Endometriosis

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Infertility causes and solutions in the Princeton Packet: Princeton IVF blog

YOUR HEALTH: Infertility: causes and solutions

By Stephanie Vaccaro

Dr. Derman talks about the causes and treatments for infertility

This article recently appeared in the Health Matters Column of the Princeton Packet...

   So You Want to Have a Baby?

   Infertility is defined as the inability to conceive after engaging in unprotected sex for one year, according to the Centers for Disease Control and Prevention.

   What causes fertility problems?

It can be a number of factors. Dr. Seth Derman of Princeton IVF and Delaware Valley OBGYN, said that approximately 40 percent of the fertility issues he sees are due to male problems, 40 percent are due to female problems, and 20 percent a combination of both partners.

   ”The exact cause of male infertility is a little harder to diagnose because it’s not well understood,” Dr. Derman said. “With female infertility, the most common cause is ovulation problems, which usually show up as irregular cycles. Polycystic ovarian syndrome is the most common of these.”

   Fertility problems can be caused by endometriosis. They also can be linked to damage to the fallopian tubes, which can be caused by previous sexually transmitted diseases. This is particularly a problem in women who have had prior Chlamydia infections.

   And sometimes infertility has no identifiable cause.

   What options exist for treatment?

   ”Well, it depends what’s wrong,” Dr. Derman said. “If there’s an ovulation problem, usually the treatment is fairly simple with fertility drugs. These are medications that induce ovulation, such as clomid or letrozole.”

   ”For tubal problems — the treatment is usually surgery or IVF (in vitro fertilization),” Dr. Derman said. “IVF is clearly the most effective treatment for these problems.”

   Oftentimes the most effective option involves treating the female partner. IVF allows for the sperm to be injected directly into the egg, and is the most effective treatment for male infertility. “The poorer the husband’s sperm the more likely the couple will need more invasive treatment such as IVF,” Dr. Derman said.

   A less invasive alternative to IVF is insemination, in which sperm is injected up into the uterus. In contrast, IVF involves fertilization of the egg outside of the body, and the transfer of that embryo into the woman’s womb. It is also much more effective than insemination. When patients have unexplained infertility, insemination is oftentimes done first, and if that doesn’t work then they may try IVF, Dr. Derman said.

   What are the odds of success?

Typical fertile couples have a 20 to 25 percent chance of getting pregnant each month. Infertile couples have a 3 percent chance when trying on their own. IVF increases the odds of having a child to twice what it would be in a fertile couple. Those numbers can vary based on age.

   IVF is very often successful in the first or second cycle, particularly in young women. If it isn’t successful, it’s not unusual for a couple to try three or four times, according to Dr. Derman.

   Who pays for IVF?

In New Jersey, the Family Building Act (August 2001) requires companies with more than 50 employees to cover fertility testing and treatment, including IVF. There are exceptions in the law, and since the passage of healthcare reform, those exceptions have gotten even larger.

   Some of the other treatments can be relatively inexpensive. “For instance, treatment using fertility pills and some monitoring is not terribly expensive,” Dr. Derman said.

   When should you go see a fertility doctor?

   ”Generally, over 35, we recommend coming after six months,” Dr. Derman said. “If they are under 35, one year is the right time.”

   What should you expect when you go see a fertility doctor? When patients go to see Dr. Derman for the first time, the first stage in the process is to try to understand why they are unable to conceive. After getting a detailed history, tests will be ordered, which include testing to make sure their eggs are not running out, to make sure their tubes are open, to make sure the ovulation process is going well and that the sperm is normal. After getting a clearer picture of what is going on, they can better determine the next steps.

   ”Not everybody with infertility needs IVF, even though it is the most effective treatment out there,” Dr. Derman said. “IVF is the last thing that we do, not the first thing.”

 

Endometriosis and pregnancy outcomes

endometriosis-miscarriage-ectopic.jpg

Can endometriosis affect the chances for a successful pregnancy?

A new study from Scotland suggests that it may. It has been known for years that endometriosis can cause infertility, but it was less clear was whether it might affect the outcomes of those who do successfully conceive.

For those who are unfamiliar, endometriosis is a condition in which tissue resembling the endometrium (the lining of the uterus) grows in places where it does not normally belong such as as on the ovary, near the fallopian tubes or in other parts in the peritoneal membrane that lines the pelvis. Besides affecting fertility, endometriosis can result in painful menses (dysmenorrhea) and painful intercourse (dyspareunia). The symptoms of endometriosis are often cyclic, fluctuating along with a woman's reproductive hormones.

In a large study presented at the ESHRE meeting in Lisbon, the group from Edinburgh in the UK, reported that women who with known endometriosis were more likely to have miscarriages and ectopic pregnancies that those who did not. While this does not prove that endometriosis causes poor pregnancy outcomes, it does suggest that women with endometriosis are more likely to experience an early pregnancy loss or ectopic pregnancy.

Endometriosis and pregnancy complications

endometriosis-miscarriage-ectopic-preterm.jpg

It is well known that women who suffer from infertility and become pregnant are more like to have a difficult pregnancy. The rates of a number of pregnancy complications are increased in these women even if the pregnancy was not the result of treatment such as fertility drugs, IVF or IUI.  It is also widely known that endometriosis may cause infertility.  What is less clear is whether is there is a relationship between endometriosis and pregnancy complications.

Now a group from the UK has studied the link  between the two and found that women with endometriosis in fact do have higher rates of pregnancy complications than other women. Their findings were presented at  The European Society of Human Reproduction and Embryology . They found that that pregnant Endometriosis patients were more likely to experience:

  • Ectopic pregnancy 
  • Miscarriage 
  • Placenta previa 
  • Preterm birth  
  • Heavy bleeding before or after birth  

While the study may be small and limited, it does suggest that like infertility, endometriosis in itself may be a risk factor for a complicated pregnancy.