Endometriosis is a benign condition in women involving the appearance and growth of endometrial tissue, typical of the uterus, outside this organ. It most frequently appears in the ovaries and rarely outside the abdomen (in the lungs, etc.).

Every time a woman menstruates, this tissue also bleeds but is not able to leave the body. This is when pain, inflammation and fibrosis appear and in some cases, fertility problems.

In half of all cases, if the endometriosis is not severe, women do not have symptoms.

In the other half of women with endometriosis, symptoms include painful periods, pain with intercourse, and even bleeding in feces or urine.

This is a common condition that affects up to 10% of women in their reproductive years after their first period. However, up to 25% of women who report fertility problems may have this condition.

When it affects the ovaries, these may have small implants or in more severe cases, blood cysts (“chocolate cysts”) of varying size, from a few millimeters to several centimeters.

There are many theories about how this disease affects fertility and how it delays conception in otherwise healthy women. It seems there are several mechanisms involved. First of all, the implants or cysts that affect the ovaries reduce the quantity and quality of a woman’s eggs. Healthy tissue is lost from the ovary and is replaced by the endometriotic tissue. Therefore, the ovarian reserve diminishes.

It also seems that these women may have permeable but low functioning tubes; a phenomenon that impedes the union of the egg and the sperm and their correct transportation to the uterine cavity.

Endometriosis is a chronic disease, meaning it will be more or less evident in different stages, but it is always there and may progress. Therefore, it is important that an early and appropriate diagnosis is made.

The diagnosis, in addition to reviewing the symptoms in the clinical interview, is quite simple with the current ultrasound technology.

In the treatment, we must distinguish whether the woman wants to have children or not at the time of diagnosis. If she is not trying to conceive, the treatment to stop the disease is medical, consisting of birth control and anti-inflammatory pills, etc.

In general, since it’s a chronic disease that can progress, it’s important that the woman knows about it and does not delay motherhood too long. Therefore, her age and the clinical context should be taken into account.

Since this disease can affect the ovarian reserve and the functioning of the fallopian tubes, the most effective way to conceive is through In Vitro Fertilization. The reproduction laboratory takes on the role of the fallopian tube, uniting the egg and the sperm and later the embryo, which is transferred into the woman’s uterus.

In Vitro Fertilization mainly appeared for the treatment of this disease and is one of the cases in which good results can be achieved.

Sometimes laparoscopic surgery must be performed in order to remove the endometriosis before conducting the fertility treatment but these cases can be individually studied.

The current trend is to not operate and conduct an early fertility treatment in order to avoid delays and the risk of removing excessive healthy ovarian tissue or even the progression of the disease.

Women with endometriosis should be diagnosed and treated as soon as possible, since it is a benign disease that can affect her quality of life due to the symptoms and pain, as well as the anxiety and suffering involved in delaying motherhood.

Reproductive medicine can provide these patients with a suitable solution for fertility problems with high success rates.

Dr. Fernando Araico, medical director of Instituto Bernabeu Cartagena

or www.ibbiotech.com/en/

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