Endometriosis is a condition wherein tissue like the uterine lining (endometrium) grows somewhere else in the body. Pelvic pain is the most common indication of endometriosis, yet a few women with the condition may likewise encounter infertility.
Endometriosis may develop outside of your uterus, ovaries, and tubes and even on your bladder or digestion tracts. This tissue can irritate structures that it contacts, causing pain and adhesions (scar tissue) on these organs.
Symptoms of Endometriosis
Symptoms can vary with some women not having any at all, and others having very severe pain. The most common symptoms are:
- Painful, heavy or irregular periods
- Pain in the lower abdomen, pelvis or lower back around ovulation time, but also throughout the cycle
- Ongoing pelvic pain lasting six months or longer
- Pain during or after sex
- Difficulty getting pregnant
- Painful bowel movements and emptying of bladder
Impact of Endometriosis on Fertility
On the off chance that you have endometriosis, it might be more difficult for you to get pregnant. Up to 30% to 50 % of females with endometriosis may encounter infertility. Endometriosis can impact fertility in different ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.
At the point when endometrial tissue wraps over your ovaries, it can block your eggs from releasing. The tissue can obstruct sperm from making its way up your fallopian tubes. It can likewise prevent a fertilized egg from sliding down your tubes to your uterus.
Treatment of Endometriosis Related Infertility
In case of difficulty getting pregnant with endometriosis you may wish to consult a fertility specialist. Treatment options for endometriosis related infertility include:
- Freezing eggs: Endometriosis can influence your ovarian reserve, so a few specialists may suggest protecting your eggs at present on the off chance that you wish to get pregnant later. This choice can be expensive, and isn’t typically covered by insurance.
- Superovulation and intrauterine insemination (SO-IUI): This is a possibility for women who have normal fallopian tubes, mild endometriosis, and whose partner has good quality sperm.
- A specialist will prescribe fertility medicines, like, Clomiphene. These medicines help to produce a few mature eggs. A specialist may likewise prescribe a progestin injection.
- A woman will routinely go through ultrasounds to guarantee the eggs are at their most matured state. At the point when the eggs are ready, a specialist will embed a partner’s collected sperm.
- In vitro preparation (IVF): This treatment includes extracting an egg from you and sperm from your partner. The egg is then fertilized externally and embedded into the uterus.
The success rates of IVF are 50 percent for women who don’t have endometriosis. But many women with endometriosis have successfully gotten pregnant thanks to IVF treatments. IVF is often recommended for women with moderate to severe endometriosis, or for women whose bodies haven’t responded to other treatments.
Fallopian tube blockage – Fallopian tubes are female reproductive organs that join the ovaries and the uterus. Consistently during ovulation, which happens generally in the middle of a monthly cycle, the fallopian tubes deliver an egg from an ovary to the uterus.
Conception likewise occurs in the fallopian tube. In the event that an egg is fertilized by sperm, it travels through the tube to the uterus for implantation.
In the event that a fallopian tube is blocked, the entry for sperm to get to the eggs, as well as the way back to the uterus for the fertilized egg is obstructed. Common caused behind blocked fallopian tubes include scar tissue, infections, and pelvic adhesions.
Symptoms of Fallopian Tubes Blockage
Most women with tubal blockage are asymptomatic. Frequently they don’t understand their fallopian tubes are obstructed until they consult a doctor for infertility, however women with broad tubal damage may encounter chronic pelvic pain.
Effect on Fertility
Blocked fallopian tubes are a typical reason for infertility. Sperm and egg meet in the fallopian tube for fertilization. An obstructed tube can keep them from joining.
If both tubes are completely blocked, pregnancy without treatment will not be possible. In the event that the fallopian tubes are partially blocked, you can conceivably get pregnant. However, the risk of an ectopic pregnancy is enhanced in that case.
Causes of Fallopian Tube Blockage
The most widely recognized reason for blocked fallopian tubes is Pelvic inflammatory disease (PID). PID is the result of sexually transmitted disease, although not all pelvic diseases are related to STDs. Additionally, regardless of whether PID is not, a history of PID or pelvic disease expands the risks of blocked tubes.
Other expected reasons for blocked fallopian tubes include:
- Current or history of an STD infection, specifically Chlamydia or gonorrhea
- History of uterine infection caused by an abortion or miscarriage
- History of a ruptured appendix
- History of abdominal surgery
- Previous ectopic pregnancy
- Prior surgery involving the fallopian tubes, including tubal ligation
- Endometriosis
Diagnosis
There are three key diagnostic tests for blocked fallopian tubes:
- An X-ray test, known as a hysterosalpingogram or HSG: A trained health professional injects a harmless dye into the womb, which should stream into the fallopian tubes. The stain is noticeable on an X-ray. If the liquid doesn’t flow into the fallopian tubes, it may have a blockage.
- An ultrasound test known as a sonohysterogram: This is fundamentally the same as the HSG test yet utilizes sound waves to develop an image of the fallopian tubes.
- A keyhole medical procedure known as a laparoscopy: A surgeon makes a little cut in the body and embeds a small camera to take photos of the fallopian tubes from inside.
Treatment and Surgery
It may be possible to open blocked fallopian tubes surgically. However, this depends on the extent of the scarring and where the blockage is.
Surgery aims to open the fallopian tube using one of the following methods:
- removing scar tissue
- making a new opening on the outside of the fallopian tube
- opening the fallopian tube from the inside
Most surgeons will carry out the procedure using keyhole surgery.
An embryo transfer is a part of IVF procedure in which a fertility specialist uses an ultrasound to guide a catheter containing the IVF-produced embryo(s) to transfer the embryo(s) directly into the uterus. The process of embryo transfer takes only a few minutes. The process does not involve anesthesia and only short recovery period is required.
[Image of the embryo transfer process in IVF]
Prior to the transfer, embryos are graded and the type of grading depends on the stage of the embryo. For cleavage stage embryos, typically on day three, the number of cells and a grade (A – D) will be assigned. For blastocysts, there will be a number and two letters assigned. The number refers to the amount of expansion of the fluid (the “cyst”) in the blastocyst. The two letters (A – D) that follow refer to the inner cell mass (destined to become the baby) and the trophectoderm (destined to become the placenta), respectively.
Cells from an embryo can also be tested for genetic anomalies prior to an embryo transfer. Scientists have a choice of two genetic tests for embryos. In preimplantation genetic diagnosis (PGD), an embryologist removes a group of cells to test for a specific genetic abnormality, such as cystic fibrosis. Preimplantation genetic screening (PGS) tests for the proper makeup in all chromosome pairs, as missing or additional chromosomes lead to disorders and diseases. An example of such a disorder is Down syndrome, in which there is an extra chromosome in pair number.
Types of Embryo Transfer
Blastocyst Transfer
A blastocyst transfer includes developing embryos in a laboratory for five days before transferring them into the uterus. When the embryo has reached the blastocyst stage (day five), it is more fully developed with multiple cells. At this point the embryo resembles the stage of a natural embryo when it enters a uterus for implantation, which increases the chances of attaining a successful pregnancy. However, it is not necessary that all embryos are able to develop to the blastocyst stage. Studies show that blastocyst transfers result in higher implantation and pregnancy rates as compared with cleavage stage embryos. Blastocyst transfers may be of particular benefit for patients who develop many good quality embryos, who have failed to achieve a pregnancy with a day three transfer in the past, or who have poor quality embryos at day three.
Cleavage Stage Embryo Transfer
A cleavage stage embryo transfer refers to embryos that are transferred at an earlier stage of development when they have fewer cells, typically six to eight, and occurs on day two or three after fertilization. Cleavage refers to the division of the cells in an early developing embryo. Cleavage stage embryo transfer is a good option for patients who have fewer good quality embryos. Also, transfer on day three is less risky than allowing the embryos to go to day five.
When Embryo Transfer is Needed
IVF and embryo transfer is required in cases where there is difficulty in natural conception or difficulty occurring. There are many reasons for embryo transfer, including:
- Ovulation disorders: If ovulation is infrequent, fewer eggs are available for successful fertilization.
- Damage to Fallopian tubes: The Fallopian tubes are the passageway through which the embryos travel to reach the uterus. If the tubes become damaged or scarred, it is difficult for fertilized eggs to safely reach the womb.
- Endometriosis: When tissue from the uterus implants and grows outside of the uterus. This can affect how the female reproductive system works.
- Premature ovarian failure: If the ovaries fail, they do not produce normal amounts of estrogen or release eggs regularly.
- Uterine fibroids: Fibroids are small, benign tumors on the walls of the uterus. They can interfere with an egg’s ability to plant itself in the uterus, preventing pregnancy.
- Genetic disorders: Some genetic disorders are known to prevent pregnancy from occurring.
- Impaired sperm production: In men, low sperm production, poor movement of the sperm, damage to the testes, or semen abnormalities are all reasons natural fertilization may fail.
What to Expect before, During, and After an Embryo Transfer
Around 2 or 3 days before the embryo transfer, the doctor will choose the best eggs to transfer to the womb. There are many processes available to aid selection, though non-invasive methods such as metabolomic profiling are being tested. Metabolomic profiling is the process of selecting the most beneficial eggs based on a number of different factors. This could limit the need for invasive procedures in the future. These eggs will then be fertilized in a lab and left to culture for 1-2 days. If many good quality embryos develop, the ones that are not going to be transferred can be frozen.
After the Embryo Transfer
A follow-up appointment after 2 weeks to check if the embryo has implanted well and the transfer was successful. After the procedure of embryos transfer, women may experience some cramping, bloating, and vaginal discharge.
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Endometriosis is a complex condition where tissue similar to the uterine lining (endometrial glands and stroma) grows outside the uterus. This tissue undergoes cyclical bleeding during menses, leading to inflammation, severe pain, and often, fertility challenges. Detecting this condition accurately is the first step toward effective management.
Common Sites of Endometriosis
Endometriosis can manifest across various pelvic regions, including:
- Ovaries: The most common site, often involving bilateral lesions.
- Pelvic Surfaces: Fallopian tubes, uterine walls, and the Pouch of Douglas.
- Deep Infiltration: Lesions penetrating >5mm into tissues like the bladder, cervix, intestines, or even old surgical/caesarean scars.
Ovarian Endometriosis: The “Chocolate Cyst”
When endometriosis involves the ovaries, it often forms cysts filled with old blood, popularly known as Chocolate Cysts. On a Transvaginal Ultrasound (TVS), these have a very specific “classic” appearance:
Sonographic Markers:
- Ground Glass Appearance: A homogenous, hypoechoic lesion with low-to-medium level internal echoes.
- No Internal Vascularity: Unlike tumors, these lesions typically show no blood flow inside the cyst on Color Doppler.
- Chronic Variations: Long-standing or chronic endometriomas can sometimes mimic solid ovarian tumors, requiring expert differentiation.
- Calcifications: Occasionally, thickened walls or central calcifications may be present.
Depth of Penetration
Ultrasound helps us classify the severity based on depth:
- Superficial: <5mm depth of penetration from the surface.
- Deep (DIE): >5mm depth, often accompanied by fibrosis and muscular hyperplasia, causing significant pelvic adhesions.
Impact on Fertility
Endometriosis can affect fertility by distorting pelvic anatomy, causing tubal blockages, or reducing egg quality. At Talwar Fertility & Child Health Centre, we specialize in “Endometriosis-safe” IVF protocols and surgical interventions to help patients conceive despite these challenges.
Dealing with Pelvic Pain or Infertility?
A precise ultrasound is the key to identifying endometriosis. Consult Dr. Pankaj Talwar for a comprehensive evaluation.
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