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What is adenomyosis, and endometriosis impact on recurrent miscarriages?

Elias Tsakos MD, FRCOG
Medical Director , Embryoclinic

Category:
Endometriosis, Miscarriages and RPL, Reproductive surgery

adenomyosis-Embryoclinic
From this video you will find out:
  • What is endometriosis, how common is it, and what are its main symptoms?
  • What is adenomyosis, and what are its main causes and symptoms?
  • How do endometriosis and adenomyosis affect fertility and miscarriage rate?
  • What treatment options are there? Is surgery always necessary?

What is adenomyosis, and endometriosis impact on recurrent miscarriages?

During this webinar session, Dr Elias Tsakos, a renowned Fertility Expert and Medical Director of Embryoclinic explained the relationship between adenomyosis, endometriosis, and its impact on recurrent miscarriages.

 

The word “endometriosis” originates from Greek, with “endo” meaning inside and “mitriosis” referring to the inner lining of the uterus. This descriptive term characterizes the presence of tissue resembling the uterine lining outside its usual location. Endometriosis has a complex nature, profoundly affecting women’s lives, fertility, and medical interventions.

Endometriosis stands as a significant bridge between fertility surgery and fertility medicine. Dr Tsako’s experience, dating back to the 90s, involves training in both fertility medicine and surgery. While this blend has evolved, endometriosis continues to underscore the interplay between these fields.

Endometriosis and its manifestations

Endometriosis involves tissue resembling the uterine lining appearing outside its normal location. It can manifest in various areas, such as ovaries, ligaments, tubes, uterus wall, and even distant locations like the diaphragm or lungs. This condition leads to inflammation and fibrosis, causing symptoms like pain, bloating, painful periods, painful intercourse, and infertility. Sometimes, endometriosis remains silent, with infertility being the primary indicator.

The complexity of endometriosis

Visualizing endometriosis is akin to observing an iceberg: what’s visible is merely a fraction of what lies beneath. Just like a chameleon adapting to its environment, endometriosis symptoms and appearances can change, posing diagnostic challenges. Another analogy is that of a time bomb—endometriosis may remain undetected for years until it presents with severe symptoms or complications.

Endometriosis is like a chameleon, changing its appearance and symptoms; we must be vigilant and adaptable in our approach.

Adenomyosis: The Uterine Wall Counterpart

Adenomyosis, like the “sibling” of endometriosis, involves tissue growing within the uterine wall muscles. This condition can lead to pain, enlarged uterus, and infertility, and often coexists with endometriosis or fibroids.

Impact on Fertility & Treatment Approaches

Both endometriosis and adenomyosis significantly impact fertility. Lowered implantation rates, fewer oocytes retrieved in IVF, increased multiple pregnancies, and elevated miscarriage rates are notable effects. Understanding these impacts is crucial for fertility management.

Treatment strategies include a combination of fertility treatments, medical interventions, and surgery. Diagnosing accurately is paramount, and vigilance is key, particularly for silent endometriosis cases. Surgical options, including minimally invasive and robotic surgery, play a pivotal role in managing these conditions and improving fertility.

A multidisciplinary approach is pivotal for comprehensive care. Collaboration among various specialists, including gynaecologists, radiologists, and psychologists, is essential for optimal diagnosis and treatment. Robotic surgery emerges as a potent tool in managing complex cases.

Conclusion

Endometriosis poses intricate challenges, but with advancing knowledge and technology, we are better equipped to tackle it. Vigilance, accurate diagnosis, and comprehensive care are crucial for helping women navigate the impact of endometriosis on their fertility journey.

 

- Questions and Answers

was told I had adenomyosis from my scan but then the follow-up scans said that it’s clear there’s no adenomyosis. Is it possible that the diagnosis wasn’t accurate?

I understand your concern. Yes, sometimes the diagnosis from scans might not be 100% accurate. It could be due to the limitations of imaging or very mild disease that resembles normal tissue. A specialized ultrasound scan, such as 3D technology with or without Doppler, could provide a more definitive answer. In your case, I’m hopeful that it might have been a small issue or a misdiagnosis.

How is adenomyosis and endometriosis diagnosed? What are the first steps in identifying these conditions?

The first suspicion arises from symptoms. Symptoms can vary from pain, fatigue, and painful periods to unexplained infertility or miscarriages. Initial evaluation involves a medical history, followed by imaging like standard ultrasounds or advanced ultrasound technology. 3D technology and MRIs can also help, but diagnosis might require further steps like diagnostic laparoscopy.

Are there any preventive measures for women with adenomyosis or endometriosis to reduce the risk of recurrent miscarriages? What strategies can help?

Yes, there are strategies to optimize outcomes. Surgical management to remove inflammation has shown to improve pregnancy rates. Communication and counseling between patients and doctors are crucial. Avoiding over-treatment is important too, as finding the right balance is complex.

Is there a common root cause for recurrent miscarriage and implantation failure in endometriosis? Do these conditions share the same underlying issue?

The connection isn’t always straightforward. Recurrent miscarriage and implantation failure might have different subtle causes, and it’s challenging to directly link them to endometriosis. However, managing endometriosis before conception, whether spontaneously or assisted, could potentially improve pregnancy outcomes.

I’ve had several 3D transvaginal scans, but no adenomyosis was found. Should I consider getting an MRI for a more definitive diagnosis?

Yes, getting an MRI could provide more clarity. If you’ve had doubts despite multiple scans, an MRI with skilled interpretation can offer a better understanding of whether you have adenomyosis or not.

Can antiphospholipid antibodies be more common in endometriosis? Is there a link between these antibodies and endometriosis?

The connection between antiphospholipid antibodies and endometriosis isn’t well-established. While inflammation factors are higher in endometriosis, there’s limited evidence of a direct link between these antibodies and the condition.

Is silent endometriosis a potential cause for recurrent implantation failure? Can this condition go unnoticed but still impact fertility?

Silent endometriosis, which lacks noticeable symptoms, could indeed contribute to infertility and miscarriages. It’s like a hidden issue that might impact fertility without causing noticeable symptoms.

With an AMH of 0.01 and endometriosis, can I still try to conceive naturally at 39 years old, or should I consider egg donation?

While it’s theoretically possible to conceive naturally, the chances are very low due to low AMH and age. You could still attempt it, but considering the low odds and potential time constraints, exploring options like egg donation might offer a more realistic chance of success.

Is conception more likely right after surgery for adenomyosis? Should one wait before trying to conceive after surgery, especially if the condition isn’t severe?

The timing depends on the severity of surgery. If surgery is successful and relatively uncomplicated, the best chance of spontaneous conception is usually within the first six months. For more complex surgeries, it’s advisable to wait for healing before attempting conception.

Can pelvic floor Physical Therapy improve symptoms and quality of life in endometriosis patients?

Definitely, any intervention that improves quality of life is welcome. Pelvic floor Physical Therapy, along with other holistic approaches, can certainly help improve symptoms and overall well-being.

Can Lupron be used for adenomyosis treatment? Are there any potential negative side effects? What other treatments are available?

Lupron can be used, but long-term use might not be ideal due to potential side effects. Treatment for adenomyosis is highly individualized and might involve downregulation before Frozen Embryo Transfer or other options based on factors like severity, location, and symptoms.

Can using DHEA to manage poor ovarian response worsen endometriosis? Is it a safe treatment option?

There’s no strong evidence suggesting DHEA worsens endometriosis. DHEA might be used temporarily before IVF stimulation, and it’s considered safe for that purpose.

I’m 46 with low AMH and possible adenomyosis. Considering donor eggs, can I still try IVF with my own eggs?

While the chances are very low, you can try IVF with your own eggs if you wish. The decision depends on your preferences, partner’s input, and clinic recommendations. Remember, the success rate is significantly higher with donor eggs at your age.

Can silent adenomyosis be diagnosed even if it’s not visible? What options are available to diagnose it?

Diagnosis of silent adenomyosis can be challenging. High-quality scans and possibly a laparoscopy might be necessary for a definitive diagnosis.
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Authors
Elias Tsakos MD, FRCOG

Elias Tsakos MD, FRCOG

Dr Elias Tsakos, FRCOG, is a Medical Director of Embryoclinic - Assisted Reproduction Clinic in Thessaloniki, Greece. He has received extensive and certified training in the United Kingdom and is a Fellow of the Royal College of Obstetrics & Gynaecology. Dr Tsakos is also a Board Member Representative of the Royal College for Greece and Cyprus and a Board Member of the Hellenic Society of Assisted Reproduction. He is a Member of the British, European and American Fertility Societies (BFS, ESHRE, ASRM). Dr Tsakos has been living and working in Thessaloniki, Greece, since 1999.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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