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Endometriosis and Fertility

Endometrioss surrogacy

What is Endometriosis?

Endometriosis, sometimes called ‘’endo”, is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. 

Endometriosis happens when tissue similar to the lining of the uterus grows outside of your uterus and in other areas of your body where it doesn’t belong. Endometriosis is a painful, chronic disease that affects approximately 176 million women worldwide. Endometriosis mostly affects women in their reproductive years, especially between the ages of 25 and 40, but can develop in girls as young as 11. 

Moreover, 75 percent of women who experience pelvic pain and 50 percent of women with fertility issues have endometriosis.

Unfortunately endometriosis often goes unrecognized by doctors or is misdiagnosed or incorrectly treated.

What Causes Endometriosis?

The endometrium is the lining of the uterus that builds up each month, breaks down, and sheds during the menstrual period. Endometriosis occurs when tissue similar to endometrial tissue exists outside of the uterus. Endometrial tissue growing outside the uterus develops into growth which responds to the menstrual cycle. Like the lining of the uterus, endometrial growths are affected by the hormonal changes that bring about menstruation. 

Anyway, no one knows for sure what causes endometriosis, however researchers are studying  some possible causes:

  • Problems with menstrual period flow; Retrograde menstrual flow is the most likely cause of endometriosis. Some of the tissue shed during the period flows through the fallopian tube into other areas of the body, such as the pelvis.
  • Genetic factors; Because endometriosis runs in families, it may be inherited in the genes.
  • Immune system problems; A faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.
  • Hormones; The hormone estrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
  • Surgery; During a surgery to the abdominal area, such as a Cesarean (C-section) or hysterectomy, endometrial tissue could be picked up and moved by mistake. For instance, endometrial tissue has been found in abdominal scars. 

The stages of Endometriosis 

Endometriosis is one of the reasons that cause infertility in women. But to be diagnosed with endometriosis does not always mean that you can not be pregnant.The task is that there are 4 stages of endometriosis, and having a certain stage of endometriosis affects whether a woman can get pregnant or not. 

These stages are:

  • Minimal,
  • Mild,
  • Moderate,
  • severe

Each stage is determined by the location,amount, depth,and size of the endometrial implants.

Why does Endometriosis cause Infertility?

Despite the fact that endometriosis is one of the reasons for not having a baby, many women with endometriosis do get pregnant. However, women with endometriosis may find it harder to conceive. In fact, researchers think that as many as half of women with infertility are affected by endometriosis. 

Some possible reasons for this infertility include:

  • Endometrial growths block or alter the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
  • The immune system, which normally helps defend the body against disease, attacks the embryo.
  • The endometrium does not develop as it should, making it difficult for an embryo to implant in the womb.

Why endometriosis can cause infertility in detail can be described so:  Scar tissue (adhesions) is similar to cobwebs and can be fine, or dense. Adhesions are more common in moderate and severe endometriosis. 

This scar tissue distorts the pelvic anatomy. If the ovary is wrapped in adhesions, the released egg gets trapped and is unable to reach the tube. The tubes and ovaries dangle down in another important area called the Pouch of Douglas. If this pocket is covered by adhesions, then the chance of getting pregnant is also lower.

 It is less clear why minimal or mild endometriosis causes infertility. In minimal-mild endometriosis, there may be spots of endometriosis, and minimal or no scar tissue. Evidence that minimal-mild endometriosis affects fertility comes from studies of women having donor insemination because of male fertility problems. 

It was found that women with minimal to mild endometriosis had less chance of conceiving than women who had no endometriosis. 

What are the Symptoms of Endometriosis?

The most common symptoms of endometriosis are pain and infertility.  Other common symptoms of endometriosis include:

  • Painful or even debilitating menstrual cramps, which may get worse over time;
  • Pain during or after sex;
  • Pain in the intestine or lower abdomen;
  • Painful bowel movements or painful urination during menstrual periods;
  • Heavy menstrual periods;
  • Premenstrual spotting or bleeding between periods;
  • Problems getting pregnant;

In addition, women with endometriosis may have painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue or lack of energy.

For some women, the pain associated with endometriosis gets milder after menopause. However, hormone therapy, such as estrogen or birth control pills given to reduce menopausal symptoms, may cause the pain and other symptoms to continue.

How is Endometriosis Diagnosed?

Typically, a gynecologist or other health care provider will review your medical history and complete a physical examination and pelvic exam.

A diagnosis of endometriosis can only be confirmed after a doctor performs a laparoscopy and biopsies suspected tissue. 

Other examinations that may be used to help diagnose endometriosis include:

  •  Ultrasound,
  • A  computer tomography (CT) scan,
  • A magnetic resonance imaging (MRI) scan. 

But laparoscopy is considered the gold standard for diagnosis of endometriosis. 

How is Endometriosis Treated?

Specific treatment for endometriosis will be determined by your healthcare provider and based on the specifics of your conditions, your age, overall health, medical history, and whether or not you plan to have children. 

Generally, doctors recommend trying conservative treatment approaches – such as medication – the first and reserving surgery as the last resort. 

Treatments for endometriosis fall into the categories of pain relief, hormonal treatment, and surgery. For pain relief one can get pain-killers of different categories, but it will be only for a little time. There are other effective methods for endometriosis treatment.

Hormonal Treatment for Endometriosis

Hormones regulate the reproductive system and the menstrual cycle. In women with endometriosis, hormone-based treatment seeks to limit symptoms and slow the progress of the disease by controlling the level of hormones in the body. 

Hormonal treatments can offer the majority of women lighter and shorter menstrual periods, or even stop periods altogether. When the treatment stops, the symptoms of endometriosis will return, as will the ability to become pregnant. 

Combination Oral Contraceptives

Combination birth control pills contain two hormones: estrogen and progestin. 

Oral contraceptives make a woman’s period lighter, shorter, and more regular while keeping pain levels lower. Combination hormone therapy is also available as a skin patch or a vaginal ring. You should take into account that in the case of taking birth control pills, you may have mild side effects,such as weight gain,bloating, and bleeding between periods – especially for the first few weeks or months of taking them.  

Surgery for Endometriosis

Laparoscopy is necessary to diagnose endometriosis, and many women undergo laparoscopic surgery to remove endometriosis implants. Some people may experience temporary relief of their symptoms following surgery.

Laparoscopy is a minimally invasive surgical method during which small incisions are made in the abdominal wall. The surgeon inserts a small camera and surgical tools into the pelvic cavity to examine and cut or burn away endometriosis implants and remove adhesions. 

In more severe and extensive cases of endometriosis, laparotomy may be necessary.

Laparotomy involves a long abdominal incision to allow the surgeon full access to remove harder-to-reach endometriosis implants and adhesions while preserving healthy tissue. 

In the most severe cases of endometriosis,a woman may opt for a hysterectomy to surgically remove the uterus and possibly the ovaries. Hysterectomy may be performed via laparoscopy, with a traditional incision, or through the vagina. A hysterectomy may not stop symptoms of endometriosis since the body continues to produce estrogen. After a hysterectomy, a woman will no longer be able to have children. If the ovaries are also removed, a woman will immediately enter menopause no matter what age she is. 

Can Diet Help Endometriosis?

Scientists have studied diet as it relates to the development of endometriosis.Research indicates that high-fat diets containing large amounts of red meat and animal fats increase the risk for developing endometriosis. The theory is that these foods may raise estrogen levels. The same studies show that women with diets high in fiber, fresh fruit,and vegetables were less likely to develop endometriosis than women with meat-based diets. 

There has not been a study on whether a similar diet benefits women who already have endometriosis.