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Understanding Endometriosis And Its Effects On Fertility

Infertility rates have been rising globally due to the prevalence of various health issues in women over the past few decades. According to the WHO, endometriosis affects almost 10 per cent (190 million) of women in the reproductive age category. Dr Prachi Benara, Consultant – Birla Fertility & IVF MBBS (Gold Medalist), MS (OBG), DNB (OBG), helps us understand what endometriosis is and how it affects fertility in women.

What Is Endometriosis?

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Endometrium, or the lining of the uterus, is the tissue found inside the uterus which is responsible for hosting the embryo at the time of pregnancy. Endometriosis is a condition when endometrial tissue grows outside the uterus and causes inflammation, leading to chronic pain in the pelvic region. “During each period cycle, the endometrial-like tissue breaks, and starts bleeding. At times, cysts known as endometriomas may form within the ovaries, developing scars and adhesions.

These can eventually lead to severe pain and cause infertility over time,” adds Dr Benara. Women suffering from endometriosis may often have symptoms involving pain and severe cramps during their menstrual cycle, heavy bleeding during periods, pain during sexual intercourse, inflammation during urination or bowel movements, and lastly, infertility.

How Does Endometriosis Affect Fertility?

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As a woman develops endometriosis, complications like infertility might occur; 30-50 per cent of women with endometriosis may face difficulties in conceiving. Endometriosis can distort the anatomy of the pelvis region due to inflammation, scarring and adhesions. It can alter the immune system and change the hormonal milieu. At times, the process of ovulation can get hampered as follicle growth due to inflammation can get altered. Further, endometriosis can affect the fallopian tubes, which may become nonfunctional due to adhesions and inflammation. Being a part of the uterus’ inner lining, it can fail to provide favourable conditions for embryo implantation if damaged.

Diagnosing And Treating Endometriosis

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Endometriosis presents with classical symptoms of pelvic and abdominal pain aggravated during periods and intercourse. As first steps, your gynaecologist will conduct pelvic examination to identify formations of cysts or other abnormalities present in the pelvic region. Ultrasounds and MRI scans are also used to diagnose more accurate results, which may help your doctor locate and identify the size of endometrial tissues present. “Sometimes your doctor may recommend laparoscopy, which is carried out by inserting a camera for precise diagnosis. This test can both diagnose and treat the disease through surgery at the same time,” says Dr Benara.

Treatment for infertility with endometriosis is usually done through Intrauterine Insemination (IUI) with ovarian controlled stimulation if the patient has mild endometriosis. If IUI fails to deliver results, IVF is the next preferred choice of treatment. If one is diagnosed with severe endometriosis, surgery is often recommended, involving the burning of endometrial-like tissue in the pelvic region, and removal of endometrioma may be considered. Higher chances of conceiving follow a treatment involving IUI or IVF.

Dr Benara says that it is essential to diagnose and get endometriosis treated as soon as possible as it may hamper quality of life and increase complications of conceiving over time. Since it has a high reoccurrence rate, the treatment process should be ongoing and not be neglected at any period.

Find Out If Vaginal Dryness Affects Your Reproductive Health

Up to 90% of women with vaginal discomfort do not seek treatment for vaginal dryness, despite the fact that it is a prevalent problem. One may find vaginal dryness embarrassing, but it should never ignore the accompanying itching and pain. Reduced vaginal moisture frequently makes sexual intercourse painful.

In normal circumstances, the cervical fluid lubricates the vaginal lining and keeps it smooth and elastic. The cervical fluid has other functions besides lubricating the vaginal canal. According to experts, it also makes it easier for sperm to reach the egg and fertilise it. This becomes critically important for guys with low sperm levels. “Vaginal dryness is defined by low or negligible levels of cervical fluid. Vaginal dryness is caused by the female hormone oestrogen, which regulates cervical fluid production. According to Dr. Tanveer Aujla, Senior Consultant Obstetrician & Gynecologist, Motherhood Hospital, Noida, stress, drug side effects, hormonal fluctuations, or even a lack of foreplay can all contribute to this.

Expert reveals that the use of feminine sprays and harsh soaps, swimming pool and hot tub chemicals, and some washing powders have been linked to vaginal dryness before menopause. Mucous membrane-drying medications include allergy and cold medications, as well as a number of antidepressants.

“Pre-menopausal women with low estrogen levels, such as breastfeeding mothers, women who have undergone a hysterectomy, and those who have experienced chemotherapy, may experience vaginal dryness,” says Dr Tanveer. She addresses whether vaginal dryness can affect fertility.

Image: Shutterstock

Image: Shutterstock

Vaginal Dryness and Fertility
The first question that comes to mind while dealing with vaginal dryness is, “Can vaginal dryness be an indicator of infertility?” Although vaginal dryness is not a direct cause of infertility, it is unquestionably a contributing factor. Cervical mucus is vital during pregnancy because it allows sperm to survive and swim from the cervix into the uterus and then into the fallopian tubes. Couples who do not have enough cervical mucus during intercourse can experience pain and tension, especially if they are trying to conceive. This can have a significant impact on your life, reducing your sex drive. f you’re trying to conceive naturally, this can be a serious problem. Other typical issues that might impact your quality of life include burning sensation, itching, and irritation.
In severe circumstances, the cervical mucus transforms into a hostile state. Hostile cervical mucus refers to extreme vaginal dryness, problems with overly acidic vaginal secretions, or immunological issues that prevent a woman from becoming pregnant.

Image: Shutterstock

Image: Shutterstock

Treatable Methods For Vaginal Dryness
Vaginal dryness is a common problem, but the good news is that it can be treated. Topical estrogen therapy is one of the most often used therapies for vaginal dryness. Other approaches include:

• Tablets: Inserted into the vaginal canal with a disposable applicator.
• Creams: Used in the vaginal area with a specific applicator.
• Water-based lubricants: Advised for vaginal dryness induced by temporary hormonal changes, such as childbirth or breastfeeding.
• Hormone Replacement Therapy: It may be an effective treatment for menopausal vaginal dryness. It helps to balance your hormones, which may improve vaginal wetness and sexual desire.
• No to chemicals – Chemical goods might irritate vaginal tissue and aggravate symptoms. Douches, spermicidal condoms, and other spermicidal products
• Stress relievers – Learning stress-relieving strategies can help to decrease vaginal dryness and increase sex quality.
• Vaginal moisturisers are also used two to three times each week and can last for up to three days, offering much-needed comfort to sensitive regions and preventing vaginal dryness from becoming severe.

Know Your Fertility Score: When To Go For IVF Treatment

Over recent years, infertility has become one of the more frequent health issues that couples are facing. A sedentary lifestyle with minimal physical activity, addictions, stress levels, different food habits, and irregular sleeping patterns, are few reasons that cause infertility. Many studies have shown that parenting is an important part of life for most couples and that infertility is the most common health issue amongst them. Dr Bharati Dhorepatil, Fertility Consultant, Nova IVF Fertility, Pune, says, “Involuntary childlessness brings psychological and psychosomatic disorders, mainly in women, becoming a real social stigma. Not only do they present with depression, distress, or high anxiety levels, among others, but also they have less social support. Thus, knowing fertility score will be helpful.”

What Is Infertility?

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Infertility has been defined as the failure to accomplish a clinical pregnancy after one year of regular sexual intercourse without protection. “Strong evidence indicates that many female and male factors can explain infertility such as failure to ovulate, menstrual cycle problems, reproductive system structural problems, infections, egg maturation defects, implantation failure, endometriosis, polycystic ovary syndrome, primary ovary insufficiency, autoimmune disorders, and uterine fibroids. Failure to ovulate is the leading cause of female infertility and ageing leading to reduced ovarian reserve. Lifestyle and environmental factors have been related to ovulation disorders, oligoospermia, and azoospermia,” states Dr Dhorepatil.

Couples tests include semen analysis, ovulation evaluation, hysterosalpingogram, and ovarian reserve test. If all tests result normal, the couple is diagnosed with unexplained infertility. Previous studies have shown that women’s smoking, high or low body mass index (BMI), and excessive caffeine or alcohol intake can affect their fertility. Physicians advise their patients to optimise BMI and strict restrictions on caffeine and alcohol intake. In these cases, the optimal treatment for patients relies on the woman’s age and duration of infertility.

fertility Score

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Primary care physicians should perform reproductive health promotion to women of advanced age, educating women about their fertility potential. “Considering age, duration of marriage, lifestyle, and environmental factors on fertility, and the availability of assisted reproduction treatment (ART), we score the contribution of these factors into the couple’s fertility. We believe this might improve the outcome of fertility treatments and help physicians make the right choice for the couple’s next step in line,” says Dr Dhorepatil.

Evaluating Fertility Score

fertility Score

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Fertility Score Predictor (FSP) application helps in knowing the fertility potential with broader social contexts. It is a simple and efficient method to calculate the couple’s score and determine the category of the treatment the couple falls into. Its purpose is to educate the couple, families, practitioners, and family physicians to have a simplified yet effective way for a treatment road map while avoiding delay for the anxious couple. On the other hand, FSP is useful for those couples who can achieve pregnancy without fear of getting into the vicious path of the treatment cycles.

The use of FSP could help with the decision-making process for the couple in their infertility treatment. This simple and user-friendly application will enable the couple to know their fertility potential, decide the treatment option and the severity of the situation. Thus FSP can provide a road map and awareness about infertility treatment for common people and improve the decision-making processes among practitioners and gynaecologists.

fertility Score

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Dr Dhorepatil explains how the fertility score is classified according to number and colour-coded as follows: 

  •   Green (>20 score): Expectant management including diet modifications, alleviation of stress with a natural try for conception for six months to one-year duration. Lifestyle changes recommended (such as weight loss, quitting smoking, reduction of caffeinated drinks) at least for six months.
  • Blue (15–19 score): Active involvement of treatment option including consultation to a fertility specialist to perform all basic investigations, timed intercourse (TIC), detection of ovulation by urinary kit, or basal body temperature (BBT), or sonographic assessment. Basic investigations include all routine investigations, female hormonal investigations, male semen analysis.
  • Orange (10–14 score): Consistent and active management including ovulation induction with ovulogens and/or gonadotropins along with intrauterine insemination (IUI) for 3–6 cycles and endoscopy procedure. 
  • Red (5–9 score): Aggressive management including IVF, ICSI, intracytoplasmic morphologically selected sperm injection (IMSI), testicular sperm extraction (TESE), percutaneous epididymal sperm aspiration (PESA), micro-TESE, assisted laser hatching, blastocyst embryo transfer, time-lapse monitoring for 3 to 6 cycles.
  •   Black (<5 score): Alternative option including using gamete donor, surrogate, embryo donor, uterine transplant.
fertility Score

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According to FSP reading, patients with black and red colour results are advised to receive IVF treatment, orange colour suggests patient should receive IUI, blue colour suggests patients should start active involvement of treatment option, and green suggests couples should receive expectant management. Note that scores are associated with the patient’s age, duration of the marriage, menstrual cycle, sexual history, and any known obvious diagnosis related to infertility. “FSP could be suitable to predict the appropriate treatment that the couple should receive to achieve the best outcome since there is a significant association between the score (colour group) and the treatment given. This association suggests that the score is suitable for detecting patients with good fertility potential or lower fertility potential at an early stage,” says Dr Dhorepatil.

Sources:

https://www.femina.in/wellness/gynaec/understanding-endometriosis-and-its-effects-on-fertility-213186.html

https://www.femina.in/wellness/gynaec/know-your-fertility-score-when-to-go-for-ivf-treatment-212515.html

https://www.femina.in/wellness/gynaec/find-out-if-vaginal-dryness-affects-your-reproductive-health-230283.html

https://www.thelancet.com/journals/lancet/article/PIIS0140673610604904/fulltext

https://www.mdedge.com/obgyn/article/99912/surgery/endometriosis-and-infertility-expert-answers-6-questions-help-pinpoint

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