Endometriosis is a disease in which endometrial tissue, or the tissue that lines the uterus, is implanted elsewhere in the body, usually in other areas in the pelvis, and starts growing. The implanted tissue swells and sheds, just like the normal uterine endometrial tissue, but because it cannot be shed normally, it can cause pain, inflammation, and infertility.
Evaluation of fertility
Patients who are struggling to conceive first meet with a fertility clinic doctor, along with their partner, for a fertility evaluation. This can include hormone and other blood tests and checking the male partner’s sperm count and sperm motility. If the doctor decides the chances of the couple conceiving naturally are too low, he or she may suggest one of many assisted reproductive techniques.
Intrauterine insemination (IUI) is usually attempted for patients in the early stages of endometriosis. Patients receive clomiphene citrate (a fertility medication) for five days soon after their menstrual period starts. At the time an egg is released from the ovary, the male partner provides a sperm sample. The sperm is processed and placed into the woman’s uterus using a thin tube during a speculum exam. The process of introducing the sperm feels similar to a PAP smear test.
The likelihood of having a baby with one treatment is approximately 10 percent for women younger than 40. If treatment is not successful after roughly three attempts, the next step may be to repeat IUI in combination with fertility medications or to try in vitro fertilization (IVF).
For patients with endometriosis stage 3 or 4, if pregnancy does not occur within six to 12 months following surgical treatment, IVF is generally recommended. For patients with severe scarring on the ovary or fallopian tubes (the tubes connecting the ovaries to the uterus), doctors may suggest IVF rather than IUI.
Before beginning an IVF cycle, it is important that women discuss their individual chance of becoming pregnant with a physician. Factors such as age and hormone levels can affect the likelihood that pregnancy will result from IVF.
IVF requires a woman to take injections of fertility medications that cause many eggs to mature in the ovaries. When the eggs are ready, the woman is placed under light anesthesia, and her eggs are harvested using a needle guided by ultrasound imaging. This process takes approximately 10 minutes. The eggs are then combined with the partner’s sperm in a laboratory. Most fertilized eggs will grow into embryos. A few days after the eggs are removed, the woman will need to go back to the fertility clinic where one or several embryos will be placed inside her uterus with a thin tube during a speculum exam.
The likelihood of success in a single attempt of IVF ranges from about 50 percent for women in their 20s to less than 10 percent for women older than 40.
Intracytoplasmic sperm injection
Intracytoplasmic sperm injection (ICSI) is a technique that can be used for patients who cannot conceive in other ways, or for women whose partner’s sperm count is too low for IVF or IUI. For the woman, the preparation for ICSI is exactly the same as for IVF. However, instead of just combining sperm and eggs in a dish, the sperm is actually injected into the egg forcing fertilization. The embryo that results is then implanted in the uterus, just like in IVF.
The likelihood of success in a single attempt at ICSI depends on the age of the woman, but the success rate is about 25 percent for one attempt at ICSI.
For women who cannot carry a baby to term, or for whom pregnancy is not recommended by their physician due to health concerns, surrogacy is an option. A pregnancy surrogate is someone who agrees, usually bound by a legal agreement, to carry a baby to term for someone else. Essentially, IVF can be used to create an embryo that is biologically the patient’s and their partner’s, but the embryo is implanted in a surrogate instead of the patient. The success rate of IVF is much higher in a woman who does not have endometriosis.
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