Endometriosis is a condition in which tissue resembling the endometrium — or the tissue that lines the uterus — grows and forms lesions outside the uterus, usually in other areas of the pelvis. These lesions act in the same way as the lining of the uterus during a menstrual cycle. They swell and shed but cannot be expelled properly. This leads to inflammation and causes pain and infertility.
What is in vitro fertilization (IVF)?
How is IVF performed?
Patients with endometriosis wishing to conceive should first meet with a fertility specialist to discuss their options. Their partner should also be tested for sperm viability (sperm count, motility, etc.). If their partner’s sperm is not viable or they do not have a male partner, then patients can discuss using donor sperm.
To collect eggs for the procedure, the patient stops taking any hormonal birth control and then starts injections of fertility medications that cause several eggs to mature at once (hyperovulation). When the eggs are mature — which is assessed by blood tests to check hormone levels, and by ultrasound scans — the patient is placed under light anesthesia. Her eggs are then harvested using a needle inserted through the vagina and guided by ultrasound imaging. This procedure usually takes less than 10 minutes.
The eggs are then combined with a sperm sample (either from the patient’s partner or a donor) in a laboratory.
Depending on the clinic, the embryos that are created may be tested for genetic viability before implantation, which can increase the likelihood of success.
The embryos are placed into the patient’s uterus using a thin tube. The process may feel similar to a PAP smear; some women report feeling mild discomfort immediately following the procedure.
About 10 days after embryo transfer, patients can begin using a home pregnancy test to determine whether they are pregnant. If they get a positive result, or if their next menstrual cycle begins, they should meet with their fertility specialist to confirm the results through blood tests or to discuss options.
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.
IVF research in endometriosis
A retrospective study published by the Cochrane Library reviewed data from published works to determine the effectiveness of administering gonadotropin-releasing hormone (GnRH) agonists for three to six months prior to IVF or intracytoplasmic sperm injection (ICSI), another assisted reproduction technique, in women with endometriosis.
Three randomized controlled trials comprising 165 women were included. The live birth rate per woman was significantly higher in patients who received GnRH agonist therapies compared with the control group. The pregnancy rate was also significantly higher. However, there was not enough data to investigate the effects of the administration of GnRH agonists on multiple or ectopic pregnancies, fetal abnormalities, or other complications.
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