The vocation of every woman is to experience the joy of motherhood, having given birth and raised a child. Alas, many face difficulties in conceiving. A special place among gynecological diseases that cause infertility is endometriosis, a disease affecting 35% of the female population of the planet. Many patients are interested in the question - can you get pregnant with endometriosis or not? We will try to answer it and find out why this disease occurs.
Endometriosis - what is it?
Endometriosis is a disease that occurs in women of childbearing age who have reached 20 years of age. It is genital (localized in the uterus and fallopian tubes) and extragenital (foci of the disease are concentrated in other organs). Also, both forms of the disease can be combined and present in a woman at the same time.
Normally, the endometrium that lines the inner surface of the uterus, during menstruation, is rejected and, together with the secretions, comes out. But the smallest particles with this disease migrate, penetrating into the muscular layer of the uterus or “travel” through the lymphatic system, settling on other internal organs.
In these places, the endometrial tissue expands, swells and begins to bleed synchronously with the menstrual cycle. The blood cannot come out and, as a result, intense pain occurs, adhesions are formed.
Causes of disease
There is no generally accepted view of the cause of the disease. According to most gynecologists, the disease manifests itself under the influence of immune, hereditary and hormonal factors. It is also accepted that an unfavorable environmental situation, a fast paced life and the presence of stressful situations increase the chance of developing the disease.
The likelihood of endometriosis increases if there have been a woman’s life:
- frequent inflammatory processes of the genital organs,
- postponed hard labor
- surgery on the uterus,
- alcohol addiction and smoking
- excessive use of products containing caffeine,
- malfunctions in the functioning of the endocrine system,
- weakening of immunity.
Symptoms and effects of endometriosis
The manifestation of the disease and whether it is possible to get pregnant with endometriosis depends on the extent of the process and its neglect. At an early stage, of all the signs, only premenstrual pain, spot bleeding and minor deviations in the cycle can be present.
In the future, among the most common symptoms note:
- pain accompanying intercourse,
- menstrual disorders, dysmenorrhea,
- very painful periods,
- prolonged and heavy bleeding between periods,
- pain when urinating and stool,
- the appearance of blood in the urine.
Prolonged infertility, especially when combined with other manifestations, is also an indirect sign of endometriosis. The diagnosis can be confirmed by an ultrasound scan 2–3 days before the onset of menstruation, sometimes a diagnostic operation is required.
Without treatment, the disease progresses and may be complicated, leading to the appearance of:
- Adhesions in the pelvis, causing severe pain during menstruation. Their presence often leads to infertility. In addition, they interfere with the normal intimate life of a woman, making sexual intercourse painful.
- Post-hemorrhagic anemia in a chronic form. Monthly menstrual flow becomes profuse, leading to excessive blood loss.
- Oncological neoplasms. Expanding, endometrial cells can be transformed into malignant tumors.
- Disorders of a neurological nature, arising from the infringement of nerve endings. As a result, it can provoke paresis, paralysis of the legs.
Does endometriosis always lead to infertility?
If endometriosis is diagnosed, is it possible to get pregnant?
This disease does not provoke 100% infertility, but simply reduces the chances of conceiving a child.
Interference in this situation often becomes ovarian dysfunction. Follicles do not mature in affected organs, ovulation is absent. But if at least one ovary functions normally and the fallopian tube leading to it is passable, the chances of fertilization remain.
The next obstacle is the defeat of the muscular layer of the uterus. As a result, the egg after fusion with the sperm cannot attach and develop normally. At the initial stage of the disease there is a chance that implantation will occur.
In difficult cases, medical or surgical treatment is required, after which the chances of having a baby are increased. It must be understood that although a woman may become pregnant with endometriosis, she needs the help of specialists during the period of carrying the child to avoid miscarriage.
How to get pregnant with endometriosis of the uterus or ovaries? The solution of the problem depends on the degree of development of the disease, the age of the patient and her hormonal background. First, diagnostics - ultrasound, laboratory tests, if necessary, laparoscopy and hysterography.
For treatment, conservative or operational approaches are used, sometimes they are combined to achieve an optimal result. Some women may become pregnant with endometriosis after taking hormones, others require surgery.
Drug therapy consists of taking drugs containing hormones for 3–6 months. During this period, artificial menopause occurs, leading to regression of the disease. After the end of hormone treatment, the menstrual cycle resumes. A relapse is possible, but during remission there is a chance of getting pregnant.
Surgical intervention involves laparoscopic surgery under general anesthesia. Adhesions are dissected, and endometroid formations are removed. Tissue samples are withdrawn for laboratory testing to confirm the diagnosis and exclude the possibility of oncology.
Among women who have undergone treatment, 60% become pregnant within 6-13 weeks.
Therefore, to the patient's question: “Is it possible to get pregnant with endometriosis of the uterus?” The doctors answer in the affirmative, specifying that the chances of each woman to conceive are different.
If a woman, despite the diagnosis, wants to acquire a child, advances in medicine allow her to do so. Qualified specialists in the field of gynecology argue that with endometriosis can become pregnant, but for successful conception and normal fetal development, you need to undergo a course of treatment.
The sooner the disease is identified, the more likely the birth of the desired child. Therefore, you should immediately contact your doctor when anxious symptoms appear and regularly undergo preventive examinations.
Author: Tatyana Cherednichenko,
specifically for Mama66.ru
Features of the disease
There is no unified theory of the origin of the disease. Some scientists even believe that endometriosis is not a separate pathology of the genital organs, but systemic disorders. Others compare the disease with cancer - when expressed forms of the disease brings no less problems, and the only thing that distinguishes it from a malignant neoplasm - endometriosis does not lead to death.
The incidence of endometriosis is steadily increasing. Perhaps this is due to the improvement of diagnostics and equipment. Approximately one third of women with established pathology have problems with conception and pregnancy. The following facts regarding endometriosis are known for certain.
- There is no radical treatment. The lack of a reliable theory of the occurrence of the disease leads to the impossibility of building an effective treatment plan. All methods and methods that are used can only relieve from the manifestations of the disease for a while. Very quickly foci appear in other places, even if endometriosis was treated surgically.
- There are endometrial cells in the foci. Endometriosis of any location during ultrasound has a tissue that is identical to that in the uterus. Endometrial cells undergo the same cyclical changes. But unlike the uterine cavity, where there is a message with the vagina and this makes it possible to delete its contents monthly, other structures and pelvic organs do not have such conditions. Therefore, the semblance of menstrual blood accumulates or is released into the abdominal cavity. This leads to the formation of cysts (on the ovaries) with thick dark brown and sometimes even black contents. In addition, the "bloody" lesions irritate the tissues every month, causing the formation of adhesions, pain and local inflammation.
- There is a genetic predisposition. It is noticed that the probability of developing the disease is several times higher in women whose grandmothers and mothers suffered from a similar ailment.
- The disease is hormonally dependent. One feature of endometriosis is reliably known - the manifestations of the disease increase with an imbalance of sex hormones and sharply decreases with an excess of gestagens - hormones of the second phase of the menstrual cycle. The latter happens during pregnancy, so often after birth, endometriosis retreats temporarily. Also with the onset of menopause, when the level of sex hormones is minimal, the disease goes away and only some of its consequences remain. All this is used to treat and attenuate the disease, including when planning a pregnancy.
- Surgeries increase the risk of endometriosis. Any surgery, especially on the genitals, increases the risk of endometriosis. This applies to cesarean section, removal of myoma nodes with surgical penetration into the uterine cavity. Endometriosis of the cervix is often formed after cauterization.
Who is at risk
Endometriosis can occur at any time throughout life. The risk group includes the following women:
- if the birth was accompanied by massive ruptures,
- if during labor a manual examination or curettage was performed,
- if a cesarean was performed,
- if endometriosis is in close relatives,
- with numerous abortions,
- in chronic inflammatory processes in the pelvis,
- in conditions of chronic stressful situations.
How to understand that there is a pathology
The clinical picture of endometriosis is nonspecific, but according to the combination of symptoms, it is very likely that a correct diagnosis can be assumed.
- Chronic pelvic pain. This is one of the permanent signs of endometriosis. Painful periods, discomfort in the lower abdomen bother on the eve of critical days and after them. The pain occurs during sexual intercourse, and sometimes intimate relationships become almost impossible. The intensity of the pain varies from insignificant pulling to unbearable.
- Daub. The spotting is a sign of endometriosis of the cervix uterus or adenomyosis (lesions of the muscular part of the body of the uterus). The duration and intensity of daub depends on the severity of endometriosis. As a rule, spotting occurs two to three days or more before menstruation and lasts a week or more after it.
- Violation of cyclical menstruation. Spotting may become more abundant, then it is difficult to establish the time of the beginning and end of menstruation. Also, with endometriosis, women often have hormonal disorders that lead to disruptions of menstruation.
- Abundant menstruation. With the defeat of the uterus (adenomyosis), the volume of blood loss increases during critical days. This is one of the most pronounced manifestations of adenomyosis along with daubs.
- Infertility. Endometriosis of the body of the uterus, cervix, fallopian tubes, endometrioid ovarian cysts, as well as complications of the disease often lead to infertility.
- Psychological problems. Constant pain, discomfort, restrictions in intimate relationships are imprinted on the psycho-emotional state of a woman. It has been observed that the pain threshold may decrease - even minor pains are perceived as very intense. As a result, women with endometriosis are more irritable, quick-tempered, unsure of themselves, hysterical.
- Signs of damage to other organs. Endometriotic foci can appear absolutely on any internal organs and even on the skin (especially in the area of postoperative scars). With the defeat of the bladder in the urine during menstruation appears blood, the rectum - traces of blood in the feces. Often there are foci on the loops of the intestine, peritoneum (covers the abdominal cavity from the inside), described the cases of detection of endometriosis on the liver, brain and eyeball.
Stadiality and degree of illness
Depending on the location, genital endometriosis is isolated (with damage to the genital organs) and extragenital (if foci develop on other organs). According to ICD-10, endometriosis has the cipher N80. Based on the lesion of the intra-abdominal organs, the following stages of endometriosis are distinguished.
- Stage 1 Small foci are found along the peritoneum adjacent to the uterus.
- Stage 2 The defeat of the appendages and fallopian tubes with the appearance of adhesions. Formation of small foci on the parietal peritoneum.
- Stage 3 Distribution of foci in the space behind the uterus (rectovaginal) and in front (vesicovaginal) with the involvement of other organs (bladder, ureter, urethra, rectum, small intestine, including the appendicular process).
- Stage 4. It is characterized by the appearance of multiple foci of endometriosis on all structures and organs of the small pelvis. There are numerous adhesions, deformations of organs (for example, ureters).
As the stage of the disease increases, the clinical picture worsens. At the first, the woman’s quality of life does not suffer; at the fourth, in addition to infertility, questions arise in intimate relationships and disability, for example, due to pain during critical days.
If only the body of the uterus is affected, endometriosis can also have significant consequences for the woman, but the foci on the internal organs and peritoneum will be minimal. In this case, there is a separate classification.
- 1 degree. It is characterized by lesions of the uterus wall at the level of the submucosal layer.
- 2 degree. Myometrium is affected no more than half.
- 3 degree. Endometrioid "moves" reach the outer (serous) membrane of the uterus.
- 4 degree. Characterized by the spread of the process to all layers of the uterus, peritoneum and organs located nearby.
How to identify
Diagnosis of endometriosis is carried out before pregnancy. During gestation, all the symptoms of the pathology are significantly reduced by increasing the number of gestagens during this period. Endometriosis can be suspected on the basis of a woman’s complaints and a general gynecological examination. But the final diagnosis can be confirmed only with the help of certain manipulations.
- Ultrasound of the pelvis. Echo signs of endometriosis are not always visible with ultrasound. Most often, the assumption of the disease can be made with endometrioid cysts and adenomyosis.
- Hysteroscopy. This is an instrumental research method in which a special device (hysteroscope) is placed through the cervical canal into the uterine cavity. This allows not only to examine the endometrium through the eyepieces (or the image is displayed on the monitor screen), but also to cauterize areas of hyperplasia, remove polyps and small fibroids in the submucosal layer that can be detected along with endometriosis and cause infertility. Hysteroscopy helps to detect foci on the cervix and in the cervical canal, as well as in the myometrium (adenomyosis). Hysteroscopy should be performed on the eve of menstruation, then areas of endometriosis look like “honeycombs” with bleeding “snakes”.
- Laparoscopy. This is the “gold standard” not only in diagnosis, but also in the treatment of endometriosis. In addition, planning for pregnancy with clear endometriosis should always include diagnostic laparoscopy. She, like any operation, requires some preparation (diet on the eve, sanitation of the genital tract with candles) and prevention of complications after performing (antibiotics). Laparoscopy is an operation during which manipulators are installed after several punctures, they can be used to view the structures of internal organs and to carry out high-tech interventions. During laparoscopy, you can remove myoma nodes, ovarian cysts. But the main thing is that during the manipulation an enlarged picture several times enters the monitor screen, therefore even the smallest foci of endometriosis on the peritoneum can be identified and removed by cauterization or excision of tissues.
- Abdominal surgery. Sometimes a diagnosis of endometriosis is established during a routine operation, for example, about a rupture of an endometriotic cyst.
- Hysterosalpingography. Helps to clarify the patency of the fallopian tubes in endometriosis.
- Colposcopy. This is a study of the cervix, which, using a magnifying technique, allows to detect foci of endometriosis in it.
- Other methods. Less commonly, there is a need for MRI or CT of the pelvic organs to determine the extent of the process.
Endometriosis and pregnancy: how the disease interferes with conception
Often the question arises whether it is possible to become pregnant with endometriosis, and whether the concepts of adenomyosis and pregnancy are compatible. Приблизительно у двух из трех женщин с бесплодием выявляются те или иные формы эндометриоза, но не всегда именно болезнь — причина невозможности стать мамой.The main problems that can lead to infertility with endometriosis are the following.
- Hormonal disorders. Endometriosis can occur on the background of hormonal changes or cause them yourself. Because of this, the process of ovulation is disrupted, pathology of gestation occurs.
- Ovarian depletion. Detection of endometrial cysts (often they are bilateral) is an indication for their removal. During surgery, it is often necessary to excise most of the ovarian tissue. Even at a young age, this can lead to premature depletion of the ovaries, reducing their reserves. At the same time, the probability of an independent pregnancy decreases sharply.
- Obstruction of fallopian tubes. Almost always, endometriosis is accompanied by adhesions in the pelvis. Outbreaks on the fallopian tubes and adhesions lead to obstruction and the emergence of a mechanical barrier in the path of the spermatozoon to the egg cell. If the lumen of the tubes is not completely blocked, the risk of ectopic pregnancy increases even after treatment of endometriosis. Laparoscopy helps partially overcome adhesions and increase chances of conception.
- Miscarriage Even if the conception has come successfully and the ovum enters the uterus, the implantation process is not always successful - it is introduced into the endometrium. Adenomyosis during early pregnancy can lead to detachment and arrest of the development of the chorion. In this case, hysteroscopy will help reduce the manifestations of internal endometriosis in the uterine cavity and increase the chances of a successful pregnancy, during which you can precisely remove and burn the pathological areas.
A treatment that will help you become a mom
Many women have heard that the treatment of adenomyosis, cervical endometriosis and other localization can be carried out by pregnancy. In fact, during gestation, serious hormonal changes occur in the woman's body. The predominance of gestagen leads to regression of foci of endometriosis, but not to its complete disappearance. This happens during breastfeeding, so women are advised to continue lactating as long as possible.
With adenomyosis and endometriosis, women often lose hope of finding the first signs of pregnancy. At the same time it is difficult not only to conceive, but also to endure. Therefore, it is often necessary to resort to eco-technology. When combining several of the following factors against the background of endometriosis, assisted reproductive technologies should be used:
- age of woman after 40 years
- problems with reproductive function in men (insufficient sperm count, poor mobility),
- multiple miscarriages or miscarriages,
- infertility for more than two or three years during treatment,
- obstruction of the fallopian tubes or lack thereof.
But even IVF guarantees a successful pregnancy only in 50-60% of cases. Therefore, couples should not waste precious time on unsuccessful treatment of endometriosis for many years - the reproductive age of a woman is short.
Is it possible to conceive naturally?
If endometriosis has become the cause of infertility in a woman, she should undergo a comprehensive treatment to increase the likelihood of conception and gestation. It includes the following points.
- Extended laparoscopy and hysteroscopy. To determine the prevalence of endometriosis and eliminate obstacles to conception, laparoscopy is performed. At the same time, hysteroscopy and hysterosalpingography are performed on the tubal patency. Thus, during one operation, it is possible to remove foci on the peritoneum and pelvic organs, remove endometrial cysts (if any), examine the uterus for polyps, hyperplasia and remove as much as possible foci of endometriosis inside the uterus. The duration of such an operation varies from an hour to two or three; it is performed under general anesthesia. But the result after such an intervention is worth it.
- Long-term hormonal treatment. To consolidate the effect and increase the chances of a successful pregnancy for three to six months, the girl is prescribed hormonal treatment. The choice of drugs and schemes depend on the age and severity of the disease. Conventional contraceptives are used (for example, Janine, Yarin, Jess), gonadotropin agonists and antagonists (Buserelin injections), progestin drugs (good effect after Dyufaston, Visanna, Mirena tablets).
- Additional treatment. In combination with the main therapy, vitamins (especially A, E, C), homeopathy, folk remedies (various herbs, fees, bee products, candles with mummy) can be used. In some cases, hirudotherapy helps - treatment with leeches, however, it is necessary to take into account contraindications to the procedure. Useful nutrition and normalization of body weight. But it’s not worth waiting for the lesions to resolve - as an independent treatment, all these methods are ineffective, the result is noticeable only in combination with the main therapy and surgical interventions.
How does the carrying
Pregnancy symptoms in adenomyosis and in healthy women are no different - signs of toxemia appear, basal temperature rises, according to analyzes, the level of chorionic gonadotropin increases. If conception on the background of endometriosis occurred independently or after treatment, the risk of complications increases most in the first trimester. This is due to the fact that during this period there is a promotion of the ovum through the fallopian tubes, then its introduction into the wall of the uterus.
After the second trimester, in most cases, gestation takes place without deviations. However, diffuse adenomyosis and endometriosis of other departments increase the risk of missed abortion and miscarriage, as well as ectopic pregnancy.
Endometriosis is a serious disease, the causes of which remain unknown until now. Pathology brings a lot of inconvenience and problems for a woman, including, can cause infertility. Treatment of endometriosis during pregnancy is carried out by the body itself - a certain hormonal background helps reduce the symptoms and size of lesions. But often, for conception, serious surgical interventions, long-term hormone therapy are required, and the whole preparation process may take several years.
What is endometriosis - a form of the disease
Endometriosis is a benign tumor-like hormone-dependent disease.
The disease develops due to the growth of tissue similar to the endometrium outside the uterus: in the muscle layer of the uterus, on the ovaries, fallopian tubes, peritoneum, intestines, bladder, other pelvic organs, distant tissues ...
Forms of endometriosis
Any classification of this disease is very conditional. Indeed, internal endometriosis (adenomyosis) is more than 70% of cases combined with extragenital or external genital endometriosis. When endometriosis of the ovaries, fallopian tubes are often found endometriotic lesions of the intestine, small pelvic peritoneum ...
Causes of endometriosis
There are many theories of the development of this complex disease. Let's name the most popular:
- Retrograde menstruation is a “reverse” discharge of menstrual blood with endometrial particles into the abdominal cavity through the fallopian tubes.
- Damage to the integrity of the transition zone of the myometrium: due to injury, inflammation, birth defects.
- The transfer of endometrial cells into various organs through the blood and lymphatic vessels.
- Mechanical skidding of endometrial microparticles into the surrounding tissues during gynecological surgical procedures and operations on the uterus.
Endometriotic cells in the foci of endometriosis are very similar to normal endometrial cells. Finding themselves outside the uterine mucosa, they are fixed and grow deep into the tissue “occupied” by them, they form infiltrates, nodules, cysts.
As in the usual endometrium, a part of the cells in the foci of endometriosis are rejected every month - “menstruate”. In response to local “monthly micro bleeding,” the border tissues inflame, swell, and become damaged. There is pain, intoxication.
Gradually around the center of endometriosis, adhesions, scars are formed. These processes affect the quality and movement of the eggs, the activity of sperm. Not surprisingly, the natural conception in endometriosis is difficult or impossible.
Endometriosis is a chronic inflammatory process that leads to the development of local hormonal and immune disorders, growth of adhesions, dysfunction and destruction of the affected organs, infertility.
Symptoms of endometriosis
- Chronic pelvic pain syndrome:
- pulling pains in the abdomen,
- painful menstruation,
- painful intercourse,
- ovulatory pain in the middle of the menstrual cycle
- back pain.
- Disruption of the menstrual cycle:
- with endometriosis of the uterus: hyperpolymenorrhea, dark brown spotting from the genitals before and after menstruation.
The main complaint of patients with endometriosis is infertility (up to 80%). Therefore, every patient with pregnancy failures is checked for endometriosis.
Diagnosis of Endometriosis
- Ultrasound of the pelvic organs - the main method of primary detection of signs of the disease.
- MRI - on accuracy surpasses ultrasound. In endometriosis of the uterus, MRI clarifies the ultrasound diagnosis.
- HSG - hysterosalpingography - a contrast X-ray method of examination, which reveals internal endometriosis (adenomyosis), intrauterine adhesions, evaluating patency of the fallopian tubes.
- Hysteroscopy with biopsy of the part of the uterine wall suspected of endometriosis.
- Laparoscopy with biopsy and subsequent histological examination of tissue suspected of endometriosis.
Laparoscopy remains the most accurate method for identifying extragenital and external genital endometriosis. This therapeutic and diagnostic operation is also prescribed for limited forms of endometriosis of the uterus: nodular adenomyosis and focal adenomyosis.
Can I get pregnant with endometriosis
Of all the patients who applied to the Centers for Assistive Reproductive Technologies (ART), one in three suffer from endometriosis.
How exactly endometriosis of light and moderate degree prevents the onset of pregnancy - sufficient explanations NO
Possible causes of unsuccessful pregnancy in endometriosis:
- Obstruction of the fallopian tubes:
- blockage or narrowing of the lumen of the fallopian tubes with sprouted endometrioid tissue,
- peritubar adhesions - overlap of the tube lumen by adhesions,
- impaired conductivity of the fallopian tubes under the influence of toxic products of endometriosis.
- Decreased functional ovarian tissue (reduced ovarian reserve):
- due to ovarian destruction by an endometrioid cyst,
- due to excision of ovarian tissue during surgical treatment of a cyst.
- Endometrial dysfunction, violation of embryo implantation in the uterine lining:
- due to local imbalance of hormones and changes in the biochemical composition of the endometrium,
- due to the deformation and damage to the inner surface of the uterus by crypts and mouths of endometrial passages.
- Hormonal imbalance, menstrual disorders due to breakdown of the neuroendocrine system of the hypothalamus - pituitary - ovaries:
- Anovulation (3.5%),
- LNP syndrome (2-3%),
- violation of the secretion of gonadotropic hormones and the synthesis of sex hormones in the ovaries,
- Changes in the immune and biochemical properties of peritoneal fluid:
- inactivation of abdominal sperm,
- "Poisoning", reducing the quality of eggs and embryos by endometriotic tissue.
- Early pregnancy termination (miscarriage) due to convulsive muscle contractions of the uterus.
- Pathology of stem cells associated with the development of endometriosis.
However, endometriosis, for reasons still unknown, does not always cause infertility. Therefore:
- In mild forms of the disease, expectant management is recommended.
- If a natural pregnancy does not occur within 5 years, you should proceed to ART.
External endometriosis and pregnancy
In endometriosis of the fallopian tubes, endometrioid ovarian cysts (endometriomas), abdominal adhesions, retrocervical endometriosis, the chances of a spontaneous pregnancy are increased by therapeutic and diagnostic surgery: laparoscopy.
If laparoscopy is contraindicated, surgical intervention is performed by laparotomic access: through the abdominal incision.
Why start infertility treatment with surgery?
- During laparoscopy (laparotomy), a revision of the pelvic cavity is performed, adhesions are dissected, excised, cauterized, and the found foci of endometriosis, endometrial ovarian cysts are removed.
- The operation makes it possible to visually assess the state of the female reproductive organs and determine a number of fertility index indicators (EFA).
Infertility treatment for ovarian endometriosis
If the fertility index in endometriosis is low, then the patient after laparoscopic surgery is recommended not to waste time and immediately proceed to the procedures of ART: IVF, ICSI or VMI.
What is IVF
In vitro fertilization is a widely used method of assisted reproductive technology.
The essence of the method: fertilization (insemination) of eggs artificially extracted from the ovary by a specially prepared partner's sperm “in vitro”, or rather, outside the woman’s body, followed by transferring (replanting) of developing embryos into the uterine cavity.
What is ICSI
The ICSI method is intracytoplasmic sperm injection. This is a modern modification of IVF.
The essence of the method: artificial insemination of one egg by a single sperm cell, by introducing it into the egg with the help of the thinnest micromanipulation needle. The procedure is performed under a microscope.
What is VMI
Intrauterine insemination is the oldest method of ART, which has not lost its relevance today.
The essence of the method: artificial introduction into the uterus received in advance specially treated sperm.
Assisted reproductive technologies for endometriosis Back to table of contents
How does endometriosis and its types
The symptomatology of endometriosis depends on the area of manifestation of the pathological process and the general condition of the girl. According to medical practice, there are cases when the disease proceeds without symptoms, and the gynecologist can diagnose it during a routine examination.
The development of endometriosis is characterized by the following symptoms:
- The appearance of pain in the pelvic region - this symptom manifests itself in 25% of women. The pain is clearly localized in a certain place for a long period.
- Painful sensations of a cyclical nature that accompany menstruation - the symptom worries 50% of patients. A pronounced manifestation occurs on the first day of the menstrual cycle as a result of the action of the following factors: the formation of spasms in the uterine vessel, bleeding in the abdominal region, increased pressure.
- Discomfort during sexual contact is present when the pathology affects the uterine ligaments or vagina.
- Disruption of the menstrual cycle:
- prolonged, copious menstruation,
- the presence of brown discharge after menstruation,
- reduction of the menstrual period
- severe bleeding.
- The most dangerous symptom is problematic conception and gestation. This feature is present in 40% of girls.
In the presence of severe complications, the manifestation of specific symptoms is observed:
- formation of urine in the urine,
- impaired defecation
- cough, accompanied by hemoptysis.
Endometriosis is considered to be a chronic disease - this is due to the absence of the acute phase. The most common classification consists of two types, each of which includes the following subspecies:
- The genital form is divided into three forms: internal, peritoneal, extraperitoneal. The first subspecies - adenomyosis involves the proliferation of foci inside the uterus, while penetrating deep into the mucous tissue. When the peritoneal form affects other organs of the reproductive system: the cervix and tube of the uterus, ovaries, vagina. Extraperitoneal subspecies involves damage to external organs.
- Extragenital appearance is diagnosed in the case of the formation of pathological foci in the intestines, lungs, bladder.
What causes the disease
First of all, endometriosis affects the uterus, as well as the nearest genitals. Endometrial tissues are sensitive to hormone cells, so in remote areas covered with mucous, the following changes occur:
- Endometrial tissues in the uterus grow and become dense - this is due to the release of estrogen cells in the first days of the menstrual period.
- The second half of the period is characterized by the influence of progesterone, which destroys the newly formed layer. This process is accompanied by inflammation and bleeding.
Thus, endometriosis of the uterus leads to the formation of a cyst, improper functioning of the organs of the reproductive system, and in severe cases it threatens the possibility of conception of the fetus and the normal course of pregnancy.
Endometriosis treatment with pregnancy
It is believed that endometriosis is effectively treated with pregnancy.This view is based on the fact that pregnancy helps stabilize the functioning of the uterus by stopping the production of hormone cells that contribute to the progression of the disease.
Despite this, medical experts believe that it is impossible to cure this pathology by pregnancy: a positive effect will be observed until ovulation occurs. In this regard, this method is inefficient.
Planning a pregnancy - is it possible
The negative impact of endometriosis on pregnancy is due to the high probability of miscarriage, and later infertility. According to medical statistics, 40% of girls suffer from problems related to conception throughout the year. Against the background of endometriosis, the reproductive function is significantly reduced:
- The resulting adhesions in the tubes of the uterus lead to disruption of the passage of the egg, thereby interfering with the conception.
- The excess in the female body of prostaglandins provokes the formation of numerous microspasms that violate the transport function of the tubes of the uterus.
- Hormonal imbalance and reduced immunity interfere with the normal course of ovulation. Pregnancy is possible with full stabilization of hormonal levels.
- Neoplasms in the form of endometrial cysts have a negative effect on pregnancy. If the fertilization process is successful, there is a possibility of abortion.
The reproductive function of the girl is significantly reduced, but with effective treatment the body quickly recovers and returns to its former form. Pregnancy with endometriosis of the uterus is allowed if the patient takes a course of hormonal medications. If the process of natural fertilization is unsuccessful, the doctor advises to apply the method of extracorporeal conception.
Pregnancy after treatment
The treatment of endometriosis is a long and complex one, since surgical and conservative intervention is used. By composing an individual technique, the doctor necessarily takes into account the biological age, which is used to determine the possibility of becoming pregnant, as well as the severity of the pathology.
Conservative therapy is the use of hormonal drugs. In order to become pregnant after endometriosis was not difficult, it is necessary to eliminate iron deficiency anemia using iron-containing medications. To improve the patient's general condition, the doctor prescribes the use of painkillers, hemostatic, and immunity enhancing agents.
Surgical intervention is carried out in the case of the formation of adhesions. In most cases, the doctor uses the method of laparoscopy, which effectively removes the lesion on the affected tissues, but does not injure the body. Pregnancy after treatment of endometriosis proceeds with positive dynamics and without serious complications.
How is pregnancy and childbirth
Endometriosis during pregnancy is not treated: conservative and surgical methods can have a negative impact on the development of the fetus. According to medical practice, there is an exception, which is the development of an endometrioid cyst that affects the ovary. In order for a woman to be able to bear the fetus, it is necessary to perform surgery in the fourth month of pregnancy.
Carrying a child, accompanied by endometriosis, should be under the close supervision of medical professionals. In order to maintain pregnancy, the girl must take hormonal medications. There are cases when in the early stages there is a threat of miscarriage due to progesterone deficiency, which ensures the correct development of the fetus. If the placenta is formed, the pregnancy proceeds positively.
Thus, endometriosis suggests the following adjustments during pregnancy:
- With the development of pathology significantly increases the chance for such an outcome as an ectopic pregnancy. For the timely detection of abnormalities, the patient is recommended to do an ultrasound scan,
- Medical professionals should monitor hormonal levels to avoid increasing the tone of the uterus. Otherwise, the girl will not be able to give birth,
- The weakened state of the uterus can cause its rupture as a result of fetal growth. For the complete safety of future mothers, they determine on inpatient treatment,
- in endometriosis, the process of labor is much more complicated: since the uterus is not elastic, it is recommended to give birth with a caesarean section.
Will the operation help you get pregnant?
Modern medicine is impossible without surgical operations, which are divided into conservative intervention and radical intervention. Most often they are combined and used as the most gentle method.
In endometriosis, laparoscopy is most often performed, during which tumors are cauterized by a special laser. If the disease is accompanied by severe complications, the doctor uses a laparotomy method - cutting the abdominal wall. After surgery, the patient needs to drink a drug course, undergo physiotherapy procedures to consolidate a positive result. In general, the operation eliminates the unpleasant painful sensations, stops the inflammatory process, restores the reproductive function, which allows the patient to get pregnant.
IVF as a variant of the long-awaited child
The program of in vitro fertilization is made individually for each patient, based on her biological age, the number of unsuccessful attempts at conception, her state of health, the severity of the disease. IVF is contraindicated in diagnosing external endometriosis. In this case, the woman is an effective method of treatment, aimed at reducing the symptoms, as well as the removal of tumors.
If the pregnancy after treatment has not come, the girl is prescribed an in vitro fertilization procedure. Patients older than 30 years old, the procedure is carried out after surgery and hormonal drugs. If the patient is at the age of 23-27 years old, doctors recommend not to hurry with IVF and try to conceive a child in a natural way.
Endometriosis in the final stages of development is not an obstacle to the implementation of in vitro fertilization. As a rule, the procedure is appointed immediately after passing special tests and thorough examination.
Reviews gave birth
Endometriosis does not exclude the probability of getting pregnant, but it greatly reduces the likelihood of a successful conception. I have been healing for four years, but so far unsuccessfully. Three pregnancies ended with a fading fetus.
Ekaterina, 34 years old
When I was diagnosed with endometriosis, I was 10 weeks pregnant. After reading reviews from other girls, I was very scared, because in most cases the pregnancy proceeds with complications. The treatment took place with the help of potent hormonal drugs. The delivery was successful, but I could not re-get pregnant.
Veronica, 27 years old
It turned out to get pregnant with endometriosis. The pregnancy was successful, despite the fact that I spent a long time in inpatient treatment, during which there was enough time to find out from other patients about their course of the disease. In most cases, the pathology disappears during childbirth, and is announced only after the birth of the baby. That's when you need to start treatment.
Can I get pregnant with endometriosis of the uterus
Endometriosis of the uterus is a pathological process that affects the body of the organ, causing soreness and an increase when the endometrium grows deep into the muscle layer. The disease has 4 stages, each of which differs in the germination depth of the endometrium.
This disease adversely affects the ability of a woman to give birth to a child, because the foci of the disease emit substances that are a kind of poison for the embryo. In addition, adhesions formed in the pelvis, destroy the reproductive system.
Given that pregnancy with endometriosis of the uterus is not always possible, additional symptoms of the disease can be:
- uterus soreness
- increasing its size
- discharge of blood-bloody character, which are observed before and after menstruation.
Despite the fact that there are still chances of getting pregnant with endometriosis, at different stages of the disease a woman may experience frequent bleeding in the interval between periods, anemia, fatigue, and drowsiness.
To endometriosis of the cervix and pregnancy did not end badly for a woman, it is necessary to undergo medical examination in a timely manner, because very often such a disease is diagnosed during a visit to the doctor when a woman is not disturbed.
How to get pregnant with endometriosis
Despite the fact that endometriosis is often diagnosed in women who are screened for infertility, endometriosis affects the fertility function of not every fair sex.
According to medical statistics, more than 50% of girls are able to carry a child with endometriosis, and for this, not everyone even needs to undergo treatment.
But it is also worth noting that ovulation and endometriosis are closely related to each other (as a result of the progression of the disease, ovulation may disappear altogether). If during the course of the pathological process ovulation cannot be maintained, it is pointless to talk about pregnancy.
Also among the factors affecting the ability to get pregnant, it is necessary to include a no less dangerous problem - adhesions. It is these structures that clog the uterine "passages", through which sperm must reach their "goal".
Very often, even with small adhesions, pregnancy occurs, but not where it should occur, but in the fallopian tubes, and this at least ends in a miscarriage.
Therefore, in order to become pregnant, you must first undergo a full examination, appropriate treatment, consultation with the attending physician, and then proceed to conceive in compliance with all the recommendations of leading experts.
How is pregnancy proceeding with endometriosis?
In healthy pregnant girls and those suffering from endometriosis, the pregnancy is the same. In both cases, women complain of toxicosis, an increase in basal temperature, an increase in hCG.
If endometriosis was diagnosed during pregnancy or before the conception was performed, the disease was treated, the risks of miscarriage may occur in the first three months of pregnancy.
This is due to the fact that it is in the first trimester that the fertilized egg moves through the fallopian tubes, after which it is embedded in the walls of the uterus.
If the most dangerous period of pregnancy has passed without negative consequences, then you should not worry further about the course of pregnancy. As a rule, no deviations are observed in the following months.
Despite this, chronic endometriosis and pregnancy require increased control by the obstetrician-gynecologist, because the disease can progress with incredible speed, affecting more and more other departments.
All these factors can lead to a fading of pregnancy, spontaneous miscarriage, in the early stages of ectopic pregnancy.
Pregnancy planning for endometriosis
As we noted earlier, getting pregnant and carrying a fetus before the expected date of delivery in combination with endometriosis is very difficult, but possible.
Such a disease can aggravate the situation, because he is able to make his own adjustments to the process of maturation of the egg and its passage through the fallopian tubes. This can not affect the conception of endometriosis.
If the course of the illness has been delayed for a long time, the probability of the formation of adhesions increases, which is fraught with sterility.
At the same time, girls who have a diagnosis of endometriosis become pregnant and bear a healthy child. Sometimes the disease is diagnosed even in those women who did not experience any problems with conception and did not complain of discomfort and other symptoms.
There were also cases when women, who couldn’t become pregnant for other reasons for a long time, finally experienced the joy of motherhood after endometriosis.
Pregnancy after endometriosis
Modern medicine at this stage of its development has achieved amazing results, which allows to cure endometriosis of the uterus and pregnancy as close as possible.
In addition, therapeutic measures are aimed not only at eliminating the foci of the disease, but also at eliminating adhesions, which prevent sperm from entering the “cherished goal”.
Getting pregnant after endometriosis is not just possible. The chances of restoring fertility after undergoing a course of treatment for an ailment increase significantly, reaching 50% or even higher.
If a woman is planning a pregnancy, it is necessary as soon as possible after therapy, after consulting with your doctor, to begin conceiving.
Features of childbirth
Unfortunately, despite the progressiveness of modern medicine, not all girls with endometriosis manage to conceive and give birth to a baby, many have no choice but to live with the terrible diagnosis “infertility”.
Despite this, a miracle still happens. That is why it is important for every woman with this disease to know what the pathological process can lead to and how to behave when you are “in an interesting position.”
There is an opinion that if a woman with endometriosis gives birth to a child, she will be able to completely get rid of the illness, and there is some truth in this. This is due to the fact that after the birth activity, the progressive disease can be transformed into a “sleep stage”, but, as a rule, the calm period does not last long.
In any case, a pregnant woman needs the entire period of childbearing to visit the gynecologist's leading pregnancy and adhere to all his appointments, after which she goes to give birth under the same close supervision of obstetricians.
According to doctors, pregnancy and childbirth of patients with endometriosis carry a certain danger, namely:
- childbirth can start early
- may require a caesarean section,
- if the birth is premature (up to 20 obstetric weeks), the probability of stillbirth is high,
- preeclampsia is possible in the second and third trimesters,
- prenatal hemorrhage can happen,
- as a result of complicated birth, the fetus can earn congenital abnormalities.
How to cure endometriosis and get pregnant
If it was possible to diagnose the disease in its early stages, treatment may consist only in the use of hormonal drugs. But such treatment is very long - at least six months.
In addition to hormone therapy, doctors may prescribe surgery, but this is in exceptional cases.
If it was not possible to state the disease in time and the disease developed into a severe form, laparoscopy will be required. This method of treatment is simple and does not carry any danger, it is unlikely to be injured during its implementation.
The essence of the procedure lies in the fact that by small perforations the doctor assesses the degree of damage to the mucous surfaces, after which he immediately removes the foci of the disease.
The indication for laparoscopy is most often obstruction of the fallopian tubes. Pregnancy after the treatment of endometriosis with such methods comes quite successfully, the fetus is successfully nurturing during the period.
But it is also worth noting that after endometriosis treatment, pregnancy may not occur. Then a visit to the doctor and an additional examination are required. In such situations, doctors prescribe additional therapeutic courses.
If additional activities do not give proper results and pregnancy does not occur, to talk about the natural conception, unfortunately, is not necessary. With this outcome, doctors offer only artificial insemination - IVF.
The use of drugs
As we have said, conservative treatment methods consist in hormone therapy, which lasts for six months or longer. This treatment normalizes the production of estrogen and improves the functionality of the ovaries. Also, hormonal drugs reduce inflammation.
If we consider endometriosis as a polysystemic disease, the prescription of other pharmacological substances is also justified, for example:
- immunomodulatory drugs.
Below in the table you can learn more about the drugs and the effect they allow to achieve.
When does the disease occur?
At the moment, it is impossible to pinpoint the causes of endometriosis. This is due to the impossibility of determining the mechanisms of its development. And this is at the modern level of medicine. Among the most possible reasons when a disease can develop, note the following:
- genetic predisposition
- hormonal disbalance,
- bad ecology,
- immune imbalance
Important! In medicine, there are cases when the disease is diagnosed in girls who have not had their first menstruation and in women who have already had menopause, but often this disease is found in girls of reproductive age.
Около 10-15% всех женщин репродуктивного возраста, сталкиваются с этой проблемой. Бывают случаи, когда внутренний эндометриоз, ошибочно считают миомой матки, из-за очень схожих механизмов развития заболевания.
As factors that increase the risk of endometriosis, the following can be noted:
- late childbirth,
- diatermocoagulation of the cervix,
- cesarean delivery
The degrees and types of endometriosis of the uterus
In medicine, there are 4 degrees of the disease:
- Endometrium grows in one or two places on the surface layers of the uterus.
- There is one focus in deep tissues.
- Numerous lesions in the deep layers of the reproductive organ, minor intestinal adhesions, cysts on the ovaries.
- Large ovarian cysts, fusion of internal organs appear.
- genital - affects the reproductive system,
- extragenital - other human organs are involved in the pathological process.
Genital is divided into:
- internal (adenomyosis) - the process takes place in the uterus, affecting its deep layers,
- outer - affects the cervix, ovaries, vagina.
Despite the fact that the disease has long been known, it is still not clear whether pregnancy treats endometriosis. A reliable fact is the improvement of health in the waiting period of the child.
At this time, the cyclical fluctuations of the female and male hormones (estrogen and progesterone) stop, the mucous tissues remain in a stable position.
Causes of development
The causes of the pathology is still not well understood. The growth of mucosal cells is influenced by the menstrual cycle.
At this time there is a change in the balance of hormones.
At the beginning of the cycle, the female hormone estrogen dominates, under the influence of which the mucosal tissue grows rapidly and gradually thickens.
From the second half of the cycle, the body gets under the action of progesterone. Cell growth stops, vessels expand.
There are some assumptions about what causes the disease:
- endometrial cells penetrate into other organs along with blood flow during operations, injuries and menstruation,
- transformed from uterine epithelial cells,
- the endometrium grows from germinal tissue that was not involved,
- abnormal narrowing of the cervical canal.
Some factors contribute to the development of pathology:
- inflammatory diseases of the genitourinary system - infectious, venereal, bacterial,
- a large number of abortions
- use of intrauterine device,
- endocrine system diseases
- hormonal imbalance
- stressful situations
- surgery on the organs of the reproductive system.
Before a routine physical examination, a woman most often does not suspect the presence of the disease. But some signs indicate a possible pathology.
- prolonged heavy menstruation,
- painful periods,
- spotting mid cycle
- the cycle has no pronounced beginning and end,
- pain during intercourse,
- pain in the pelvic region, which increases before menstruation,
- pain during urination and bowel movements,
- pronounced PMS,
- anemia, which manifests itself in weakness, drowsiness, dizziness,
- the appearance of adhesions in the pelvic organs.
Women often feel pain in the lower back and abdomen before menstruation, which gives to the rectum, genitals and thigh.
Severe symptoms observed in any course of the disease.
Are endometriosis and pregnancy compatible?
Pathology adversely affects the possibility of conception, reducing the chances by half. It is reliably known why pregnancy does not occur with endometriosis.
This happens for several reasons:
- lack of ovulation - menstruation goes at one time, but this happens because of the rejection of pathological tissues. Ovulation does not occur, because the egg can not leave the ovary or pass through the fallopian tubes,
- in adenomyosis, the egg is fertilized, but its attachment is difficult. Often, with a similar pathology, an ectopic pregnancy occurs.
- an excess of the female hormones estrogen and estradiol inhibit the functioning of the corpus luteum.
However, the possibility of conception is preserved, and depends on the individual characteristics of the organism. If overall health is good, ovulation and successful conception occur.
If a woman managed to become pregnant with endometriosis, it is necessary for her to be observed by specialists from the first days in order to avoid spontaneous interruption.
Before conception, it is necessary to undergo a medical examination, consult with a gynecologist and undergo a course of treatment. In addition, the doctor will tell you how the pregnancy proceeds with endometriosis in general terms and what to expect in a particular individual case.
Usually, conception eliminates the symptoms of the disease, since during this period hormonal changes occur, the abnormal growth stops.
The patient's condition improves, and stable remission occurs.
Compatibility depends on the degree of the disease:
- When retrocervical form hampered the possibility of conception and safe carrying.
- In case of genital third and fourth degree, conception and gestation are impossible due to pathological changes in the internal organs.
Often a woman learns about the disease during a pregnancy and does not know what endometriosis is. She needs to follow the recommendations of the doctor and strictly follow the medical instructions. In this case, the child will be born without complications.
What is dangerous endometriosis uterus during pregnancy
With endometriosis, pregnancy planning is essential. This will help you get pregnant successfully, avoid complications with health and give birth to a healthy baby in time.
For a safe delivery, a caesarean section may be recommended.
The main question for women is how to maintain a pregnancy with endometriosis, because all the dangers are reduced to one threat - to lose a child.
Preventive measures include:
- regular check-ups at the gynecologist,
- follow-up with a doctor in the postoperative period (abortion, cesarean section),
- timely treatment of inflammatory gynecological and venereal diseases,
- rejection of the use of intrauterine device.
What is endometriosis?
Endometriosis is as common and mysterious as the disease. For some not entirely clear reasons, the endometrial tissue that lines the uterus from the inside begins to behave strangely. In excess, it grows in the body of the uterus, on other genitals - on the cervix, in the tubes, ovaries, or even begins to “travel” around the body, and it is found in completely unexpected and inappropriate places for this — in the intestine, urinary tract, lungs, and even in the tissues of the eyes.
Everything would be fine, but the endometrium is a special tissue, which is conceived by nature to receive a fertilized egg and create comfortable conditions for it. For these purposes, each month at the beginning of the cycle, the endometrium actively grows and is compacted under the influence of the hormone estrogen. At about the 15th day of the cycle, another hormone, progesterone, is connected to the process: endometrial tissues begin to secrete a lot of mucus, the vessels dilate and become full-blooded to provide the best possible reception for a new life. If conception did not occur - by the end of the cycle the content of both hormones sharply decreases, the overgrown layer of the endometrium collapses and is rejected - menstruation begins.
Excessive growth of the endometrium inside the uterus or its presence in other organs leads to pathology - endometriosis. Like the normal mucous membrane of the uterus, such tissues grow at the beginning of each cycle and collapse during menstruation. This can lead to the formation of adhesions and endometrial cysts.
Endometriosis is a dyshormonal, immune-dependent and genetically determined disease, which is characterized by a benign growth of tissue similar in morphological structure and function to the endometrium, but outside the uterine cavity. Endometriosis belongs to the most common gynecological diseases, especially often it occurs in women aged 20-40 years. According to the localization of foci, it is divided into genital and extragenital.
Genital endometriosis is internal - when tissue grows in the body of the uterus, isthmus and interstitial parts of the tubes, and outer - when the vaginal part of the cervix, vagina, ovaries, tubes and peritoneum of the pelvis are affected.
Extragenital endometriosis is a lesion of all other organs, except the sex organs. Endometriosis lesions are subject to hormonal influence during the menstrual cycle and it is these cyclical changes that cause the main symptoms and complaints of women suffering from this pathology.
Causes of Endometriosis
There is no unequivocal opinion on why endometriosis occurs in the medical community. It is assumed that during the menstruation the endometrial cells get from the fallopian tubes into the abdominal cavity, or they are carried through the body with the lymph and blood flow from the uterus.
There are cases of endometriosis in men treated with estrogen, which proves the hormonal nature of this disease.
The occurrence of endometriosis is explained by several theories, and none of them has been clearly proven. At present, the theory of the displacement of endometrioid particles “inwards” has become the leading one, that is, with the retrograde flow of menstrual blood through the fallopian tubes into the peritoneum, viable cells of the uterine mucosa in menstrual blood are attached to the peritoneum and expand. It is established that this phenomenon is especially common during abortions and medical interventions (curettage of the uterus, cesarean section).
However, due to the prevalence of endometriosis in girls, a genetically determined theory of the origin of endometriosis is currently coming to the second place: changes occurring at the stage of fetus formation in the womb. Often at a young age, the disease is combined with malformations of the genital organs.
Risk factors for endometriosis include:
hormonal disorders, when receptors pick up hormones with increased activity,
frequent intrauterine interventions,
chronic stress state of the body.
Congenital disorders, cautery erosion and other development theories
The development of endometriosis explains several theories, but none of them is considered absolutely proven.
- The most common implant theory is considered. Studies have shown that endometrial particles penetrate into the internal organs through the fallopian tubes with blood released during menstruation.
- According to the traumatic theory, the formation of lesions in the peritoneum occurs as a result of surgical operations on the uterus, such as:
- abortive intervention
- cauterization of erosive areas of the mucous membrane,
- cesarean section.
- traumatic labor.
- Embryonic theory implies that endometrial foci in distant tissues are formed as a result of impaired embryonic development.
This theory confirms the detection of the disease in girls who have not yet had menstruation.
Some experts believe that the particles of the endometrium move through the blood or lymph vessels.
This theory explains the detection of pathological lesions in organs distant from the uterus - the lungs, the nasal cavity, and even the eye tissues.
Hormonal disorders play an important role in the development of pathology. So, with a decrease in the amount of progesterone in the body and an overabundance of estrogen, the inner lining of the uterus grows excessively. Endometrial particles are introduced with the menstrual blood into neighboring organs, forming the affected areas.
Another important factor is a violation of immunity.. Normally, the body is protected from foreign agents, including from formations that are not characteristic of a particular organ or tissue. With inadequate functioning of the defense system, endometrial cells freely take root almost anywhere.
In addition, scientists have identified a number of factors that provoke the emergence and further development of endometriosis:
- early onset of monthly bleeding,
- genetic predisposition
- gynecological diseases
- inflammatory processes in the internal organs located near the uterus,
- late start of sex life
- late first childbirth,
- hypodynamia (muscle weakness),
- excessive exercise
- thyroid disease,
- bad habits,
- unfavorable ecological situation
- abnormalities of the structure of the uterus.
Typical and specific symptoms
The clinical picture of the disease is largely due to the specific localization of the pathological foci of the endometrium and the general state of health of the woman. In some cases, the disease is asymptomatic, especially at the initial stage. In this case, it is possible to detect endometriosis only on a regular preventive examination or when referring to a gynecologist because of difficulties in conceiving a child.
As the pathological process develops, the following characteristics appear:
- Pain in the pelvic region. This symptom is observed in 16-24% of patients. Pain syndrome is constantly present, with a clear localization or, conversely, spilled character.
- Cyclic pain associated with menstruation. Occur in half of the patients. Especially strong pain syndrome is observed in the first three days of menstruation and is associated with factors such as:
- spasms of uterine vessels,
- the outpouring of blood from the affected lesions to the peritoneum,
- increased pressure and blood flow to the cyst.
- Unpleasant and even painful sensations during sex. More often, they appear in the occurrence of lesions in the vaginal epithelium and on the ligaments of the uterus.
- Changes in the normal course of the monthly cycle:
- prolonged and too "strong" menstruation,
- weak brown discharge before and after menstruation,
- short periods,
- mid-cycle bleeding.
- Problems with conception and childbearing. This symptom occurs in 25–40% of female patients. Possible causes of infertility are ovarian dysfunction, low immunity and impaired ovulation.
In addition to the characteristic signs of endometriosis, in some cases such specific symptoms appear as:
- bleeding in stool and urine,
- violation of defecation
- navel bleed
- bloody tears.
These signs are rare (or extremely rare) and depend on the localization of areas affected by the endometrium in the female body.
Diagnosis: laparoscopy and other procedures and analyzes
If the doctor suspects endometriosis in a woman, then he first analyzes complaints and anamnestic data. The specialist is interested in such important points as:
- the beginning of the monthly and features of their flow,
- the timing of the occurrence of pain, their localization,
- Does the pain increase before menstruation, during stool,
- previous gynecological diseases, surgery, uterine trauma,
- Did maternal relatives suffer from endometriosis?
After making a preliminary diagnosis, the doctor conducts a further examination of the patient, which includes the following diagnostic procedures:
- Gynecological examination, involving mandatory two-handed palpation of the vagina. It is necessary to determine the size of the uterus, its cervical, ovaries, the condition of the uterine ligaments and appendages. The procedure is uninformative, however, it allows the doctor to make an assumption about the presence of areas affected by endometriosis in the internal genital organs.
- Ultrasonography of the pelvis, which is advisable to perform before the next menstruation. Research helps to discover:
- enlarged uterus
- pathological thickening of uterus and other internal organs,
- large foci of affected tissue.
- Computed tomography and MRI (magnetic resonance imaging) are performed to identify the affected areas, their size, location, and the relationship with other nearby organs.
This method is considered very informative - accuracy is about 96%.
- hysteroscopy - the study of the uterus,
- colposcopy - examination of the mucous membrane of the vagina and uterine cervix,
- laparoscopy - examination of the abdominal cavity,
- colonoscopy - examination of the rectum,
- cystoscopy - the study of the bladder.
- intrauterine adhesions,
- plots of experimental fluid spilled into the peritoneum
- increase in the size of the uterus.
- Symptoms and signs
- What is this disease
- Causes of Endometriosis
- Why can not get pregnant with endometriosis
- Prevalence of disease
- Complications of pregnancy with endometriosis
- Pregnancy rate
- Infertility formation mechanism
- Decreased ovarian reserve
- Violation of the anatomical structure of the genital organs
- Changes in the composition of peritoneal fluid
- Immunological disorders
- Predisposing factors
How does endometriosis manifest itself? Symptoms and manifestations
Symptoms of endometriosis in women:
- Pain syndrome. Intense pain can be at the beginning of the cycle, during the entire period of menstruation, after intercourse and even during the act of defecation.
- Disorders of the menstrual cycle. But not in a widely accepted sense, when menstruation is not regular or absent, but in the form of spotting bleeding (before and after menstruation, after sex), by its texture and color resembling chocolate paste.
- The appearance of peri-ovulatory (in the period of ovulation, approximately in the middle of the cycle) bleeding is a peculiar marker of endometriosis.
- The combination of these signs with the absence of pregnancy within 1 year of conscious pregnancy planning.
Often the disease is formed in women, even if the family already has a child.
Why not get pregnant with endometriosis?
Endometrium is one of the important links for the onset of pregnancy. It consists of two layers of cells: the basal and functional. The functional layer during the cycle undergoes a continuous transformation required for the implantation of the ovum.
Each new endometrial cycle is prepared to embryo the embryo and ensure its nutrition at first, for which it is thickened, expands, and is stored with nutrients. And when the body realizes that conception did not happen - the inner layer is rejected and goes out with menstrual secretions. The same thing happens with endometriosis lesion cells located in the abdominal cavity. But unlike the endometrium of the uterus, menstrual-like discharges remain under a thin layer of epithelium, which covers the site of endometrioma. Islets of pathological tissue cause pain, local inflammation and irritation of the organ on which are localized. In addition, endometriomas are hormonally active. The secreted hormones violate the endocrine balance of the reproductive system, which negates the possibility of becoming pregnant with endometriosis.
Prevalence of disease
According to statistics, every tenth woman in reproductive age suffers from endometriosis, the incidence of the disease is from 2 to 10%. If we consider patients with infertility, then every third woman has endometriosis (25-35%). And in women with pelvic pain, endometriosis is diagnosed in 39-59% of cases.
Complications of pregnancy with endometriosis
In some cases, untreated endometriosis can become pregnant, more often it occurs in the early stages of the disease. But in the early stages it is possible to terminate the pregnancy due to the failure of the endometrium of its functions as a result of hormonal imbalance.
If the islands of the endometrial tissue are located in the uterus, this causes the embryo to migrate in search of a better place for implantation. This situation leads to an ectopic pregnancy, which is doomed to interrupt, where the fertilized egg does not stick: in the tube, cervical canal, peritoneum. There is a risk of internal or external bleeding. That is why, in order to become pregnant, endometriosis must be cured at the planning stage of conception.
The incidence of pregnancy with endometriosis
A healthy woman in the natural cycle can become pregnant with a probability of 15–20% per menstrual cycle. The probability of pregnancy with endometriosis decreases significantly and amounts to 2-10%. When performing intrauterine artificial insemination in healthy women, the pregnancy rate is 12%, and using the same fertilization technique for endometriosis, it is possible to become pregnant with a probability of 3.6%, that is, the pregnancy rate is reduced 3 times.
2. Violation of the anatomical location of organs
When the foci are located on the peritoneum and fallopian tube, as well as during the formation of the scar, the tissues move towards the pathological formation. This condition is called adhesions. Because of him, the fallopian tube may be passable, but removed from the ovary. After ovulation, the oocyte cannot cover the distance and enter the fallopian tube.
3. Changes in the composition of peritoneal fluid
Normally, there is a small amount of fluid in the abdominal cavity, which is formed from blood plasma.
Endometriomas — foci of endometrioid tissue — release specific substances into the peritoneal fluid: prostaglandins, proteases, tumor necrosis factor, interleukin-1. These pro-inflammatory substances in a toxic way affect the sperm cells, eggs, worsening their quality and viability. Reduces the likelihood of fertilization. And if conception occurs, they have a toxic effect on the embryo itself. In some cases, even after surgical treatment, the effect of substances persists for some time, and it is impossible to get pregnant.
4. Immunological disorders
The natural reaction of the immune system to the appearance in the internal environment of the body of a foreign agent is the appearance of antibodies. In the case of endometriosis, antibodies to endometriod cells appear. But the inner wall of the uterus - the endometrium consists of very similar cells, and protective agents of the immune system begin to attack the cells of not only endometriosis, but also a healthy endometrium. This leads to a violation of the mechanisms of embryo implantation, the receptor apparatus of the endometrium is destroyed.
Predisposing factors for endometriosis
The question arises - why some women do not have endometriosis and they can become pregnant, in others it occurs and interferes with conception. A number of conditions contribute to the occurrence of the disease.
- Immune system disorders.
- Menstruation delays at elevated levels of estrogen, hyperestrogenism supports the existence of these lesions.
- Early onset of menstruation and short cycles (the more often menstruation occurs, the higher the chance of developing the disease),
- Abnormal development of the uterus and the bend of the uterus posterior. Endometriosis is common if the uterus is located in retroposition. In this position, the refusal of menstrual discharge into the abdominal cavity is more likely.
- The presence of the disease in the next of kin. Women with endometriosis who have female children should be aware that their daughters are likely to develop the disease. This should cause wariness, mothers need to know what the sooner their daughter gives birth, the less problems she will have with pregnancy.
- Overweight: adipose tissue - an endocrine organ that produces estrogens. Remember that estrogens support the growth of endometriotic tissue.
- Inflammatory diseases of the pelvic organs (contribute to violations of local immunity).
- Common factors are smoking, stress, environmental influences.
Endometriosis is a benign tumor that can degenerate into cancer in 1% of cases. Even if there is no question of infertility and the possibility of becoming pregnant, it is still necessary to treat it. Endometrial cysts themselves do not regress (do not reverse development, do not disappear).
In the presence of genital endometriosis, diagnosed by ultrasound or during laparoscopy, surgical treatment is indicated. The purpose of radical therapy is to remove pathological foci, restore the anatomical location of organs, separate adhesions, carry out the collection of pathological tissue for histological examination.
Removal of small foci, without the formation of cysts (endometriosis stage 1-2) leads to the onset of spontaneous pregnancy for 1 year and improves the outcome of the treatment of pain, which greatly improves the quality of life.
According to the results of numerous studies at stage 3-4 of the disease (cysts on the ovaries from one or two sides) after surgical removal, the probability of becoming pregnant is low, therefore, women with reduced ovarian reserve are recommended to prepare for the IVF or IVF ICSI protocol immediately after the operation.
There are relapses after surgical treatment. The following recommendations are recognized worldwide:
If the endometrioma is less than 4 cm, then the patient is sent immediately to the IVF program, because a second operation can further reduce the ovarian reserve. The effectiveness of IVF in relapses of the disease is not worse than if the patients were operated on again.
To get pregnant with endometriosis need to be treated. Do not be afraid of prompt removal of cysts and lesions of pathological tissue, they cause infertility and early miscarriage. The postponement of the operation leads to a loss of time, destruction of the ovarian tissue - reducing the supply of eggs and their quality, reducing the likelihood of pregnancy, early climax.