• video

Endometriosis and IVF treatment – IVFwebinars #IVFCaseStudy

Studies say that worsening endometriosis definitely affects the success rates for IVF and clinical and ongoing pregnancy rates. Endometriosis is an extremely painful and distressing condition that may affect up to 10% of the female population. Apart from the pain the endometriosis patients face, many women also encounter problems with conceiving naturally. If your endometriosis is untreated, you may only have about 2-10% of chance to conceive each month. How endometriosis causes infertility depends on the stage and severity of the condition.

Is IVF for me if I have endometriosis?

IVF treatment is usually the first-choice option for endometriosis sufferers. IVF can provide hope for women struggling with infertility. If you have been diagnosed with endometriosis or you suspect that you might have it, it is paramount that you find a specialist that understands this condition well. Watch the video above that is the recording from a webinar presented by Dr. Harry Karpouzis from IVF Pelargos on endometriosis and IVF.

You should bear in mind that even if you are not planning on becoming a mother in the near future, it is crucial you seek medical assistance. Untreated endometriosis is going to get progressively worse – start preserving your fertility today. With the right medical care, this debilitating condition does not need to stand between you and your dream of becoming a mother. Good luck!

Endometriosis and IVF – Questions & Answers

Question

What is a “frozen pelvis”?

Answer

This is a pelvis in which all the organs are stuck to each other and nothing is moving – sometimes we do a laparoscopy and we see that the bowels are stuck to the womb, the womb is stuck to the ovaries, and the ovaries are stuck to the tubes. It is not very common, but can sometimes happen in stage 3 or stage 4 disease, and it can be a very difficult surgery to separate all these adhesions.

Question

I read on Instagram that there are only 200 doctors specialising in endometriosis worldwide. That would be very few. Do you think this may be true? I don’t mean IVF doctors, just endometriosis doctors.

Answer

The truth is that a lot of doctors say they are endometriosis specialists but they are not – it depends on the country. For example, in the UK, there are specific doctors who are allowed to treat severe endometriosis – mild endometriosis is not a problem, but stage 3 or stage 4 disease have to be treated by doctors that have vast experience in cases like that. Endometriosis surgery is very difficult and a steep learning curve, and stage 3 or 4 disease, like rectovaginal endometriosis, for example, is not very easy to find, so there are a few centres that have access to all those cases, therefore there are not many doctors are endometriosis specialists. About the number, I’m not sure if that’s the exact number or not, but the truth is, not all the doctors who say they are, are endometriosis specialists. Also, it would be good for an endometriosis surgeon to have some fertility experience as well, or work in a team with a fertility specialist, because you treat endometriosis differently in terms of pain, but also differently in terms of fertility. Sometimes the most important thing in treating fertility in endometriosis is the answer to the question “do we need to operate or not?”

Question

Would surgery be recommended if there are endometriomas but the ovaries are difficult to access?

Answer

Well, yes, but this is another question where we need some more details about this specific case – what is the AMH? What is the age of the woman? Was she operated on before? I cannot give a clear answer, and as I said, we need to treat every case differently. If we cannot do an egg collection because the ovaries are so displaced or we have a high risk of injuring the bowel, then maybe the only option would be to mobilise the ovaries. The decision of whether or not to remove the endometriomas from the ovaries depends on many things: the AMH, whether or not it was operated on before and other factors.

Question

You mentioned that operating on and removing endometriomas can cause an improvement in egg quality, however, I thought poor egg quality is irreversible – please could you clarify?

Answer

Yes, egg quality which is to do with age is mostly irreversible, so if we talk about a patient who is 43 or 44 years old, even if you remove the endometriomas, then this will not change the egg quality. Sometimes, but not always, we find that if we remove an endometrioma in a young patient who does not have any other reasons causing poor egg quality, and we treat the endometriosis, then it can improve the quality of the eggs, because the environment becomes less toxic. In cases like that, when we can see quality problems in young patients and when using normal sperm, it may be a solution.

Question

Do the different stages of endometriosis matter with donor IVF?

Answer

When we talk about stage 3 or stage 4 disease, sometimes this can affect the lining of the womb as well. First of all, a hysteroscopy is very important to find out if the lining of the womb is okay, or if there are any endometrial problems. Also, the fact that there is a generally unhealthy environment in the pelvis can compromise the chances of success of egg donation and generally, we have less chance of success for pregnancy with donor eggs in a patient with endometriosis than without. For example, if there is a hydrosalpinx, then this has to be removed before the donor IVF, but if it is an open tube without hydrosalpinx but there is an element of severe disease in the pelvis, then sometimes the best solution would be not to operate, but to down-regulate and give the patient some pre-treatment for a couple of months before the embryo transfer. Generally, as much as we down-regulate the very unhealthy environment, or as much as we operate on this environment, then this can help with chances of success off egg donation. If we’re talking about stage 1 or 2, then it actually shouldn’t play a big role.

Question

Have you ever seen AMH increase after surgery?

Answer

What happens sometimes, is that immediately after the surgery, we usually have a drop [inaudible] six months, and we may have an increase and it can reach the same levels as before the surgery. Also, it depends on the surgery. Like I said, the technique, the doctor and the way that we remove an endometrioma is very important – if it is done correctly, with proper hemostasis and not a lot of bleeding, then the AMH can come back to the same levels as before. Higher levels? Not sure, but AMH is difficult to test in laboratories as well, and so a result showing a small increase can be insignificant. Here I was talking about surgery of endometriomas (chocolate cysts), but if we’re talking about the disease in the pelvis, without endometriomas, then possibly, if we treat it, then AMH levels can get higher.

Question

A few years ago, a doctor saw on the USG something on my right ovary and said it can be a symptom of endometriosis. He checked the Ca 125 marker on the 3rd day of the cycle, and the level of this marker was too high. Later in the cycle this marker level was okay. The conclusion was that I might have endometriosis. Last year, I had IVF and 4 ETs. Because of this endometriosis diagnosis, I was taking prednisolone before IVF and the ETs, but none was successful. Recently I repeated the Ca 125 marker test on the 3rd day of the cycle and it is okay now. Was the diagnosis of endometriosis incorrect?

Answer

It is not possible to diagnose endometriosis without a laparoscopy, I’m afraid. Ca 125 is a marker, and it can be increased by many things. Even having your period can increase the levels of Ca 125. Also, if it is very highly increased, then we need to check what sort of cyst it is, as the ultrasound only gives us a general view. If you want to know if you have endometriosis or not, then you need to have a laparoscopy to check this, otherwise, the diagnosis cannot be conclusive. If you need to do a laparoscopy before your IVF, then this is something different, and we need to go through your history to find out if this would be the appropriate thing to do or not, because I’m not sure if the reason that the embryo transfers were failing was due to this suspected endometriosis or something else, like the quality of the embryos etc.

Question

Are you able to recommend a particular consultant or hospital/clinic in the UK that specialises in the treatment of endometriosis?

Answer

I was partially trained at UCH, and this is a very good endometriosis centre in London, for example.

Question

What is the difference between endometriosis and adenomyosis and their implications in egg donation outcome?

Answer

Endometriosis is a disease that is causing painful periods, pain during intercourse and is usually in the pelvis, in the ovaries, and inside the womb. Adenomyosis means “thick wall” of the womb – it can be related to fibroid tissue as well as endometriosis. Both of them can play a role in egg donation outcomes – if we are talking about severe endometriosis, then this can affect the chances of pregnancy, as well as adenomyosis – if it affects the endometrium, then it can play a big role, but if it is restricted to the muscle of the womb, they shouldn’t really affect chances of pregnancy unless it co-exists with endometriosis.

Question

Do you work with gynaecologists in other countries if I decide to have IVF in Greece?

Answer

Yes, we do, especially in the UK and for example Belgium, Qatar or Dubai – we have colleagues that we cooperate with abroad to do the initial ultrasounds and scans.

 

 

#IVFWebinars are brought to you with the help of our Partners:
Eizellspende.de
Donor Conception Network UK

About the Author

Harry Karpouzis

Harry Karpouzis

Dr. Harry Karpouzis is an Obstetrics and Gynecology Consultant, specialized in Reproductive medicine/infertility and minimally invasive surgery, with over 7 years of full-time experience in the field of assisted reproduction. Dr. Karpouzis was fully trained and specialised in the UK. He has worked at some of the busiest hospitals in London (Guy’s & St. Thomas NHS Trust, King’s College Hospital, Newham University Hospital, University College Hospital, Homerton University Hospital. He has been a member of the Royal College of Obstetricians and Gynecologists since 2011 and is a scientific director and founder of IVF Pelargos Fertility Group.

Leave a Reply

Your email address will not be published. Required fields are marked *