What are my options when I have been diagnosed with endometriosis?

Jana Bechthold, Dr.
Fertility Specialist at Clinica Tambre, Clinica Tambre

Category:
Endometriosis

Endometriosis and your options
From this video you will find out:
  • What is endometriosis? What are the causes?
  • How to notice and diagnose endometriosis? What are the symptoms?
  • Does endometriosis affect fertility?
  • What are the methods of treatment: surgical vs. conservative?
  • What are the fertility options for women suffering from endometriosis?
  • How to improve endometrial receptivity?
  • Does endometriosis affect pregnancy?
     

Endometriosis and infertility - what are my options?

Watch the webinar with Dr. Jana Bechthold, gynecologist, fertility specialist at Clinica Tambre, Spain, in which she talked about endometriosis and how it affects fertility. Dr. Bechthold also discussed patients’ options of IVF treatment.

Endometriosis and infertility - what are my options? - Questions and Answers

I am 33. I was diagnosed with endometriosis in July 2018 when I had a laparoscopy. I was taking GnRH injections for 3 months, in 2018. In January 2019, I started IVF. Ovum pick up and the embryo transfer was done, in Feb. (18 eggs retrieved. 12 blastocyst Day-3 embryos developed. 3 embryos transferred). After this, I had 3 more transfers using the frozen embryos – unsuccessful implantation. During recent MRI and hysteroscopy, endometriosis is still seen. The recommendation of the new doctor was to start IVF. Once ovum pick up is done, treatment for endometriosis is advised for 3-4 months (GnRH /Zoladex or equivalent to be used). After this treatment, the embryo transfer will be done. Only frozen embryos to be used. Is it advisable to take GNRH again? What other cure can be suggested for endometriosis?

Regarding GnRH, it depends on the stage of your endometriosis. We know that the implantation of the embryo is decreased in patients with endometriosis. Sometimes, we use the GnRH to down-regulate the ovaries, so we know that with that, we can improve the implantation rates. I think it would be recommendable to use it and you have to use it for 3 months, maybe 4 months, it’s not necessary, but it can improve the cycle or the transfer if you use it for 3 months. There is no such thing as a cure, if you suffer and have a lot of symptoms, it’s possible to do an operation, but if you want to get pregnant, it’s also risky. We could remove too much ovary tissue, so normally, we do not recommend surgery before getting pregnant. The only thing we can do is to give some birth control pills Gynogest or also a Progesterone called Gynogest t like the mini pill and you would take it just without any break, so you would not do the 21/ 7 cycle with the pills, you would just take it straight through. You will not cure the endometriosis, but you can get rid of the symptoms, and it would not get worse, let’s say. You can live with that, and many patients live well with that taking that medication.

Does GnRH injection have long term side effects? I had taken the birth control pills during 1 cycle, but unfortunately, the transfer didn’t work.

If you take it for like 3 months, it should not have long term side effects. What GnRH more or less does is putting you in a menopause status, so it just stops the ovarian function, so of course, if you would take GnRH for a long time, you would be in a pre-menopause that can have effects that we don’t want in young women or women before menopause. If you take it for like 3 months, there shouldn’t be any problem.

Is endometriosis the same as fibroids?

No, it’s not the same. Fibroids are called little tumors, it’s not a bad thing, it’s like benign. Endometriosis is derived from the word endometrium. Endometrium, so the inner tissue of the uterus that can be found outside of the womb, so it’s not the same.

I have adenomyosis, is there any treatment for this?

Adenomyosis is a bit similar to endometriosis. It’s just inside the uterus, so inside the uterus wall. The treatment would be very similar to endometriosis. We would use birth control pills or for example, if we do an embryo transfer in patients with adenomyosis, we recommend doing the down-regulation for 3 months, before having the transfer. More or less, it’s the same treatment.

I have endometriosis in my ovaries, low AMH, and thin endometrial lining 3mm – currently on an estrogen course of 3 months. Is there anything I can do to improve my egg quality? I have just had an operation to remove my septate uterus and have a coil to keep my uterus in shape. Is IVF or ICSI my option?

Unfortunately, there’s not much we can do to improve egg quality. We know, that patients with endometriosis sometimes suffer from poor egg quality, so it’s important to have endometriosis controlled. As I said, it’s not necessary to do an operation, but try to avoid having regular cycles, so with that, maybe we can improve a bit your egg quality. I think that IVF or ICSI would be the option, so if we’re talking about low ovarian reserve, insemination would not make any sense depending on how low, the AMH would be. The option would be IVF, ICSI, or even if it’s really low, and the ovarian reserve is really low, my suggestions would be to go for an egg donation. Normally, IVF or ICSI would be the option.

Is it advisable to down-regulate even though you used donor eggs, and if so, for how long? Also, 1 of my tubes is blocked due to endometriosis and is swollen. Should that be removed before embryo transfer, and should I do the ERA, ALICE, EMMA test?

Yes, if your tube is blocked and swollen, so if it’s filled with liquid, we recommend doing an operation before because if it’s filled with liquid, this liquid can enter the uterus when the embryo wants to implant, and that can be kind of toxic for the embryo. In this case, the recommendation would be to have surgery and remove one tube that is blocked and swollen.

When it comes to down-regulation, we do not recommend it for all patients with endometriosis, it depends a bit on the stage of the endometriosis. As I’ve said, with adenomyosis, we would recommend doing a down-regulation before the transfer. With light endometriosis, it would not be necessary.

Would the percentage of implantation be lower if you have endometriosis and adenomyosis? Even if you use donor eggs?

We know that the implantation can be lower if you have endometriosis and adenomyosis. More important is egg quality. We also know that implantation can be affected, but often in medicine, there are many studies, and it’s not 100% clear what those studies see. If you have endometriosis and adenomyosis and if you used donor eggs, there was no significant difference in pregnancy rates. It doesn’t seem to have such a great impact. The egg quality is more important, the pregnancy rates are almost the same if you use donor eggs.

Both my tubes are blocked because of adenomyosis. Is surgery essential for IVF success – to prevent toxins to reach the embryo, as you said, in the last question? I shall undergo GnRH treatment – will that be enough?

Yes, GnRH treatment is a good idea. There’s a difference if just the tubes are blocked, there would be no surgery necessary, it would be necessary if the tube is filled with liquid. That can be seen in a vaginal ultrasound scan, so you just would need to do surgery if the tubes are full of liquid.

Authors
Jana Bechthold, Dr.

Jana Bechthold, Dr.

Dr. Jana Bechthold has just joined the Clinica Tambre team to help German, English and Spanish patients fulfil their dream of starting a family. She graduated in medicine from the University of Innsbruck, Austria, and had her first contact with Spain during her semester at the University of Elche. She then worked as a Specialist in Gynaecology and Obstetrics at HELIOS Kliniken Schwerin, Germany. She also worked for a while in palliative medicine and started her work in the field of reproductive medicine at the prestigious University Hospital Fundación Jiménez Díaz, Madrid, Spain. Dr. Bechthold always has a smile on her face and her professionalism is reflected in every interaction with her patients.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is an International Patient Coordinator who has been supporting IVF patients for over 2 years. Always eager to help and provide comprehensive information based on her thorough knowledge and experience whether you are just starting or are in the middle of your IVF journey. She’s a customer care specialist with +10 years of experience, worked also in the tourism industry, and dealt with international customers on a daily basis, including working abroad. When she’s not taking care of her customers and patients, you’ll find her traveling, biking, learning new things, or spending time outdoors.

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