Adenomyosis and endometriosis lead to the development of temporary or permanent infertility, and the treatment of these ailments takes a lot of time. Not always a woman is ready to wait for this period, and only after that start planning a pregnancy. On the help in this case, it would seem, can come IVF with endometriosis. But is this really a solution? Is it possible to carry out the procedure of in vitro fertilization with this diagnosis.
Is it possible to conduct?
In general, adenomyosis and IVF are poorly compatible. Of course, it can be done, but doctors do not recommend it for two reasons. First, the chances of success of the procedure are very low, and secondly, it is not worth getting pregnant with this diagnosis, if the patient has a choice, since the pregnancy is difficult, it can be interrupted, etc.
Is it possible to do IVF for endometriosis? Doctors recommend waiting with the procedure to complete cure, even for women of older reproductive age. The treatment of this disease is not so long that during this time significant changes in the reproductive ability of the woman could occur.
Why not get pregnant with endometriosis? What can be dangerous such carrying:
- Spontaneous abortion,
- Miscarriage in the early stages,
- Freezing pregnancy at any time,
- Incorrect placenta previa
- Insufficient blood supply to the placenta.
Moreover, all these dangers arise regardless of whether the conception occurred naturally or artificially. These phenomena adversely affect both the health of the mother and the fetus, because natural conception or IVF is better to postpone until cure.
In what cases is conducting possible?
After cure of this disease, the procedure of in vitro fertilization can be carried out without fear. The chances of success in this case will be almost as high as that of women who could not tolerate the disease before. Therefore, when it is impossible to self-pregnancy and there are no specific contraindications, after the treatment of endometriosis this procedure can always be carried out.
But in what cases it is advisable to carry out such intervention in developing adenomyosis? Doctors recommend doing it only in the following, exceptional cases:
- Treatment is, but does not bring results, and the woman, at the same time, is in the older reproductive age,
- In the pelvis there are adhesions that are to be surgically removed, but the intervention is not recommended,
- There is anovulation that cannot be cured by hormones (that is, the eggs do not mature as a result of hormonal imbalance),
- Immunoresistance is a condition in which the endometrium rejects the embryo and does not allow it to attach.
IVF after treatment is recommended by doctors in the following cases:
- For more than two years after cure, an independent conception has not come,
- The presence in the pelvis active adhesive processes,
- There is anovulation,
- As a result of the treatment, it was not possible to get rid of the immunoresistance of the endometrium to the embryo, or it developed just against the background of such therapy.
Of course, the question of the feasibility of IVF is decided individually in each case. On what dangers are there, and what are the chances of success, you will notify the doctor reproductologist.
Chances of success after treatment
If the procedure is carried out after the diagnosis is cleared, that is, the disease is cured, then the chances of success of in vitro fertilization are quite high. They are almost as tall as women who have not experienced a previous illness. However, there is a risk of endometrial immunoresistance. This is a condition in which the endometrium prevents the embryo from adhering, rejecting it as a foreign organism.
It is worth noting that although such a phenomenon sometimes occurs, in fact it is quite rare. And, usually, it can be diagnosed even before fertilization is carried out.
Preparing for IVF with endometriosis, as without it, is quite long. This is an important part of the process, without which the success of the procedure is impossible. While the procedure itself is merely a mechanical manipulation, all other processes are performed by the patient’s body. It depends on his condition whether the embryo will get accustomed or will be rejected, etc.
The main stage of preparation is hormone therapy. At first the hormonal background is normalized. At this stage, by the way, endometriosis degradation may occur, since this is a hormone-dependent process that develops with hormonal imbalance. Normalization occurs by taking hormonal preparations of the combined composition. Such therapy lasts from two to six months.
Sometimes before eco for adenomyosis, surgery is performed, during which nodes and cysts are removed if they have formed. Foci usually do not cauterize, so the presence of scars adversely affects the likelihood of embryo attachment. Also during the intervention, spikes and scars are excised, if they are large enough.
After surgery, the therapy is carried out with deposited drugs that reduce the level of estrogen. As soon as it remains at a stable level, they are directly prepared for conception, that is, they stimulate superovulation, under which the embryo can adhere and develop.
The procedure itself goes in several stages:
- Getting eggs
- Getting sperm,
- Embryo cultivation,
- Transplantation of the embryo into the uterus using a catheter, through the cervical canal,
- The introduction of drugs to increase the likelihood of survival.
Further, only the current diagnosis of pregnancy is carried out.
Contraindications to this procedure are divided into relative and absolute. In the presence of absolute contraindications IVF can not be done. But with relative, this issue is solved individually for each patient. For absolute contraindications include:
- Pathology of development of the uterus, when pregnancy is impossible for objective reasons,
- Cancer of the cervix or ovaries,
- Pathology of the uterus or ovaries of another type,
- Heart defects,
- Complicated diabetes
- Renal or hepatic failure.
With such diagnoses, IVF is not performed because it will pose a real threat to the life of the woman, as it can cause progression of the disease. In this case, the procedure chances of success are minimal.
In the presence of relative contraindications, the issue of in vitro fertilization is decided by the doctor on an individual basis. These are contraindications such as:
- Benign neoplasms and tumors in the uterus,
- Syphilis in the acute stage
- Active tuberculosis,
- Infectious diseases,
- Exacerbation of chronic diseases.
In some cases, the doctor may recommend surrogacy instead of IVF.
The effect of endometriosis on the reproductive system
Any imbalance in the reproductive system of a woman can cause irreversible processes.
The proliferation of the internal endometrium lining the uterus, provokes inflammation, which further contributes to the beginning of adhesions, infertility.
The causes of endometriosis are not fully understood, but the main prerequisites for its development are:
- hormonal imbalance
- traumatic endometrial disturbance of the uterus by scraping, abortion,
- uncontrolled wearing of an intrauterine device and taking contraceptives.
Pathology is characterized by unexpressed symptoms, the main of which are considered a cycle failure, acyclic bleeding, problems in the process of carrying a child and infertility. Even with a successful conception, the disease is the cause of spontaneous miscarriage, placental abruption, abnormalities in the development of the fetus.
Pathological changes in the endometrium reduces the chances of attaching the ovum to the uterine walls, the inflammatory focus in the abdominal cavity leads to the formation of adhesions, causing obstruction of the tubes. There is a violation of fertility, ovulation processes, menstruation.
The reproductive system can be improved with hormone therapy in only one third of all cases of endometriosis. The therapy started in the early stages of the development of pathology allows restoring the cycle, normalizing ovulation, and making conception possible. In other cases, treatment with hormones does not bring results, surgical cleaning is used, which eliminates the pathological growth of tissue, but does not contribute to fertilization, since the adhesive process remains.
Chances of successful IVF
Adenomyosis and IVF are compatible concepts, but with this pathology, the likelihood of successful fertilization is significantly reduced:
- in the first and second stages of endometriosis, successful attachment of the egg is observed in no more than 30% of women,
- on the third and fourth - a maximum of 14%.
Successful conception depends not only on the degree of the disease. The following factors also matter:
- general health of a woman
- lifestyle, bad habits,
- background and associated diseases.
Artificial insemination today is the most effective way to become pregnant with infertility. After treatment of endometriosis, doctors resort to expectant tactics, when for 12 months women are advised to have sex without contraception. If a pregnancy does not occur after a year, IVF or insemination is prescribed (with preserved patency of the tubes).
Features of the procedure
Artificial insemination is not always appointed immediately after the diagnosis of the disease. It is carried out on the basis of the following nuances:
- At the initial stage of the pathology, a waiting tactic is chosen for one year. At this time, the couple carries out attempts at natural conception.
- If obstruction of the tubes is diagnosed, pre-stimulation of ovulation and further insemination is performed by the partner’s sperm. This method is most successful in half of all cases.
- Expectant tactics do not use in women older than 35 years. At the age of 40–45 years, IVF is prescribed immediately after laparoscopy and prior hormonal treatment.
- In the final stages of endometriosis, superlong protocols are used for up to 6 months. During this time, ovulation is stimulated, experts are seeking a large number of healthy eggs, so the chances of successful conception increase.
The follicular reserve is also taken into account. It is determined by the anti-Muller hormone (AMH) and the number of antral follicles. In order for implantation to be successful, drugs may be prescribed to restore uterine blood flow, which is important for carrying the implanted embryos.
Will the result
On average, the success of in vitro fertilization with endometriosis is 14–50%. Chances are higher in women with good tubability and a large follicular reserve.
Before the procedure begins, it is important to obtain a healthy egg cell and to prepare the uterine cavity as much as possible for successful embryo attachment. For this purpose, always use the extra long or long protocol of IVF, ovarian hyperstimulation, so that the female reproductive system is ready for the onset of pregnancy.
But even after that it is not always possible to save the child. It all depends on the characteristics of the mother, her age, the presence of chronic diseases, congenital abnormalities of the structure of the uterus and other organs.
It is strictly forbidden to carry out artificial insemination with diabetes in severe form, liver failure, ulcerative colitis, mental disorders and anatomical anomalies of the genital organs.
Unfortunately, the IVF procedure does not always give a result, therefore we recommend that you familiarize yourself with the nuances of menstruation after unsuccessful IVF.
Advantages and disadvantages
The main advantage of the procedure, which allows to prescribe IVF to women with diagnosed endometriosis, is the ability to become pregnant with relatively short preparation time. The long protocol is performed for 3 weeks, after which embryo transfer is possible.
In older age and in the presence of 3-4th stage adenomyosis, a superlong protocol is used, which involves the use of the same drugs, but for up to 3-6 months.
The disadvantage of the procedure is the presence of contraindications. It is impossible to prescribe IVF for problems with the liver, kidneys, stomach, and insulin-dependent diabetes.
With a favorable course of endometriosis, pregnancy often occurs naturally in 8–12 months after treatment. Only if this does not occur, apply the IVF procedure, insemination (sperm injection with a syringe) or ICSI.
A significant problem of in vitro fertilization in women with endometriosis is the low quality of oocytes, embryos, as well as inadequate implantation. The chances of conception increase if therapy with drugs that inhibit the growth of endometrial formations is carried out for 3–6 months.
Artificial replanting of an already fertilized egg is sometimes the only way for a woman to become a mother. To date, more than 7 million people have been born under this methodology. The procedure makes conception possible not only for endometriosis, but also for other diseases of the uterus and obstruction of the tubes.
How to prepare for IVF for adenomyosis
The main form of preparation for IVF with this ailment is its treatment, which includes several steps:
- 1. Therapeutic treatment of hormonal drugs in order to suspend the formation of estrogen (steroid hormones).
- 2. Laparoscopy is a minimally invasive treatment method in which appropriate preparation of the uterus is made for replanting through simple surgical procedures: elimination of local lesions in the nodular form of the disease and dissection of adhesions to ensure the patency of the fallopian tubes.
IVF protocol for uterine adenomyosis
At the end of hormonal therapy, IVF is carried out in accordance with the stimulation protocol chosen by the gynecologist-reproductologist.
At the first two stages of the disease, as a rule, a long protocol is prescribed, the purpose of which is to suppress the hormonal background with a further decrease in the level of estrogen.
In the case when the disease has passed into the third or fourth stage, an ultra-long protocol is used, which differs from the previous stimulation scheme by the duration of administration of hormonal agents, as a result of which a temporary menopause is created.
To carry out IVF with adenomyosis is not an easy task. We have to confront the mysterious pathology, which seems to be aimed at suspending the continuation of the genus: the disease appears in the reproductive period of the woman’s development and leaves with the onset of menopause. However, by joint efforts of the patient and high-class specialists, using modern methods of treatment, it is possible to achieve pregnancy after IVF with adenomyosis.
Diagnosis and treatment of endometriosis
According to modern medical standards for accurate diagnosis of endometriosis, laparoscopy or hysteroscopy is necessary to see foci, take a biopsy and perform a microscopic examination. But often the complaints and the course of the disease are so specific that the diagnosis is justifiably made according to the clinical picture.
Endometriosis often reduces the chances of conceiving and carrying a pregnancy. It is associated with various complications that accompany or are part of endometriosis. 80% of patients have adhesions and deformation of the fallopian tubes. For more subtle changes include reducing the level of LH in the blood and the follicle itself. In addition, the level of the female sex hormone estradiol increases, which impairs the function of the corpus luteum.
In addition, numerous studies conducted in patients undergoing IVF on the background of endometriosis showed that during IVF in women with endometriosis, the quality of oocytes (oocytes), their ability to fertilize and the ability of the resulting embryos to implant are reduced.
Finally, since with endometriosis there are immune abnormalities in the body, antisperm antibodies are often detected in the blood and in the peritoneal fluid of women.
As for the state of the uterus itself, inferiority of the endometrium (uterine mucosa), as well as autoimmune processes in it, are often identified.
To combat endometriosis as such and as the cause of infertility, a combination of surgical and hormonal treatments is currently used. Perform laparoscopy, removing as much as possible foci of endometriosis. Then, hormone therapy is prescribed to temporarily suppress the production of estrogen. To do this, use modern drugs - analogues of gonadotropin-releasing hormone, such as Buserelin, Dekapeptil and others. Since the drugs are available in various forms, the doctor has the ability to vary the route of administration, which is justified from a clinical point of view.
The most convenient form of deposited drugs. The depot provides a constant concentration of the drug in the blood for a long time, which is necessary for the disappearance of foci of endometriosis.Statistics carried out in many IVF centers (including in the MAMA clinic) shows that the percentage of pregnancy in the IVF cycle after a course of hormonal therapy in patients with endometriosis is significantly increased.
IVF protocols for endometriosis
Endometriosis usually uses “long” or “extra-long” protocol schemes, although, as usual, the approach to choosing a scheme remains strictly individual.
With a “long” stimulation protocol, the introduction of agonists begins on the 21st day of the previous menstrual cycle. Use as a daily injection, for example, Diferelin in a dose of 0.1 mg, and a single injection of Diferelin-depot in a dose of 3.75 mg under the skin of the abdomen. Stimulation of superovulation starts from 3-5 days of the menstrual cycle. Daily intramuscular injections of gonadotropins in individually selected doses are used. Stimulation is carried out under the control of hormone levels and ultrasound, until the leading follicles reach a diameter of 18-20 mm. On this day, appoint an ovulatory dose of CG. After 35-36 hours after administration of CG, puncture and collection of eggs are performed. Fertilization, cultivation in an incubator and embryo transfer into the uterus are carried out according to the usual rules.
In the "superlong" protocol, gonadotropin-releasing hormone agonists are administered for several months (from 2 to 6). Assign several (according to the clinical picture) injection, for example, Diferelin-depot or Decapeptila-depot every 28 days, and then begin to stimulate superovulation. At the same time, the activity of the ovaries is suppressed more deeply, which is of great importance especially for patients with endometriosis.
Unfortunately, statistics show that with endometriosis, implantation of embryos occurs somewhat less frequently than with other forms of infertility, for example, tube-peritoneal. This applies even to patients with 1-2 degrees of endometriosis. The reasons may be a decrease in the quality of oocytes (ova) or because endometriosis disrupted the structure of the uterine mucosa and caused an accumulation of substances toxic to the embryo in the uterus.
Despite the urgency of the problem of infertility in women with endometriosis, especially during IVF treatment, there is still no consensus on how to carry out hormonal and laparoscopic treatment before IVF, on conducting immune correction, on the features of IVF protocol, etc.
Nevertheless, many IVF clinics conduct both clinical and laboratory studies aimed at optimizing the achievement of pregnancy with IVF in women suffering from endometriosis.
What are the chances of conceiving and successful pregnancy?
The success of IVF depends on how common endometriosis is. Important stage of the disease.
The first and second stages.
The highest chances of becoming pregnant up to 30% can be expected in the first or second stage of the disease. They are characterized by small single lesions of the ovaries. The deep layers of uterine tissues are not affected.
The chances of fertilization are reduced to 14% in the third stage of the disease. The ovaries are affected bilaterally, adhesions develop actively, capturing the myometrium or the tissue of the abdominal cavity.
The fourth stage of endometriosis is the hardest. In the adhesions involved not only the uterus, but also the intestine and bladder. The ovaries are affected by large cysts. In this state, pregnancy occurs only in 8% of cases of IVF.
Successful gestation also depends largely on the degree of development of the disease. And the worse the condition of the patient, the harder it is to bear the fruit.
What thickness should be the endometrium for successful conception?
Endometrium may have a different thickness, it depends on the day of the cycle. On day 5, the thickness is 3 mm, and on day 27 it can reach 17 mm. Deviations are also possible if the cycle is long. For conception to be successful, the 15th day of the cycle is considered the most favorable day.
These indicators are very important for artificial insemination. When the embryo is inserted, a new stage begins (day 23), when the thickness does not exceed 2 cm and the egg of egg can attach to the wall of the uterus.
What procedures are performed before IVF?
Before artificial insemination, a woman suffering from endometriosis must be trained. Preparing for IVF with endometriosis in each case is individual.
For example, if the disease is in the first or second stage of development, and the patient is not 35 years old, then surgical intervention is performed, followed by therapy with medicines.
But if a woman is already 35 years old or she is in the third or fourth stage of the disease, then in vitro fertilization can be carried out only after a full clinical examination and surgical treatment, if there is a need.
Before IVF, women are prescribed the following tests:
- Blood test,
- Analysis of urine,
- Biopsy (if necessary).
All this helps to assess the condition of the patient's uterus, and with the help of a biopsy, they check the body for the presence of cancer lesions and infections, as well as to determine the cause of bleeding. Often before IVF spend scratching. This procedure involves scratching the endometrium. It is believed that the scratches on the mucous layer of the uterus help the embryo to settle down.
How does IVF affect endometriosis
Pregnant patients suffering from endometriosis during pregnancy should be constantly monitored by a doctor. This is because under these circumstances miscarriages often occur.
During pregnancy, the hormones of a woman change, and this slows down the progression of the disease. This can be called natural therapy, which lasts throughout pregnancy. Estrogen is produced in small quantities, and progesterone is produced actively, which contributes to treatment.
With normal lactation, natural therapy is prolonged for the period of breastfeeding. This is due to the fact that prolactin, a hormone of lactation, suppresses the production of estrogen.
Of course, it will not be possible to fully recover from the disease during pregnancy, however, it is often possible to achieve long-term remission, and the foci of the disease suppress their activity.
Thus, endometriosis is a disease that affects the uterus and adjacent tissues, causing infertility. It is possible to get pregnant with this pathology, and if the pregnancy does not occur naturally, IVF is indicated. The success of this procedure depends on the stage of the disease.
Concept of adenomyosis
What is it and how to deal with it? Adenomyosis is a pathological condition of the uterus in which endometrial cells grow uncontrollably, damaging a thin layer of connective tissue that separates the endometrium from the walls of the uterus, and then grow into the muscular layer of the uterus, thickening it around the adenomatous foci, which leads to deformation of its inner surface and its formation spherical uterus. Everyone knows that during menstruation, the cells of the inner layer of the endometrium are rejected and removed from the uterus through the genital tract. But in case of adenomyosis, not all cells are removed from the uterus and thus cause inflammation, the formation of cystic tumors and adhesions, which is clinically manifested by abundant painful menstruation and intermenstrual bloody discharge. The reason for the development of such a state has not yet been clarified, but the factors that lead to its formation are:
- small gynecological operations that violate the integrity of the inner layer of the uterus - curettage of the uterus, abortion ...
- traumatic labor
- hormonal changes
- genetic predisposition.
IVF and adenomyosis
Before you understand what features of in vitro fertilization for adenomyosis - first of all, you need to understand its main form of manifestation.
- Focal adenomyosis, in which there is a punctal lesion of the uterus
- The diffuse form of adenomyosis is observed when endometrial cells appear in the wall of the muscular organ in the form of pockets that end blindly, of different depths and without clear lesions, which aggravates its treatment and diagnosis.
- Nodular adenomyosis, in contrast to the previous ones, is characterized by the formation of nodes, the contents of which are blood or exudate, while the cells of the glandular epithelium also grow into the muscle tissue.
- Mixed form occurs most often, while in itself it combines all previous forms of manifestations.
As for the damage of muscle tissue, it is customary to allocate four degrees of damage depending on the depth of penetration of glandular cells into the myometrium. If only the submucosal layer is affected, then it is classified as a first degree. With the defeat of muscle tissue less than half - the second degree. If endometrial cells penetrate into the myometrium more than half of it, then it is distinguished as a third degree. And finally, with the defeat of the entire thickness of the myometrium and the germination of serous cover, sometimes with the spread to the peritoneum or adjacent organs, then indicate the fourth degree of adenomyosis.
IVF for adenomyosis is performed only after a reliable diagnosis and a course of treatment. First of all, it is necessary to determine the form of pathology, which appeared in the woman’s body and prevents her from becoming pregnant and carrying out the child, the depth of its distribution. For this purpose, inspection using mirrors and classical bimanual examination, colposcopy and hysteroscopy are used, with the help of which it is possible to conduct a histological study and exclude oncology, ultrasound, analysis of secretions and, in rare cases, MRI for more accurate distribution of the process to nearby organs.
Sometimes before the fertilization procedure, a course of hormonal therapy is shown to reduce estrogen production for at least 3 months, and sometimes it reaches a year, and an artificial amenorrhea occurs in the body with a further recovery of menstruation after discontinuation of drug treatment. For this use:
- KOKI with a large amount of ethinyl estradiol (Yarin, Regulon, Janine, Midiana)
- Androgens are rarely used because they have a lot of side effects.
- Progestogens have a very good effect on the endometrium and thereby reduce its spread to the myometrium.
- Gonadotropin agonists are capable of causing osteoporosis, but they have a favorable outcome for the distribution of endometrial foci, but their use should be monitored for ethinyl estradiol levels in the blood.
Only your doctor - fertility specialist, who deals with the selection of a protocol for you, will help you choose the right treatment regimen and drugs that will be most effective for successful treatment and further pregnancy.
In case of focal and nodular forms of adenomyosis, surgical laparoscopic treatment with removal of foci of adenomyosis will be most appropriate, while all the efforts of the doctor are aimed at preserving the organ. But, if it is impossible to preserve the organ, with its total lesion and spread to all the organs of the small pelvis, then the only method of treatment and disposal of this disease can only be the removal of the uterus.
Adenomyosis of the uterus and IVF require a certain preparation, where exactly it is necessary to establish the cause of infertility. And if such a cause is confirmed by adenomyosis, then such factors as ovulation, the flow of the tubes, the age of the woman, the duration of infertility, the autoimmune condition of the uterus and the condition of the ovaries affect the outcome of IVF. If the cause of infertility is endometriosis in its first stages of development, then hormone therapy should be carried out within a year, if no other pathologies have been identified.
In case of severe adhesions and impaired patency of the fallopian tubes in adenomyosis, laparoscopic diagnosis and treatment should be performed with dissection of adhesions and restoration of patency of the fallopian tubes, which increases the likelihood of pregnancy on their own. When the disease recurs after half a year of treatment, and also when a diffuse or mixed form of adenomyosis is established, with a barren woman over 35 years of age, then she is shown to have a long protocol of extracorporeal fertilization.
If the first IVF attempt fails, but this does not indicate that the new attempt will also fail, because each subsequent fertilization protocol increases the likelihood of a favorable outcome, since the fertility specialist will correct the treatment regimen and the drugs used in the protocol will change to another manufacturer . There must be at least two months between fertilization attempts during which the body must prepare for the next implantation. With a positive result of fertilization and implantation of the embryo after IVF, the course of the pregnancy should be monitored during the antenatal clinic. This is due to the fact that in the first trimester complications occur most often due to the fact that the woman’s body still lacks its own hormones, and the doctor has to monitor and correct the hormones and monitor the development of pregnancy with ultrasound. If any complications occur, you should immediately consult a doctor.
If you have problems with conception and you have undergone treatment for this, and the diagnosis of infertility in your life is the lead, since you really want to have your genetic child, and you are a Russian citizen and have an OMS policy, then do not lose a unique chance to carrying out a free procedure of artificial insemination, as a result of which you will become happy parents. Fill out the form on our website for free in vitro fertilization and then motherhood will be a step closer to you. I wish you success.
IVF success in various types of adenomyosis
There are four stages of the disease, which differ in the depth of germination of the endometrium in the walls of the uterus. If at the first stage the symptoms of adenomyosis are as follows: the endometrium has not yet penetrated into the uterus more than one third, then in the fourth its cells grow through the walls of the uterus into the peritoneum. The first 2 stages of adenomyosis are easier to treat, after which there are chances of getting pregnant.
In addition, the possibility of successful conception, including after IVF, depends on the type of adenomyosis.
There are 3 types of adenomyosis:
- Diffuse adenomyosis - the endometrium occupies the entire cavity of the uterus,
- Focal adenomyosis - endometrium grows in the uterus in the form of clusters (lesions),
- Nodular adenomyosis - The endometrium forms nodes of various sizes in the walls of the uterus.
The least chance of conceiving at 3-4 stages of the diffuse form of adenomyosis. In these cases, the success of IVF will be questionable, since the egg is unlikely to take root.
Treatment of adenomyosis before IVF
How to treat uterine adenomyosis? Before resorting to IVF, doctors recommend treatment. Treatment of the disease consists of taking hormonal drugs that suppress the growth of the endometrium. This therapy helps with the initial degree of adenomyosis, it lasts from 4 to 6 months.
With nodal forms of the disease, often combined with uterine myoma, surgical intervention is used. Only 35% of women can become pregnant themselves after the treatment, others are recommended to turn to IVF.
What is the indication for IVF for adenomyosis
Doctors refer patients to IVF in the following cases:
- If within 2 years after treatment, the pregnancy never occurred,
- In the presence of the pelvic organs adhesions, causing obstruction of the fallopian tubes,
- If adenomyosis has led to a lack of ovulation,
- In case of violation of the immune response of the body, entailing the impossibility of fixation of the embryo in the uterus
How does the disease affect reproductive function?
According to statistics, more than 60% of women with endometriosis have impaired fertility. The disease is considered cunning, in the early stages it is asymptomatic. But it is in the first months to get rid of it the easiest. With the further spread of foci, they inevitably affect the work of the main reproductive organ - the uterus, as well as appendages.
Endometriosis is a pathology in which the functional layer of the reproductive organ spreads to places not intended for this. The disease has two forms:
- genital - endometrial tissues grow in the uterus (internal adenomyosis) or outside on the pelvic organs (endometriosis of the ovaries, uterine tubes, cervix),
- extragenital - when foci of the disease affect organs that are not involved in the performance of reproductive function (intestines, liver, lungs, bladder).
The exact causes of the pathology are not established, therefore it is difficult to foresee the development of the disease in the patient. Endometriosis is becoming one of the main provocateurs of infertility.
- A disease affecting the uterus, provokes the germination of the endometrium in the muscle layer - myometrium. Even if conception takes place, the fertilized egg will not be able to implant - there will not be proper conditions for it.
- The proliferation of foci on the ovaries alters their work. This causes hormonal imbalance. The follicle does not mature, there is no ovulation.
- Эндометрий, распространившийся на органы малого таза, подвержен гормональным изменениям и ежемесячно кровоточит. Скопление слизи вызывает спаечный процесс, что приводит к непроходимости фаллопиевых труб.
- Pathology causes a decrease in the ovarian reserve of the ovaries.
- The disease is quite common and often causes infertility. And doctors have developed assisted reproductive technology methods applicable to patients with endometriosis.
Is it possible to do IVF for endometriosis: the pros and cons
One of the indications for in vitro fertilization is endometriosis. Hormone-dependent disease must first be cured. Modern drugs are used for this, as well as a surgical method of treating infertility - laparoscopy. Women under 35 years of age are given time for the onset of independent pregnancy. Many manage to conceive a child within six months after therapy. If the treatment does not help after a year, then it is recommended to resort to ART.
For patients aged 35 years after treatment, doctors prefer to prescribe IVF immediately, so as not to waste time. In this group of women, the quantity and quality of eggs decreases every year.
Contraindications to in vitro fertilization with endometriosis will be "chocolate" cysts on the ovaries and impassable fallopian tubes. In this case, surgical treatment is first performed (resection of the ovaries, removal or plastic of the oviducts, separation of adhesions and cauterization of the lesions), then IVF is performed.
Whether to do IVF for endometriosis, decides not only a woman. Arguments of experts "for IVF" fit into the list:
- after treatment, the woman increases the chances of realizing the childbearing function,
- pregnancy has a positive effect on the disease, since the absence of menstruation causes regression of foci,
- modern hormonal drugs support pregnancy and prevent its interruption,
- The patient has the opportunity to experience the joy of motherhood with the help of ART.
The opinion of other experts boils down to the fact that endometriosis with IVF significantly reduces the chances of success. In addition, it is not known how the body will respond to shock doses of hormones.
With external genital or extragenital endometriosis, IVF can and should be done. When adenomyosis is resorted to this method less often. Insemination in endometriosis of the cervix allows male germ cells to overcome the pathological barrier. Intrauterine sperm injection increases the statistics of live births after the treatment of a hormone-dependent disease in a woman, provided that the oviducts are passable.
How to prepare?
Preparing for IVF with endometriosis begins with an assessment of the patient’s general condition, determining the form of the disease and the stage. At the initial stage, with 1-2 degrees of pathology, drug therapy is performed. If the lesions are widespread, there are cysts and obstruction of the tubes, then laparoscopy is performed. After this, the patient is prescribed a long-term hormonal treatment with the deposited drugs. They reduce the level of estrogen in the body, turn off the ovaries and prevent the growth of the endometrium.
Medical training lasts from 2 months to six months. In parallel, doctors evaluate the body's response to the injected funds. Normally, the patient stops menstruation and blocks ovulation.
The first IVF programs for endometriosis were carried out according to the superlong protocol. Now for the treatment of infertility apply more gentle techniques involving the use of fewer drugs. A long IVF protocol for a woman taking deposited drugs starts on any given day. If the patient has a menstrual cycle, then she enters the program for 20-25 days.
Stimulation of the ovaries in IVF is sparing and short, since in most patients the sex glands are depleted. Additional resections performed in the presence of endometrial cysts exacerbate the decrease in ovarian reserve.
How is IVF going?
IVF protocols for endometriosis involve a long or super-long program. In the first case, the fertility specialist prescribes gonadotropin-releasing hormones from the end of the menstrual cycle for 10 days. After this, egg growth is stimulated.
The stage of stimulation continues until the formation of mature follicles (18-20 mm), which is controlled by regular ultrasound. At this stage, the features of IVF end, and further actions are performed according to the standard.
When the follicles have reached the desired size, an HCG injection is performed, and after 36 hours a puncture is performed. Embryo transfer takes place 3-5 days after fertilization. Then, the patient is prescribed hormone support for the second phase.
The effectiveness of IVF in patients with endometriosis depends on:
- age (the younger the woman, the higher the chance of becoming pregnant)
- forms of pathology (with external endometriosis, the chances are higher than with uterine adenomyosis),
- stages of the disease (with 1 degree of distribution of the endometrium, pregnancy occurs more often than with 4),
- hormone levels (depletion of the ovaries does not allow for the stimulation and getting cells, so there is a chance only when using donor material).
Statistics depends on the specific clinic. On average, 40-50% of women can become pregnant. This means that approximately half of patients with endometriosis become pregnant after IVF. It happens that conception occurs independently after an unsuccessful protocol, but the age of patients with this result usually does not exceed 35-40 years.
After 40 years of age, the probability of conception in a healthy woman decreases, and in a patient with endometriosis, it almost disappears.
What is adenomyosis
Normally, the endometrium (the inner mucosa of the uterus) is separated from the walls of the organ by a thin layer of connective tissue and grows only inside the cavity of the organ. Adenomyosis is a chronic disease in which endometrial cells expand uncontrollably, damage the connective tissue layer and penetrate the muscle tissue of the uterus. The body begins to react to the invasion - muscle tissue thickens around the foci of penetration of foreign cells, so the uterus takes a spherical shape, and its inner surface is deformed.
Regardless of the location, endometrial cells grow and are rejected by the body in accordance with the menstrual cycle. If in a healthy uterus cells during menstruation are excreted with blood through the vagina, then during pathological spreading, the detached endometrium causes inflammation, cysts and adhesions in the affected tissues and organs. This fact explains the most common symptoms of adenomyosis - painful, long and heavy menstruation and bleeding between menstruation.
There are other symptoms of adenomyosis:
- severe premenstrual syndrome,
- sharp pains on the eve of menstruation and during intercourse.
Adenomyosis, especially at the initial stage, can occur without obvious symptoms or blurred, and then diagnosed by chance or when visiting a doctor with complaints about the consequences of the disease. From heavy menstruation can develop iron deficiency anemia, which is characterized by weakness, drowsiness, decreased immunity. Against the background of deterioration of general condition, pain and severe PMS, the patient is subject to stress and neurosis. And most importantly - the disease in the later stages leads to infertility.
Doctors can not yet say exactly what causes the disease. It is believed that provoke the development of adenomyosis can:
- abortion, scraping and other procedures that violate the integrity of the uterine lining,
- hormonal disorders,
- genetic predisposition, etc.
It is important to diagnose and begin to treat the disease as soon as possible. When referring to the doctor with complaints of pelvic pain and problems with conception, the patient is diagnosed with adenomyosis in half of the cases.
IVF with different types of the disease
There are 4 forms of adenomyosis:
- diffuse nodular (mixed).
The focal form of the disease is manifested by a point lesion of the uterus.
The diffuse form is characterized by endometrial germination in the walls of the body in the form of blind pockets. At the same time, pockets of different depths, fistulas in the pelvic cavity are possible. In this case, the pathological process takes place uniformly throughout the cavity, without forming clear foci. This is the most difficult to treat type of adenomyosis.
Nodular adenomyosis is characterized by germination of the glandular epithelium in the muscle tissue, with dense nodes that are filled with blood or exudate.
Diffuse-nodular form is represented respectively by a combination of diffuse and nodular.
The depth of penetration of the endometrium in muscle tissue is divided into 4 stages:
I degree - affected submucosal layer,
- Grade II - less than half the depth of the muscle layer is affected,
- Grade III - more than half of the muscle layer is affected,
- IV degree - the entire muscular layer is affected, the serous layer of the organ is involved, penetration into the peritoneum and adjacent organs is possible.
The smaller the stage of adenomyosis, the less damaged the uterus, which means that there are more chances for the return of reproductive health and success of IVF. The most favorable prognosis for initial degrees, especially the nodal and focal forms of the disease.
More difficult with 3 and 4 stages of the disease. The more deformed the surface of the uterus, the more difficult the egg cell to gain a foothold in the epithelium even after curing adenomyosis and using IVF. With the last degrees of the diffuse form, there is little chance - the treatment of severe cases implies a surgical intervention, including the removal of the uterus and even the ovaries.
Treatment of adenomyosis before the procedure
For adequate treatment of the disease before IVF, it is necessary to find out what form the pathology has taken and how far it has gone. For the diagnosis using the following methods:
- gynecological examination (with mirrors),
- colposcopy, diagnostic hysteroscopy with a sample for histology,
- MRI for suspected myoma,
- analysis of the microflora of the vagina.
Depending on the results obtained, 2 types of adenomyosis treatment are prescribed before IVF: conservative and operative. Conservative therapy is reduced to taking hormonal drugs to suppress the formation of estrogen - a steroid hormone that most affects the endometrium. Pathological endometrium responds to hormonal effects, gradually dying off.
Drug treatment is carried out for 3-12 months, causing amenorrhea - the absence of menstruation. The cycle is restored after discontinuation of drugs along with the return of production of estrogen to normal.
The following groups of hormonal drugs are prescribed:
Oral contraceptives with a high content of ethinyl estradiol mimic the state of pregnancy and reduce estrogen levels. The drug is prescribed in continuous mode (tablets need to be taken every day) for a long period - up to 1 year. Preparations of the group: Yarin, Midiana, Femoden, Janine, Regulon.
- Androgens better than other substances reduce the risk of recurrence, but because of unpleasant side effects, they are rarely prescribed and in difficult cases. Preparations of the group: Danazol, Danol.
Progestogens are the only ones on the list that do not affect the ovaries, because menstruation is scheduled, and the substance effectively affects the distribution of the endometrium. Preparations of the group: Gestrinon, Didrogesterone, Medroxyprogesterone, Duphaston, Norkolut.
- Gnadoliberin analogues are poorly absorbed through the gastrointestinal tract, therefore, are available in the form of injections and nasal sprays. Continuous monitoring of ethinyl estradiol in the blood is required, since the likelihood of developing osteoporosis is high. Group preparations: Goserelin, Leuprorelin, Triptorelin, Buserelin, Nafarelin.
Depending on the form and degree of adenomyosis, as well as on the basis of contraindications and medical history, the doctor selects the drug and the regimen with the greatest efficiency. Self-medication is not allowed.
The second possible treatment option is surgery. A minimally invasive surgery is performed - laparoscopy, during which the affected areas are locally removed in the focal and nodular form of adenomyosis. Often within a few years after surgery, there is a relapse. Doctors try to preserve the organ as much as possible, but sometimes this is impossible, and when the diffuse adenomyosis is neglected, the uterus must be removed.
The effect of endometriosis on reproductive function
The exact cause of the disease is not installed. It is believed that in the development of pathology, genetic factors play a role, disturbances in the functioning of enzyme systems, and hormonal imbalances.
Typical complaints of patients who contact gynecologists due to endometriosis are:
- Lower abdominal pain. Most often they are pulling and associated with menstruation.
- Dark bloody discharge before and after menstruation.
- Discomfort or pain during intercourse.
- Fertility impairment.
Infertility with endometriosis is a fairly common problem. Reproductive function depends on the localization of the pathological area, its vastness.
The main causes of impaired fertility in patients with an appropriate diagnosis are as follows:
- Pathological changes in the genital organs of women on the background of endometriosis can cause the formation of adhesions, which leads to obstruction of the fallopian tubes. The possibility of egg migration to the uterus disappears.
- Endometriosis is a hormone-dependent disease. It is accompanied by an imbalance of biologically active substances in the body of a woman. The number of prostaglandins and interleukins increases. The process of egg maturation may be disrupted.
- The disease also has a negative effect on the patient’s immune system. Accordingly, fertilization of the egg may not occur even with preserved ovulation and passable fallopian tubes.
- When ovarian endometriosis occurs, a decrease in ovarian reserve is characteristic.
These pathogenetic mechanisms are not always able to eliminate hormone therapy or surgery. Therefore, natural fertilization sometimes becomes impossible. IVF in such cases - the best way out of this situation.
Do IVF with endometriosis?
One of the indications for the use of ART is endometriosis. Before IVF, conservative treatment is usually used. At the initial stages of the development of the disease, hormone therapy can level the symptoms of the disease and restore reproductive function. But treatment aimed at the normalization of fertility, is used no more than 1 year. If pregnancy does not occur, recommended IVF.
If the patient is older than 35 years old, then she can do IVF for endometriosis right away, without any prior waiting tactics.
Endometriosis often requires surgical treatment. It is necessary if the patency of the fallopian tubes is impaired, there are endometrioid ovarian cysts, and foci of endometriosis are found on the peritoneum. If pregnancy does not occur in the coming months after surgery, IVF is indicated.
Hormone therapy does not eliminate the foci of endometriosis, at the time of its reception, the spread of endometriotic foci is suspended. With the abolition of hormones, there is a risk of recurrence of the disease.
In vitro fertilization in patients with endometriosis is carried out according to the standard scheme. Previously, fertility specialists preferred long protocols. However, it is now clear that the presence of endometriosis in a woman does not affect the choice of protocol.
If a woman is diagnosed with endometriosis, after IVF, she needs support for the luteal phase to reduce the risk of spontaneous abortion.
Endometriosis with IVF - what are the chances?
Different clinics show different efficacy of IVF for endometriosis. The chances of a successful onset of pregnancy using IVF in patients with endometriosis in Vitro Clinic are about 48%. But this is an average figure. It depends on a number of factors:
- the age of the patient
- duration of infertility
- localization and size of endometrial foci,
- the severity of the disease
- levels of sex hormones in the blood,
- the functional state of the ovaries.
Endometriosis is not a sentence. IVF in VitroKlinik allows many women with this disease to successfully get pregnant and have a baby, despite the existing violations in the organs of the reproductive system.