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.
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.
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.
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.
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.
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.
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.
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.
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.