Endometriosis Infertility
The endometrium is the inside lining of the uterus which is shed and regenerated with every menstrual cycle. When endometrial tissue is located outside of the uterus, the diagnosis of endometriosis is made. Such tissue may be pathologically located on various pelvic organs such as the uterus, tubes, and ovaries, as well as bowel and bladder. When present in the pelvis, endometrial tissue may lead to an inflammatory reaction which has been shown to affect the reproductive process at various levels from egg development and ovulation to fertilization, embryo travel through the fallopian tube, and uterine implantation. Furthermore, endometriosis may lead to scar tissue (adhesion) formation within the pelvic cavity, which in turn may lead to blockage of the fallopian tubes as well as debilitating pelvic pain.
The treatment of infertility associated with endometriosis often depends on the patient’s symptoms, and findings on hysterosalpingogram (HSG). Treatment may range from surgical fulguration (burning)/resection (usually by laparoscopy) of endometriotic implants to pituitary downregulation and superovulation with intrauterine insemination or in vitro fertilization (IVF). Occasionally, combination treatment with various modalities is employed to achieve pregnancy. Infertile women with endometriomas (endometrial implants within the ovary which have grown into cysts visualized by ultrasound, also known as “chocolate cysts” due to their chocolate-colored cyst content consistent with old blood) present a unique challenge as a careful evaluation for ovarian reserve and consideration of clinical findings such as endometrioma size and pelvic pain must be made before proceeding with surgical resection.
Endometriosis may present itself in multiple forms of varying severities, and treatment must be customized for each patient based on history, symptoms, and clinical findings. The California Center for Reproductive Health employs only safe and proven methods in establishing a clear diagnosis of endometriosis and administering appropriate treatments. Patient with endometriosis suffering from infertility are treated with specific stimulation protocols which have been validated to have superior success rates. Important ovarian reserve tests are performed to determine how aggressive fertility treatments should be (not every patient with endometriosis will need IVF). Every effort is made to avoid surgical resection of endometriomas in order to prevent deterioration of ovarian reserve and damage to healthy ovarian tissue.
FAQ
Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.
Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.
However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.
Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).
Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.
At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.
Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.
Additional work up is then individualized to direct the best possible treatment option for each couple.
In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.
The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.
Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.
While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.
Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.
At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.
The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.
Our clinic’s success rate consistently beats the national average year after year.
Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).
After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.