Monday, 25 August 2014

Early diagnosis of Endometriosis for infertility treatment

Infertility problems in women can be congenital (from birth) or can be caused by various factors. Endometriosis is one of the medical conditions, which leads to infertility in women.

Endometriosis is a condition, where inner uterine lining (endometrial lining) grows outside the uterus often affecting the function of the ovaries, uterus and fallopian tubes. This tissue will bleed every month internally, during the menstruation time and the blood collects inside, which acts like a gum  sticking together the internal organs like intestines / urinary bladder to uterus, tubes and ovaries. Sometimes the collection is big enough to form a chocolate cyst, which is nothing but old blood. We have removed  a  30 cm cyst in a patient. It was bigger than a large watermelon. Even a small spot measuring 0.5 mm can cause infertility in some women and often goes undiagnosed. 

This extra tissue growth can cause scarring or obstruction of the tube producing tubal blocks. This  can also produce certain chemicals which will impair  the  implantation of the fertilised egg inside the uterus. Symptoms are painful menstruation or painful intercourse, acute or chronic  pain in pelvic area or infertility. In some women the pain is very acute and it interferes with the day to day activities of her life, but in some women, there will be no visible symptoms.

The word endometriosis comes from the word “endometrium”, endo means “inside” and metrium means “mother”. There may be no specific reason for getting endometriosis, it can affect any women, but family history suggests genetic linkage. Theory of back bleeding also seems logical, as we often find blood around the uterus in pelvis,  while we do laparoscopy for women during  their period time. Also the cervix is quite tightly closed in some women, which may be causing back bleeding and the endometrium which is shed along with the menstrual blood is pushed up through the tubes to the pelvis, where it gets collected and grows responding to the hormones in the subsequent cycle. The contraction of uterus is abnormal in some women which can also attribute to back bleeding and  may even end up in ectopic pregnancies .

Endometriosis can stand in the way of pregnancy, in fact a very large percentage of infertile women suffer from this condition. Though mostly you can detect this through clinical examination, ultrasound or MRI scan, confirmation is possible only through laparoscopy. Laparoscopy is the gold standard in the treatment of endometriosis and should be done early in this condition, as if it is too late we cannot save the tubes, if it is severely damaged.

Treatment for endometriosis is to surgically remove endometrial tissues, cauterise it to destroy it ( electro- cautery is used to burn the spots ) or unblock the tubes. Medical therapy can be used to stop the ovulation, which in turn will stop the  growth of lining. The side effects of medical treatment can be hard, as it can cause early menopause, hence it is better to opt for surgery. After surgery,  up to 40 percent of women  get pregnant  naturally, rest has to take the help of assisted reproductive treatments like IVF or surrogacy. While doing laparoscopy, the doctor will evaluate the damage done and inform you if you have further chance for conceiving. Endometriosis cannot be cured permanently and even after hysterectomy or removal of ovaries, any time it can grow back. 

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Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre


Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy . Her proficiency is in genetic abnormalities and high risk pregnancies.

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