Endometriosis

Best Endometriosis treatment in Delhi by Janini IVF

What is Endometriosis?

An abnormal condition where endometrial tissue (inner lining of uterus) starts growing in places outside of the uterus. This abnormal growth of endometrium outside the uterus is also responsive to female sex hormones and this leads to a local bleeding at the time of normal menstruation. This results in an increase in symptoms at the time of menstruation like pain and fatigue. Although usually the endometrial tissue is non-malignant it behaves like a local ‘tumour’ often developing into an ovarian cyst.

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Being the finest IVF clinic in Delhi, we know that the most common and serious problem of Endometriosis is Infertility or inability to conceive. This results from the damage caused to the organs where Endometriosis exists like ovaries and fallopian tubes. Apart from direct injury there are several other mechanisms by which Endometriosis causes Infertility. Janini IVF the best IVF Centre in Delhi offers effective, safe and result-oriented approaches to treat Infertility associated with Endometriosis. A firm proponent of evidence-based medicine, renowned and gold medalist FNB Dr. Dalal believes in incorporating latest technology and experience generated over a decade to give you the benefit of advanced reproductive capabilities of IVF and ICSI. Indeed, most if not all patients with Endometriosis will take a baby home for sure.

How common is Endometriosis?

Endometriosis is quite common - seen in almost 10% of ALL women and almost 30-40% females attending OPD of IVF clinics. Endometriosis is believed to have multi-factorial origin so it requires both some genes and right environmental conditions for it to develop. It has no relation with education, economic status or blood groups. You must have heard of many celebrities like Hillary Clinton or Celina Jaitley or Katrina Kaif also having Endometriosis. Nobody knows the exact cause of Endometriosis, in spite of varied theories formed on its causation, it is called “The enigmatic disease of Gynaecology”.

How is Endometriosis diagnosed?

  • The classical symptoms pin-point toward its provisional diagnosis
  • Ultrasound scan is done where pelvic structures are seen for adhesions or cysts
  • Pelvic examination is done to feel for nodules or induration
  • MRI can sometimes be needed
  • Laparoscopy is definitive. It not only helps in confirming diagnosis but also treating it in the same sitting by vaporising the lesions (Laser) or by removing the diseased tissue (Laparoscopy done under general anaesthesia is an operative technique of inserting a thin telescope through your navel and visualising the abdomen from inside. It saves the patient from a large incision and has many advantages over open surgery).

What are the common areas or organs of the body where Endometriosis develops?

  • Most common site is the ovary - enlargement of which causes cysts
  • Fallopian tubes are commonly affected and this causes a block in tubes leading to Infertility
  • Uterus is also affected from outside leading to its adhesions with posterior pelvic wall
  • Broad ligament, round ligament and other surrounding structures of peritoneum
  • Rarely bowel (intestine) is affected that may cause monthly rectal bleeding during periods
  • Ureter (a pipe carrying urine from kidneys to bladder) can be affected
  • Bladder can also be affected leading to monthly hematuria (blood in urine)
  • Scar site (skin), liver, lungs and brain are very rare sites of Endometriosis

What are the situations that lead to a higher chances of developing Endometriosis?

  • Late marriage and delayed child-bearing
  • Not breast feeding your infant
  • If you are tall, lean and thin
  • Early menarche (Starting of menstruation at earlier age)
  • Nulliparity (not having any kids till middle life)
  • Presence of uterine fibroids
  • Presence of certain uterine anomalies like vaginal septum or outflow tract obstructions - this would lead to Endometriosis because of “Retrograde menstruation”
  • Having a first degree relative also suffering from Endometriosis increases your chances of developing it

Symptoms of Endometriosis

  • Most common is painful periods or dysmenorrhea
  • Heavy menstrual bleeding or menorrhagia
  • Pain while having sex or Dyspareunia
  • Spotting (bleeding in between periods)
  • Lethargy and feeling of tiredness
  • Chronic pelvic pain which is continuous
  • Painful urination (Dysuria) and painful motions (Dyschezia)
  • Last but not the least, Infertility. Almost 50% of all women with Endometriosis have infertility

How does Endometriosis affect fertility?

There are many ways by which this disease impairs fertility potential :

  • Abnormal endometriotic impacts invite inflammation wherever they are. Inflammation means scavenging of the tissue by the white blood cells. The same white blood cells, along with disease tissue, would also destroy sperm and egg leading to failed fertilisation.
  • Endometriosis is commonly associated with hormonal imbalances like high prolactin, high estrogen, etc.
  • It is very common that the Fallopian tubes get blocked mechanically due to Endometriosis
  • The scarring and fibrosis that occurs also lead to blocked tubes and altered pelvic anatomy
  • When Endometriosis grows in the ovary it takes shape of a cyst. Many times the cyst can grow very big to even 8-10 cm. This cyst is filled with old, tarry blood that gives it a brownish hue. So endometriotic cyst is also called ‘Chocolate cyst’
  • Ovarian reserve is disrupted in Endometriosis patients because normal ovarian follicles are replaced by diseased tissue
  • Endometriosis affects both egg quality and implantation

Is there a cure to Endometriosis?

No unfortunately there is no permanent cure but the disease can be kept in control by either surgery or medicines. In surgery we remove all endometriotic patches and disease tissue. If there is an ovarian cyst even that could be removed or aspirated. Medicines that can help include a wide variety like Danazol, Dienogest, Medroxy Progesterone Acetate, DMPA injections, GnRH analogues like Injection Triptorelin, Combined Oral Contraceptive pills and Mirena or Intra-uterine LNG device. Pain killers like NSAIDs are given for controlling pain.

All these medicines only help in controlling the disease, they do not help in conceiving. Indeed, if the primary concern is fertility, then rather than medical treatment one should go for Assisted conception methods like IUI or IVF. What is the most noteworthy fact is that pregnancy itself is a good temporary cure of the disease. For the entire duration of 9 months of pregnancy and also few months of lactation, Endometriosis keeps in control due to the elevated Progesterone hormone in pregnancy. Thus, even though endometriosis causes infertility, once we achieve a pregnancy the endometriosis will subside.

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Stage wise treatment of Endometriosis :

Staging of Endometriosis is done as per the revised AFS (American Fertility Society) classification into 4 stages:

  • Minimal: Superficial implants with no/minimal scarring
  • Mild: Superficial implants but with mild fibrosis or patches of fresh disease
  • Moderate: Cysts and/or prominent fibrosis. Size of the cyst can vary
  • Severe: Cyst in one or both ovaries. Significant scarring involvement most pelvic organs

There has been a lot many published articles of good quality in impactful International journals and the evidence is pretty clear in what is advised. For minimal to mild stage of disease with infertility, various treatment models can be recommended depending on the age of the woman, duration of infertility, ovarian reserve and semen parameters. If everything is favourable one can go for IUI in a stimulated cycle. If one comes across mild disease in a laparoscopic procedure it is best recommended to treat the disease in the same sitting.

For moderate and severe disease the best approach is IVF. IVF has far higher success rates than IUI or performing laparoscopy for cyst removal. Even if the cyst is as large as 5-6 cm latest evidence is very strong in advocating that the cyst should be left alone and the couple should go for IVF or ICSI directly WITHOUT GOING FOR A CYST REMOVAL SURGERY.

Dr. Dalal, the best infertility doctor in Delhi, in his extensive experience spanning more than a decade has come across and treated many cases of Endometriosis from India and abroad. He believes that patients of Endometriosis are very commonly advocated to go for surgery unnecessarily and wrongly. Surgery is not only unnecessary it can also be harmful because while removing the cyst some part of ovary is also removed, no matter how good the surgeon is. By doing so there is a further reduction in the egg reserve and ultimately patient has to go for IVF with egg donation treatment. To prevent that from happening, one should consult the right fertility doctor and weigh the pros and cons in determining the best decision for themselves.

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Janini IVF
A3/12, First Floor Paschim Vihar, New delhi - 110063
+91 9717 99 66 55
011-25 25 66 55
info@janiniivf.com

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