Endometriosis

Endometriosis (en-doe-me-tree-O-sis) is an often-painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial-like tissue may be found beyond the area where pelvic organs are located.

With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.

Symptoms

The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that is far worse than usual. Pain also may increase over time.

Common signs and symptoms of endometriosis include:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.
• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. You are most likely to experience these symptoms during a menstrual period.
• Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
• Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
• Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain may not be a reliable indicator of the extent of your condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

Stages of Endometriosis

• Stage 1 or minimal: There a few small implants or small wounds or lesions. They may be found on your organs or the tissue lining your pelvis or abdomen. There is little to no scar tissue.
• Stage 2 or mild: There are more implants than in stage 1. They are also deeper in the tissue, and there may be some scar tissue.
• Stage 3 or moderate: There are many deep implants. You may also have small cysts on one or both ovaries, and thick bands of scar tissue called adhesions.
• Stage 4 or severe: This is the most widespread. You have many deep implants and thick adhesions. There are also large cysts on one or both ovaries.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation, and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Adenomyosis

Adenomyosis (ad-uh-no-my-O-sis) occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle. An enlarged uterus and painful, heavy periods can result.

Doctors are not sure what causes adenomyosis, but the disease usually resolves after menopause. For women who have severe discomfort from adenomyosis, hormonal treatments can help. Removal of the uterus (hysterectomy) cures adenomyosis.

Symptoms

Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, adenomyosis can cause:

• Heavy or prolonged menstrual bleeding
• Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
• Chronic pelvic pain
• Painful intercourse (dyspareunia)

Your uterus might get bigger. Although you might not know if your uterus is bigger, you may notice tenderness or pressure in your lower abdomen.

When to see a doctor

If you have prolonged, heavy bleeding or severe cramping during your periods that interferes with your regular activities, make an appointment to see your doctor.

Endometriosis & Infertility

Endometriosis may make it more difficult for a woman to become pregnant. 30% to 50% of endometriosis patients may have infertility. Endometriosis can affect fertility in several ways, including pelvic anatomy disruption, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system function, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and alterations in egg quality.

Your doctor may assign you a “score” based on the extent, location, and depth of endometriosis at the time of surgery. This score indicates if your endometriosis is minimal (Stage 1), mild (Stage 2), moderate (Stage 3) or severe (Stage 4). (Stage 4). This rating system correlates with successful pregnancy. Women with severe (Stage 4) endometriosis, which involves extensive scarring, obstructed fallopian tubes, and damaged ovaries, have the most trouble conceiving and frequently require advanced reproductive treatment.

IVF

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple’s own eggs and sperm. Or IVF may involve eggs, sperm, or embryos from a known or anonymous donor. In some cases, a gestational carrier someone who has an embryo implanted in the uterus — might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive, and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

Why it’s done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in the uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Endometriosis. Endometriosis occurs when tissue like the lining of the uterus implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumours in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you wish to conceive after tubal ligation, IVF may be an alternative to tubal ligation reversal surgery.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, a visit to an infertility specialist might be needed to see if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they are screened for certain genetic problems, although not all genetic problems can be found. Embryos that do not contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you are about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who do not have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.

Egg Freezing

Egg freezing, also known as mature oocyte cryopreservation, is a method used to save women’s ability to get pregnant in the future.

Eggs harvested from your ovaries are frozen unfertilized and stored for later use. A frozen egg can be thawed, combined with sperm in a lab and implanted in your uterus (in vitro fertilization).

Your doctor can help you understand how egg freezing works, the potential risks and whether this method of fertility preservation is right for you based on your needs and reproductive history.

Why it’s done

Egg freezing might be an option if you are not ready to become pregnant now but want to try to make sure you can get pregnant later.

Unlike with fertilized egg freezing (embryo cryopreservation), egg freezing does not require sperm because the eggs aren’t fertilized before they’re frozen. Just as with embryo freezing, however, you will need to use fertility drugs to make you ovulate so that you’ll produce multiple eggs for retrieval.

You might consider egg freezing if:

• You have a condition or circumstance that can affect your fertility. These might include sickle cell anaemia, autoimmune diseases such as lupus, and gender diversity, such as being transgender.
• You need treatment for cancer or another illness that can affect your ability to get pregnant. Certain medical treatments — such as radiation or chemotherapy — can harm your fertility. Egg freezing before treatment might enable you to have biological children later.
• You are undergoing in vitro fertilization. When undergoing in vitro fertilization, some people prefer egg freezing to embryo freezing for religious or ethical reasons.
• You wish to preserve younger eggs now for future use. Freezing eggs at a younger age might help you get pregnant when you are ready.

You can use your frozen eggs to try to conceive a child with sperm from a partner or a sperm donor. A donor can be known or anonymous. The embryo can also be implanted in the uterus of another person to carry the pregnancy (gestational carrier).