A woman’s uterine cavity is internally lined by a layer of tissue called the endometrium. This layer of tissue normally becomes thick and blood vessel rich between menstrual cycles. Part of the endometrium is shed as menstrual bleeding at the time of periods. This cyclical thickening of the endometrium followed by its shedding is a natural process of the female reproductive system in preparation for pregnancy. When the endometrial tissue, which should only be found inside the uterine cavity starts growing elsewhere in the body, the condition is called endometriosis. The endometrial tissue in such cases may end up growing on the ovaries, in the fallopian tubes or other pelvic organs like the bladder and bowels.
It is generally acknowledged that about 176 million women around the world suffer from Endometriosis. Many women in the UAE are also affected by this disease. Although there isn’t much statistical data available about the exact number of women in the UAE suffering from this disease, it is estimated that nearly 7-10% women in the UAE may be suffering from Endometriosis. One of the biggest challenges for these women is getting pregnant with endometriosis. According to Dr. Pankaj Shrivastav, Director of Conceive Gynaecology and Fertility Hospital in Dubai, about 20-25% of women who consult their clinic for infertility, indeed suffer from Endometriosis. He acknowledges that this is not a true reflection of the prevalence of Endometriosis in the general population, but it certainly throws some light on the numbers as most women with endometriosis do have a problem conceiving naturally and hence tend to gravitate towards a fertility clinic.
Endometriosis and Infertility
Although it is possible for women with Endometriosis to conceive naturally, about 1/3rd of women with Endometriosis have trouble getting pregnant. The endometrial tissue growing elsewhere in the body functions similar to the endometrium in the uterus. It continues to thicken and bleed with every menstrual cycle causing scars and adhesions within the pelvis. Dr. Shrivastav says, “The condition can spread throughout the pelvis and cause organs within the pelvis to stick to each other. Severe adhesion in the pelvis will make it difficult for the egg to reach the fallopian tubes where fertilisation of the egg takes place, thus causing infertility. Even in women with less severe endometriosis there could still be problems with conception as the cysts caused by Endometriosis release certain chemicals that cause harm to sperm, eggs and the embryo.”
A silent disease
Endometriosis causes moderate to severe pelvic pain, especially during menstrual periods, but sometimes a woman may not even be aware of the disease. “In a large number of women, the disease can be silent and picked up incidentally during a routine ultrasound scan or laparoscopy,” remarks Dr. Pankaj Shrivastav, indicating that the condition is often discovered by chance, when a woman consults the specialist for infertility rather than menstrual pain.
Getting pregnant with endometriosis – is there hope?
While there is currently no cure for endometriosis, pain and other symptoms can be successfully treated with medication. The treatment approach will of course depend on the severity of symptoms and whether or not the patient wants to get pregnant. Those who wish to conceive are usually referred to a fertility specialist for specific approach to treatment.
We asked Dr. Shrivastav about their approach to Endometriosis treatment at Conceive and he indicated that they often go with conservative treatment first. “When a woman with endometriosis consults us with difficulty in conceiving, we first try to determine the extent of the disease and whether the tubes are open or not. If the fallopian tubes are open and there are no other complicating issues like age of the couple or poor sperm quality in partner, then we give them an option to try simple inexpensive treatments like ovulation induction or Intrauterine Insemination (IUI) for 2-3 cycles. Many of them will Conceive with this. As long as the woman has sufficient number of healthy eggs and the tubes remain open, conception with endometriosis is possible with this approach,” he said. “However, if the tubes are blocked, then the only option available is IVF. Sometimes if the endometriosis cysts are very large, some doctors suggest that these be removed surgically before doing IVF, but I usually do not favour this approach in most situations, unless absolutely required. When the cyst is removed surgically, some part of ovarian tissue may also be lost, further compromising the woman’s fertility.”
IVF success rates in women with Endometriosis
Dr. Shrivastav is fairly optimistic about the success rates of IVF in women with severe endometriosis. “As long as the egg numbers in the ovaries are not compromised, IVF success rates in women are quite good and only just a little less, say 5% less than women who do not suffer from the disease. Unfortunately, some women would have had multiple ovarian surgeries previously and are left with less ovarian tissue and fewer eggs. Lower egg reserve can markedly decrease the success rates with IVF. Having said that, IVF is still the most effective and best possible option when all other treatments have failed,” he adds.