A woman goes through a lot of internal changes and complications due to menstruation and pregnancy. Sometimes, there are some problems that make it difficult in terms of fertility. Have you ever heard of Endometriosis? Endometriosis comes from the term endometrium. Endo is inside so endometrium is the inner lining of the uterus. Endometriosis means that this same lining that is inside the uterus is actually the one which is responsible for bringing the monthly cycles as well as for keeping the baby in the womb. So, this inner lining when grown at abnormal places, at aberrant places like on the tubeson the ovaries, probably sometimes in the lungs, in the vagina, on the intestines, all these places, it is then called endometriosis. Onlymyhealth editorial team spoke to Obstetrician and Gynaecologist, Fertility specialist Dr. Shanujeet Kaur, Cloudnine Fertility, Chandigarh, to know everything about Endometriosis and infertility.
What are the impacts of endometriosis on infertility?
Because the endometrium of the uterus has the glands and it responds to hormones and has blood. So, as we bleed every month, because of this endometrium shedding every month, in the same way endometrium which is present outside the uterus in aberrant places like tubes and ovaries, they also react and bleed in the same way. In a way, what happens is that as you're menstruating outside, you're also menstruating inside on tubes and ovaries and that is what leads to collection of blood which we call endometriomas or we have endometriotic spots everywhere so that is what you call endometriosis. The impacts are:
1. Destroys the sperms and environment
So, what this endometriosis does is that since it is blood and glands, it releases a lot of inflammatory negative chemicals which decrease the quality of the gametes of both the eggs and the sperms. Due to this, the whole environment in your abdomen has endometriomas. In a woman suffering from endometriosis, the sperms coming in your tube for fertilization get destroyed, the eggs are anyway growing in the environment of endometriosis so they get destroyed. So, it just spoils the eggs and kills the sperms.
2. Jams the pelvis
The other thing that endometriosis does is that it jams up the pelvis to varying degrees. For some, the pelvis is clear, it is only focussed on a small place, for others the whole pelvis is jammed. So it is graded according to how much jamming it causing to the pelvis. The jamming would mean that the relation between the uterus, the tubes and ovaries which should be perfect, these three ave to be in sync, gets disturbed. As far as the anatomy is concerned, the placement as nature has done it should be perfect. Because of the jamming up, the tubes also do not perform their function, the uterus isn't able to perform well, so it leads to infertility.
Endometriosis and Infertility treatment
Dr. Shanujeet said, "We try to do good surgery avoiding the normal ovaries as much as possible so that you have a decent ovarian reserve so permanent infertility is not so bad." The main treatment methods are:
1. Usually if you get an endometriosis, one has to get a surgery for it and then it recurs. It recurs because as long as you're bleeding and the blood from the endometriotic spots is collecting inside, it will go on. The only way it will stop is when you get pregnant and breast feed so there is relaxation for about 1-2 years or when you finally get menopause. There is no such thing as permanent infertility nowadays. If the tubes are distorted or destroyed, one can actually go for IVF or test tube baby where you don't need the tubes.
2. However, stage 4 endometriosis is actually the jamming of the endometrium when the pouch of Douglas is totally obliterated. It means that tubovarian relation is obliterated. So, the treatment of stage 4 endometriosis apart from surgery if you're unable to conceive it's IVF. In minimal or mild endometriosis, you can conceive either on your own or doctors can give you ovulation induction and IUI to concentrate the gametes or make more eggs.
3. Estrogen is bad for endometriosis. Reversing endometriosis is best done by getting pregnant. Once you conceive, size of endometriosis does not matter because the process is anyway stopped. Some people have stage 4 endometriosis and doesn't hurt at all and some have mild endometriosis and hurts a lot.
4. Sedentary lifestyle, obesity, constipation can add to the pain of endometriosis. More exercise and diet can help with the pain. If you only need symptomatic cure, you can take a pain killer during periods. Otherwise, to avoid surgery, there's a medicine called dinogest, cabagolin, GNRH agonist. But, this is just temporary cure.
These were the impacts of endometriosis on fertility and it's treatment. So basically, infertility is likely because it kills the gametes, spoils the environment, and probably distorts the anatomy also. And, all this happens in different degrees and not everyone suffers so much.
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