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Archive for the ‘endometriosis and infertility’ tag

March is Endometriosis Awareness Month

By David Kreiner MD

February 29th, 2016 at 11:14 pm

 

image credit: ohmega1982/freedigitalphotos.net


I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging.

Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

* * * * * * * * * ** * * * * * * * * **

Do you suffer from endometriosis? How has it impacted your fertility journey? Do you have any advice for others who are suffering?

no comments

March is Endometriosis Awareness Month

By David Kreiner MD

March 24th, 2015 at 10:34 pm

 

photo: OhMega1982/ freesigitalphotos.net


I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging.

Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

* * * * * * * * * ** * * * * * * * * **

Do you suffer from endometriosis? How has it impacted your fertility journey? Do you have any advice for others who are suffering?

no comments

March is Endometriosis Awareness Month

By David Kreiner MD

March 5th, 2014 at 6:35 am

 

credit: wikipedia

 

I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies
 have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

* * * * * * * * * * * *  *

Do you suffer from endometriosis?

 

Photo credit: http://en.wikipedia.org/wiki/File:Endometriosis,_abdominal_wall.jpg

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 11 Endometriosis and Your Infertility

By David Kreiner MD

April 29th, 2013 at 9:50 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Eleven: Endometriosis and Your Infertility. You, the listener, are invited to ask questions and make comments.  You can access the podcast here:http://podcast.longislandivf.com/?p=70

Endometriosis and Your Infertility

Endometriosis is caused by tissue which is normally lining the inside of the uterine cavity.  Instead it implants outside the uterus, most often in the lining of the pelvis or ovaries.  Five to ten per cent of women have endometriosis, though of infertile women 30% are afflicted with it.

Scar tissue often forms where the endometriosis implants grow that can exacerbate pain and increase the likelihood of infertility.  The only way to be certain when making a diagnosis is to perform a surgical procedure called a laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope.  Absent a laparoscopy, the appearance of an ovarian cyst with a characteristic homogeneous appearance showing echoes in the cyst is highly suspicious for endometriosis.

Women with any stage of endometriosis, from minimal (few small implants) to severe (cysts and scarring), can have severe lower abdominal and pelvic pain or they may have no pain whatsoever.  In the absence of scarring, it is thought that infertility caused by mild stages of endometriosis may be chemically transmitted perhaps affecting sperm motility, fertilization, embryo development or even implantation.

Treatment is individualized based on symptoms, infertility and whether a woman is interested in future fertility.  Medical or drug therapy (usually monthly depot lupron) can suppress endometriosis and relieve pain in many women especially when dealing with the milder stages of endometriosis.    Surgical removal of lesions and/or ablation may also reduce pain temporarily.  However, studies fail to show significant improvement in pregnancy rates as compared to expectant management in these mild stages.  Ovulation induction with intrauterine insemination (IUI) increases conception when no other significant fertility factors are present.

Surgical treatment of more advanced conditions of endometriosis improves pregnancy rates to about two per cent per month.  There remains controversy over whether postoperative medical treatment may be helpful for fertility as the greatest success of surgery exists in the first 6 to 12 months post-op and the medical therapy reduces the time a patient may conceive as they cannot ovulate with the usual therapy of lupron.  IUI is rarely successful in these advanced stages necessitating In Vitro Fertilization in order to conceive.

As endometriosis is a progressive condition it is recommended that women so afflicted become proactive with their procreation before the endometriosis destroys too much ovarian tissue and prevents them from being able to achieve a pregnancy with their own eggs.

* * * * * * **  * * * *

Was this helpful in answering your questions about Endometriosis and its effects on a woman’s fertility?

Please share your thoughts about this podcast here. And ask any questions. Dr. Kreiner will be happy to answer them.

If you’ve been diagnosed with Endometriosis, do you have any advice to share?

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 10 Endometriosis

By David Kreiner MD

April 23rd, 2013 at 7:53 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Ten: Endometriosis. You, the listener, are invited to ask questions and make comments.  You can access the podcast here:

http://podcast.longislandivf.com/?p=66

 

Endometriosis

Endometriosis is a disease state in which the lining of the uterus, endometrium, is found outside the uterus, most often lining the pelvis behind the uterus and by the ovaries.  Endometriosis can cause pain and/or infertility in some women.  Among women who have infertility, as many as 30% may have endometriosis and this is not always associated with pain.

Though cysts of endometriosis may be suspected by a pelvic ultrasound, the diagnosis is typically made at the time of a laparoscopy by visual inspection and biopsy.  Endometriosis may be minimal or mild with no more than flat implants noted in the pelvic lining.  These are thought to contribute to infertility through chemicals that these implants produce which can cause scarring or adhesions of the ovaries and fallopian tubes thus affecting egg pickup by the tubes.  They may affect egg/embryo transport down the tube, sperm motility, fertilization, embryo cell cleavage and implantation.

Moderate and Severe endometriosis involving ovarian cysts containing old blood from cycles of menstrual-like bleeding from the implants, commonly impact egg pickup by the tubes due to the scar tissue that they cause.  They could affect egg maturation as well as cause all of the other factors that mild endometriosis may cause.

Treatment should be tailored to the major problems caused by the endometriosis. 

When pain is the main issue, medication that suppresses ovulation and estrogen production may be helpful, as can surgical resection or vaporization of the implants.

When infertility is the main issue, the benefits of surgery and medicine must be compared to the downside limitations caused by them, such as the inability to conceive during medical therapy and the risk of destroying limited normal ovarian tissue along with the endometriosis.  This can be a particular issue in cases of more severe endometriosis where the cysts of endometriosis and prior surgery to re-sect them have already diminished the remaining ovarian reserve.  In such cases, aggressive fertility treatment such as In Vitro Fertilization would be the recommended course of therapy to optimize an individual’s chance for successful childbearing.  

Patients with endometriosis and infertility are unfortunately in a race to conceive before the endometriosis destroys too much ovarian tissue and makes achieving a pregnancy with one’s own eggs impossible.

* * * * * * **  * * * *

Was this helpful in answering your questions about Endometriosis and its effects on a woman’s fertility?

Please share your thoughts about this podcast here. And ask any questions.

Or, if you are in the Long Island area, please come down to our Melville office for one or more of our “Evenings of Education” seminars this week. Details are here:  http://blog.longislandivf.com/2013/long-island-ivfs-national-infertility-awareness-week-events/

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 6 Have You Had A Fertility Workup?

By David Kreiner MD

March 18th, 2013 at 7:33 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Six: Have You Had a Fertility Workup? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=43

Have You Had A Fertility Workup?

A fertility specialist called a Reproductive Endocrinologist, who has performed a three year fellowship training in IVF and infertility after an Obstetrics and Gynecology residency, will initiate the fertility workup by conducting a history and physical examination.  The exam includes a pelvic ultrasound of a woman’s uterus and ovaries to determine if there are any abnormalities that may affect implantation or pregnancy, as well as assess ovarian activity and the presence of endometriosis.

Different causes of infertility will be tested.  The most common factor, that affecting the male, is easily tested with a semen analysis.  Tubal obstruction preventing a woman’s eggs from reaching the sperm can be ascertained by a hysterosalpingogram, a radiograph of the uterus and fallopian tubes performed after injecting radio-opaque contrast through the cervix.

Other tests to better delineate problems in the uterine cavity may be performed such as a hydrosonogram, where water is injected through the cervix and the cavity inspected by vaginal sonography or with hysteroscopy, where a scope is placed through the cervix to directly inspect the uterine cavity.

Blood tests may be performed to assess ovarian activity, in particular day 3 FSH and estradiol levels and AntiMullerian Hormone.  Prolactin and TSH levels are checked to rule out other hormonal disorders that may affect ovulation and fertility.

Treatment can be directed at the cause of infertility, such as ovulation induction for women with ovulatory disorders or surgery to remove uterine polyps or it may be independent of the cause such as with ovarian stimulation and intrauterine insemination or IVF which will improve success rates regardless of the cause of infertility with some exceptions.  IUI will have limited success for tubal factor, male factor infertility and endometriosis.  IVF will have limited success in women who have diminished ovarian reserve or abnormal eggs unless they use eggs donated by young fertile women.  Today, there is a highly successful treatment available for all.

* * * * * * **  * * * *

Was this helpful in answering your questions about what to expect from a fertility workup?

Please share your thoughts about this podcast or ask Dr. Kreiner any questions here.

no comments

Want to “Kick the Cramp” Out of Endometriosis?

By Tracey Minella

March 9th, 2013 at 10:10 pm

image courtesy of Ohmega 1982/free digital photos.net

Got killer cramps?

Are your periods so painful that you feel like you’ve been hit by a bus… or that you wish you had the strength to throw yourself under the next one just so you could finally be put out of your misery? Curled up with a heating pad and a bottle of Advil every month? Pain so bad you can’t work or go to classes or important social events? Does your period come complete with nausea, vomiting and/or diarrhea? Do you have pain during intercourse? Well, maybe it’s time you find out if there’s something sinister to all that suffering.

Endometriosis is a condition where tissue resembling the lining of the uterus is found outside the uterus, usually in the pelvic cavity, around the ovaries, fallopian tubes, or bowels. But it can sometimes migrate further, in rare instances even as far as the lungs, eye, skin, and brain. http://www.longislandivf.com/endometriosis.cfm In moderate or severe cases, adhesions due to endometriosis can bind organs together and even cause infertility by among other things, preventing an affected ovary from releasing an egg or an affected tube from receiving the egg. Even mild endometriosis can inflame or alter the pelvic environment and may impact fertility in more subtle ways, on a hormonal or immunological level. (Dr. Kreiner reviews the stages and treatment options for endometriosis here http://blog.longislandivf.com/2013/march-is-endometriosis-awareness-month-2/)

While there is no cure for endometriosis, there are treatments for its management, including hormonal therapy and surgery. The treatment plan will be determined by your physician factoring in individual goals including pain management and fertility. Endometriosis does not always cause infertility, but it can be found in approximately 30% of infertile women. Many women do conceive, though assisted reproductive technologies like IUI or IVF may be needed depending on the case.

But here’s the scary thing: you can have endometriosis…and have no pain at all. True, pain…either with your period or during intercourse…is very often present, it is not always the case. Sometimes the only way a woman finds out she has it is during an infertility work-up. And interestingly, there is no correlation between the level of pain experienced and the severity of the disease. You can have severe pain with mild endometriosis or no pain with severe endometriosis.

There are support groups and blogs devoted exclusively to managing and coping with endometriosis and we will be highlighting some of those throughout March for Endometriosis Awareness Month on our Facebook page, so please take a moment to follow us there: http://www.facebook.com/longislandivf

You can get information, help raise endometriosis awareness, and “kick the cramp out of endometriosis” through the Endometriosis Foundation of America’s NYC half-marathon on St. Patrick’s Day, March 17, 2013. Details available at: http://www.crowdrise.com/Endo/fundraiser/endometriosisfoundat

* * * * * * * * * * * * * *

Do you have endometriosis? If so, do you have pain associated with it? How has it impacted your fertility?

 

Photo credit: http://www.freedigitalphotos.net/images/Healthcare_g355-Woman_Suffering_From_Abdominal_Pain_p84166.html

no comments

March is Endometriosis Awareness Month

By David Kreiner MD

March 3rd, 2013 at 9:09 pm

credit: wiki free public domain

I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging.

Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.


 

* * * * * * * * * * * *  *

Do you suffer from endometriosis?

 

Photo credit: http://en.wikipedia.org/wiki/File:Endometriosis,_abdominal_wall.jpg

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 11 Endometriosis and Your Infertility

By David Kreiner, MD

May 31st, 2012 at 2:00 pm

 

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Eleven: Endometriosis and Your Infertility. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=70

Endometriosis and Your Infertility 

Endometriosis is caused by tissue which is normally lining the inside of the uterine cavity.  Instead it implants outside the uterus, most often in the lining of the pelvis or ovaries.  Five to ten per cent of women have endometriosis, though of infertile women 30% are afflicted with it. 

Scar tissue often forms where the endometriosis implants grow that can exacerbate pain and increase the likelihood of infertility.  The only way to be certain when making a diagnosis is to perform a surgical procedure called a laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope.  Absent a laparoscopy, the appearance of an ovarian cyst with a characteristic homogeneous appearance showing echoes in the cyst is highly suspicious for endometriosis. 

Women with any stage of endometriosis, from minimal (few small implants) to severe (cysts and scarring), can have severe lower abdominal and pelvic pain or they may have no pain whatsoever.  In the absence of scarring, it is thought that infertility caused by mild stages of endometriosis may be chemically transmitted perhaps affecting sperm motility, fertilization, embryo development or even implantation. 

Treatment is individualized based on symptoms, infertility and whether a woman is interested in future fertility.  Medical or drug therapy (usually monthly depot lupron) can suppress endometriosis and relieve pain in many women especially when dealing with the milder stages of endometriosis.    Surgical removal of lesions and/or ablation may also reduce pain temporarily.  However, studies fail to show significant improvement in pregnancy rates as compared to expectant management in these mild stages.  Ovulation induction with intrauterine insemination (IUI) increases conception when no other significant fertility factors are present. 

Surgical treatment of more advanced conditions of endometriosis improves pregnancy rates to about two per cent per month.  There remains controversy over whether postoperative medical treatment may be helpful for fertility as the greatest success of surgery exists in the first 6 to 12 months post-op and the medical therapy reduces the time a patient may conceive as they cannot ovulate with the usual therapy of lupron.  IUI is rarely successful in these advanced stages necessitating In Vitro Fertilization in order to conceive. 

As endometriosis is a progressive condition it is recommended that women so afflicted become proactive with their procreation before the endometriosis destroys too much ovarian tissue and prevents them from being able to achieve a pregnancy with their own eggs. 

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March is Endometriosis Awareness Month

By David Kreiner MD, and Tracey Minella

March 6th, 2012 at 11:01 pm

Got killer cramps?

Are your periods so painful that you feel like you’ve been hit by a bus… or that you wish you had the strength to throw yourself under the next one just so you could finally be put out of your misery? Curled up with a heating pad and a bottle of Advil every month? Well, maybe it’s time you find out if there’s something sinister to all that suffering.

Are “chocolate cysts” lurking inside you eating away at your fertility?

Huh? Chocolate WHAT? Bet you never heard of that.

Endometriosis is much more than the debilitating cramps or painful intercourse that the public associates with that disease. For instance, you can have it…and have no pain at all. Bet you didn’t know that either.

Well, prepare to get an education.

In honor of Endometriosis Awareness Month, Dr. David Kreiner of Long Island IVF sheds light on the causes and treatment options of this disease:

I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies  have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging.

Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

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Do you suffer from endometriosis? How has it impacted your fertility journey? Do you have any advice for others who are suffering?

Photo credit: Public domain http://en.wikipedia.org/wiki/File:Endometriosis,_abdominal_wall.jpg

 

 

 

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