients, whether they have symptoms or not; This will help increase the number of patients diagnosed
If I want to be a mom and I have endometriosis?
We know that fertility decreases in women with endometriosis.
The treatment approach has changed in recent years in young women and / or with maternity wishes; now we advocate a conservative attitude in these patients, with medical treatments to control symptoms (mainly pain), and avoiding surgery as much as possible.
Multiple studies have shown that operating endometriomas (“chocolate cysts”) negatively affects fertility, because no matter how careful the surgeon is and how well the operation goes, a large number of eggs will be lost, and this is critical in fertility, both natural and when IVF is required.
Does endometriosis affect the quality of the eggs?
This is a not very well-known aspect, but we know that endometriosis affects the quality of the ovules in patients with endometriosis and sterility.
Since we do not know well the origin of this loss of quality of the ovules, we do not have any specific treatment to avoid it; But if we can give advice: every woman with endometriosis who is going to delay maternity beyond the age of 30, or who is going to undergo surgery for endometriosis, should consider in conjunction with her gynecologist @, the preservation of fertility.
What is preservation: in obtaining and freezing your own eggs, the younger the better, to use them in the future, in case you had difficulties to get pregnant naturally, which will happen in 1 out of 2 or 3 women with endometriosis.
At HC Fertility we have a team specialized in fertility and endometriosis cases, any questions that may arise, do not hesitate to contact us if this is the case; we like our work and we are at your disposal.
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