In order to understand whether the IVF method can solve the problem of infertility due to endometriosis, it is necessary to understand its features

One of the causes of female infertility is a chronic disease -. It is a growth of tissue outside the uterine cavity that is very similar to the endometrium. Endometriosis can be multifocal in nature and spread to the ovaries, fallopian tubes, peritoneum, bladder, intestines, and even grow into the thickness of the walls of the uterus.

This disease is considered mysterious because nothing is known about the nature of its occurrence. However, its connection has been established with hormonal imbalance and immune disorders that occur in women of reproductive age. Endometriosis - in half of the cases. But there is no need to panic, because the specialists at our clinic know what to do in such situations.

Endometriosis as a cause of infertility

In order to understand whether it can solve endometriosis, you need to understand its features:
. Firstly, changes occur in the pelvic organs due to the formation of an adhesive process in it, which leads to obstruction of the fallopian tubes or the formation of dense tissue fusion and disruption of the ovulation process and the movement of eggs.

If endometriosis is external and its degree is 1-2, then the clinic doctors advise not to rush. During this period, they carry out a standard set of procedures to reduce the symptoms of the disease and eliminate lesions as much as possible. Next, future parents are given a year to attempt natural conception.

If attempts at conception are unsuccessful, relapse of the disease is excluded. Its reappearance will be accompanied by the same symptoms as the first time: pain in the lower abdomen, ovarian cysts. If the sensations are very painful, then a repeat treatment is prescribed, but if the pain can be tolerated, then IVF is prescribed.

However, there is an exception - confirmed tubal patency. In this case, subsequent ones will be carried out. According to statistics, this method is successful in 13-50% of cases.

It is worth noting that the waiting tactic is possible only if your age does not exceed 35 years. If we are talking about a more mature age, then it is prescribed literally immediately after hormonal treatment and laparoscopy. A method called egg fertilization can also be used, which involves inserting a sperm into the egg using a special needle.

If you think that carrying out the IVF procedure at later stages of development (3-4) is impossible, then you are mistaken. On the contrary, then the IVF protocol is prescribed immediately: of course, after undergoing a full examination and donating a large number of samples. In this case, the protocols are long, from two weeks to three months, because with their help it is possible to obtain healthy eggs in larger quantities.

The effectiveness of IVF for endometriosis

Endometriosis of the uterus (adenomyosis) is a fairly common disease in our patients, and in order to make the IVF program effective, it is necessary to prepare the uterus for implantation, because it is the uterus affected by endometriosis that causes the failure of embryo implantation.

With endometriosis of the uterus, the muscular structure of the uterus is affected; endometrioid tissue is located between the fibers, which disrupts the blood supply to the myometrium, and with the nodular form of adenomyosis, sometimes the node deforms the uterine cavity.

Surgical treatment cannot solve the problem of endometriosis of the uterine body; it is not advisable to perform embolization of the uterine arteries in women in the reproductive period and planning pregnancy. Since there is insufficient nutrition of the ovarian tissue.

Exists several preparation tactics women suffering from endometriosis to the IVF program. Tactics depend on the patient’s follicular reserve. We determine the follicular reserve not only by AMH (anti-Mullerian hormone), but also by the number of antral follicles. For successful implantation, we need to restore sufficient blood flow in the uterus and, of course, restore the damaged receptor apparatus.

Ultrasound with Doppler of the vessels of the basal layer of the uterus allows the doctor not to delay the treatment of patients with adenomyosis.

If the patient has a good follicular apparatus, then it is easier for the doctor to deal with adenomyosis, since the patient recovers well after using deposited drugs.

Deposited drugs - hormone releasing hormone agonists - 1 injection of the drug works for 28 days. The doctor monitors the size of the uterus, controls tumor markers and decides for how many cycles to block menstrual function.

After 2 blocked cycles with a good follicular reserve, you can safely begin ovulation stimulation.

For those who have a small follicular reserve, we treat with Visanne. The use of this drug in a continuous mode with a smooth transition to stimulation has already helped hundreds of patients become pregnant, although it appeared on the pharmacological market quite recently.

We have many interesting, complex case histories of patients with adenomyosis that ended in pregnancy.

Is it difficult to carry a pregnancy to term after treatment for adenomyosis? Yes, there can be difficulties with pregnancy, so it is important to follow the doctor’s recommendations, choose the right dose of progesterone and estrogen drugs, and correctly discontinue them.

Endometriosis often causes the inability to conceive a child. Modern medicine has achieved successful results in solving this issue and overcoming natural barriers to fertilization. With the help of the latest reproductive technologies, there is a chance for artificial conception outside a woman’s body. Is IVF possible for endometriosis? Is it possible to carry and give birth to a healthy baby? Let's look at all the issues that worry women in this article.

This pathology is characterized by the proliferation of endometrial tissue in the genital or extragenital areas, that is, in a place atypical for the reproductive system. Endometrial tissue can even appear in the lung area or throat.

What are these fabrics? This is the mucous membrane that lines the inner walls of the uterus. Usually it should leave the woman’s body along with menstrual blood, but remains inside the body due to a failure in the production of hormones - those responsible for the monthly cycle.

The cause of hormonal imbalance may be:

• genetic predisposition of the patient;
• decreased immune defense - local and general;
• metaplasia - pathological degeneration of tissues;
• hormonal disorders - lack of hormone production;
• disturbances of the monthly cycle - delay, heavy bleeding, etc.

Important! The main feature of endometriosis is the uncontrolled proliferation of tissue of the uterine mucosa along with a disruption of the ovulation cycle.

At risk are women who have undergone abortion multiple times, as well as:

• living in an environmentally unfavorable place;
• with a lack of iron in the blood - anemia;
• survivors of pelvic organ surgery;
• with chronic inflammatory processes of female organs;
• with liver dysfunction;
• delivered ;
• obese.

Hormonal therapy and surgery do not always give a positive result in treatment, so the chance of getting pregnant on your own is unlikely. In vitro fertilization (IVF) comes to the rescue. However, it should be taken into account: before artificial insemination, a long course of therapy is carried out - you need to be prepared for this.

Why does endometriosis lead to infertility? The proliferation of endometrial tissue can lead to adhesions that block the fallopian tubes - they become impassable. In this case, sperm cannot reach the site of fertilization and the movement of the eggs is blocked. Also, during adhesions, the ovulation mechanism is disrupted. If the production of hormones fails, the follicles do not mature, without which the process of fertilization is impossible.

Endometritis

This pathology is characterized by the presence of foci of inflammation of the uterine mucosa - the endometrium. This causes a decrease in the functionality of the mucous membrane, the cells of which degenerate. The cause of the pathology is infection of tissues with E. coli or the penetration of other viruses into the uterine cavity. This health condition prevents successful implementation.

Therefore, before prescribing the artificial insemination procedure, complex therapy is carried out to eliminate the causes of the pathology. Immunomodulators and vitamins are also prescribed to strengthen local and general immunity, hormonal and metabolic therapy is carried out along with physiotherapy.

Treatment for endometritis takes several months, so you need to be patient. After successful treatment, the chance of conception increases to 67% out of a hundred. Endometritis in 97 cases out of a hundred is the cause of early pregnancy termination. That is, even with a successful conception, it is impossible to carry the pregnancy to term.

Unlike endometriosis, endometritis does not reduce the functionality of the ovaries, so the chance of obtaining high-quality biomaterial is quite high. Preparation for the procedure does not require a long or super-long stimulation protocol, since ovulation occurs without pathology. Patients are prescribed hormonal therapy based on age. IVF for endometritis is the only chance for successful conception, so treatment and preparation must be taken responsibly.

IVF protocol

What kind of procedure is this, and how does it affect the ability to conceive a child? With the help of in vitro fertilization, you can bypass the obstacles that prevent conception - without long-term treatment. Fertilization occurs in vitro, then the formed embryo is transplanted into the body of the uterus.

1. inhibition of ovarian functionality;
2. hormonal drugs;
3. ovarian puncture - collection of follicles;
4. spermatozoa - in vitro;
5. growing embryos in an incubator;
6. embryo transfer into the uterus.

From the second day of menstruation, the woman undergoes an intensive course of hormone therapy to hyperstimulate the ovaries. This is necessary to produce a sufficient number of eggs. Subsequently, the doctor selects the highest quality biomaterial for subsequent actions.

The stages of follicle maturation are monitored using ultrasound scanning. When the follicles are mature, the ovaries are punctured to collect material. The operation is performed under anesthesia, so there is no pain.

Selected eggs are placed in a nutrient solution for further medical manipulations. All actions are carried out by a trained embryologist under sterile conditions. After the eggs are fertilized by sperm, the doctor monitors the development of the embryo. After about 4-5 days, the fetus is transplanted into the mother’s uterus.

Note! Two embryos are transplanted into the body of the uterus, the rest of the material is frozen. In case of unsuccessful pregnancy, it can be used for a secondary transplant.

Next, the woman is prescribed a course of medications to maintain pregnancy. This is necessary to prevent rejection of the embryo from the uterus. IVF for endometriosis is possible, however, the risk of miscarriage remains. In medical practice, successful childbirth occurs in only 30 patients out of a hundred.

Why does fetal rejection occur? This does not depend on the quality of the embryo transplantation, but on the health characteristics of the patient’s reproductive system. However, there is a chance to give birth to a child, so the IVF procedure is carried out several times.

IVF for endometriosis

Is IVF done for endometriosis? Recently, doctors categorically denied the success of embryo transplantation for this pathology. Nowadays, IVF is also performed for endometriosis. An individual procedure plan is developed for each patient. This depends on several factors:

• age;
• severity of the disease;
• ovarian functionality;
• duration of the disease.

First, an infertile woman is given a course of classical therapy for a year - the foci of overgrown tissue are eliminated. What treatment is carried out before the artificial insemination procedure? It depends on the degree of tissue damage. If the fallopian tubes are closed due to the growth of the endometrium, surgery is prescribed. Surgery is also indicated to remove cysts or the appearance of overgrown tissue in the peritoneal area.

Next, a long course of stimulation is carried out to obtain a large number of eggs. How long does stimulation last? From one to three months. If the functionality of the eggs is reduced, the patient is offered to use it.

Is there a chance of getting pregnant after IVF with endometriosis? Approximately every second patient is capable of bearing a fetus after artificial insemination.

The success of the manipulation depends on the following factors:

• patient's age;
• features of the pathology of the reproductive system;
• ovarian functionality;
• activity of hormone production by the body;
• duration of infertility.

Important! Doctors believe that endometriosis is not a death sentence for a woman. Every patient has a chance to successfully carry a pregnancy.

A special feature of the procedure for endometriosis is long-term stimulation of the ovaries. The training course includes both activation of follicle maturation and inhibition of endometrial growth. A super-long IVF protocol in preparation can last six months. First, the patient is put into a state of artificial menopause, and then hyperstimulation is performed.

Laparoscopy for endometriosis

Should laparoscopy be done to remove foci of overgrown uterine mucosa? Doctors note an increase in the chances of successful conception after laparoscopic intervention. Since laparoscopy combines surgical removal of pathological tissue and diagnosis, it is possible to predict further actions regarding conception:

• onset of spontaneous pregnancy:
• application of the IVF protocol.

Laparoscopy helps to get rid of foci of enlarged endometrium quickly and effectively. This greatly increases the chance of conception even without IVF. However, the patient’s age and general health also play an important role here.

When removing ovarian endometriomas, a different picture may emerge - often organ tissues suffer from surgical instruments. Due to surgical removal of cysts, the integrity of the organs may be compromised, which negatively affects its functionality. That is, the ovaries lose the ability to create eggs.

Therefore, removal of cystic formations on the ovaries is carried out in the following cases:

• when there is a threat of tissue cells degenerating into malignant ones;
• with severe pain in the patient;
• for large cysts.

What are the dangers of surgical removal of cystic formations on the ovaries? This does not pose a threat to health, however, the ovaries lose their functionality. In this case, the woman will only be able to use donor material to carry a pregnancy - someone else's eggs.

The decision to remove cysts is made by the gynecologist after examination. If their size does not exceed 3-4 cm, removal surgery is not performed. In this case, the integrity of the follicles is preserved, and the woman can count on successful artificial insemination of her own eggs.

Endometriosis during IVF makes its own adjustments to the success of medical procedures. Common problems with this procedure are:

• egg infertility;
• problems with embryo formation;
• rejection of the embryo from the uterus.

Another obstacle to bearing a fetus is the poor quality of the uterine mucosa, which cannot ensure comfortable development of the fetus and its supply of oxygen and blood. Therefore, the chance of successful implantation is very low.

To avoid such problems or reduce their level, long courses of therapy are prescribed. A woman should be ready to take medications within the time frame specified by the doctor. There is no specific regimen for this pathology; in each case, an individual course of therapy and surgical intervention is prescribed.

Bottom line

Advances in reproductive medicine in recent years have allowed many infertile women to achieve the happiness of motherhood. If a couple of decades ago, patients diagnosed with endometriosis did not dare to dream of pregnancy, now the desire to become a mother is feasible.

The effectiveness of the artificial insemination procedure largely depends on the degree of damage by the disease: at the initial stage, 30 women out of a hundred have a chance of becoming pregnant, at the last stage - only 10-14% of those who wish.

The state provides funding for the IVF protocol, so the lack of funds for an expensive operation is not an obstacle to its implementation. A woman can also undergo a paid IVF procedure if she wishes, if she considers it necessary.

Is it possible to do IVF for endometriosis if the functionality of the ovaries is reduced? In this case, doctors will offer an alternative - the use of donor eggs. Therefore, the chance to become a mother remains.

Article outline

Endometriosis is considered perhaps the most common disease of the female genital area, next to it are thrush and vaginosis: seven out of a hundred women aged 14 to 50 years have one form or another of the disease. In addition, it is found in approximately 35% of patients who turned to the doctor because of the inability to get pregnant; every fifth of this number subsequently has to resort to in vitro fertilization.

IVF for endometriosis is a very effective way to combat infertility in women who have been diagnosed with this pathology. For this reason, modern reproductology pays special attention to the issue of IVF and the study of this disease; great efforts are made to increase the effectiveness of the technique.

The effect of endometriosis on conception

Despite the fact that medicine has made great strides, the causes of endometriosis are not fully understood. There is also very little information about the development of the disease and its impact on the female body. The main factors causing infertility in the case of this disease are:

• obstruction of the fallopian tubes, which is provoked by the formation of adhesions (they affect the pelvis);
• changes occurring with hormonal levels. Foci of the disease are a real “factory” of estrogens, the high content of which negatively affects the natural balance of female sex hormones, they simply destroy it, and also prevent the normal course of ovulation;
• immunological infertility. Affected lesions disrupt local immunity in the uterus, as a result, embryo implantation is inhibited, and the process of sperm advancement is inhibited;
• pain syndrome. If sexual intercourse is accompanied by pain, this is a characteristic symptom of pathology.

Due to the fact that endometriosis has such a negative impact on the female body, often even active treatment measures do not provide the result that is necessary for the normal functioning of the body. For this reason, assisted reproductive technologies are the only way to overcome infertility.

What is IVF?

In vitro fertilization is the main way to combat infertility around the world. Each of its forms is effective. This technology has been in demand for over forty years. There are more than seven million people on Earth who were born thanks to IVF. Its essence is as follows: sperm and eggs meet in a test tube, after which they are implanted in the uterus. At the moment, the possibility of getting pregnant using this procedure is quite high, more than 30%.

Artificial insemination is a method of assisted reproductive technology, which consists of the following: sperm is injected into the uterine cavity. This procedure is quite popular, many medical institutions resort to it, but the success rate is low, no more than 10%. The process of introducing sperm is very painful, in addition, there is a risk that the woman will get some kind of infection and pregnancy will not occur.

Is it possible to do IVF with endometriosis?

Pathology is the most common indication for the use of assisted reproductive technology. Before in vitro fertilization, conservative treatment is usually necessary. At the initial stage of development of the disease, hormonal therapy can destroy its symptoms and have a positive effect on the restoration of reproductive function. However, treatment, the task of which is to normalize fertility, should be used for no more than one year.

If pregnancy does not occur, it is recommended to turn to in vitro fertilization. When the age of a woman with such a diagnosis has passed the age of 35, IVF is done immediately; preliminary wait-and-see tactics are not needed. With the help of hormonal therapy, the foci of the disease cannot be eliminated; if hormones are discontinued, the possibility that the disease will recur is very high.

IVF in women with this disease is carried out based on the standard scheme. If earlier doctors made a choice in favor of long protocols, today the presence of a disease does not in any way affect the choice of protocol. It is important to emphasize that after IVF, patients with endometriosis cannot do without luteal phase support, this will help reduce the risk of miscarriage.

How to prepare properly

Endometriosis negatively affects the uterine muscles, this leads to the growth of endometrial tissue through the fibers, as a result of which the blood supply is disrupted, and deformation of the uterus is possible. Therefore, preparation for IVF for endometriosis involves the following activities:

• Laparoscopy is performed based on individual indications. The operation is provided when damaging lesions form on the abdominal organs;
• To temporarily suppress the production of estrogen, they resort to hormonal therapy. This will help prevent the growth of foci of the disease, and also cause its regression;
• For such a diagnosis, long in vitro fertilization protocols are used (extra-long ones are possible). Daily administration of Diferelin stimulates ovulation. Stimulation occurs under ultrasound control;
• if you had to resort to an extra-long IVF protocol, hormonal injections are administered over six months; when this stage is completed, ovulation is stimulated. This method suppresses the functioning of the ovaries, blocks menstrual functions, increases the number of healthy eggs and increases the likelihood of embryo implantation.

Features of IVF

The choice in favor of one or another IVF program is made based on:

• ovarian conditions;
• a period during which pregnancy did not occur;
• level of illness;
• woman's age.

If a patient develops external endometriasis with the first or second degree, symptomatic therapy should first be carried out, and inflammatory foci should be eliminated through surgery. A woman is required to visit a doctor for a year and have regular sexual relations (without using contraceptives).

If attempts to conceive a child are unsuccessful, then it is worth excluding a recurrence of the disease. If it appears again, it will be accompanied by the same symptoms. When the sensations are too painful, you should resort to repeat laparoscopy. If the pain can be tolerated, in vitro fertilization is prescribed.

However, it is important to emphasize that waiting is only possible for those women who are not older than 35 years. For older women, the procedure is prescribed immediately, after such stages as:

• hormonal treatment;
• laparoscopy.

The opinion that if the degree of development has reached stage 3 or 4, the procedure is impossible, is erroneous. Everything is completely different; in such cases, IVF protocols are prescribed immediately. They will definitely be long, from 2 to 3 months. It is worth noting that IVF is not performed for thin endometrium. The reason for this is that the chances of a successful outcome are too weak. If the thickness of the endometrium is insufficient, IVF will need to be postponed.

Advantages of long and super-long IVF protocols

Eco treatment for endometriosis involves choosing one protocol or another. This is the sequence of drug administration. The advantage of long protocols is that:

• follicles develop in a synchronous manner;
• the percentage of immature eggs is minimal.

Long protocols are indicated for patients whose ovarian reserve volume is at an average level. The long protocol scheme begins on the 20th day of the menstrual cycle, the procedure for administering Diferelin and Decapeptyl occurs every day. Then you need to wait for your period and prescribe stimulant medications for a week.

A distinctive feature of the super-long protocol is the introduction of a deposited form of the same drugs, but only once every 27 days. The maximum number of injections is six. After regression of pathological foci, ovarian stimulation is prescribed.

Forecast

The effectiveness of the procedure is influenced by the stage of the disease and the tactics chosen for preparation. For example, if endometriosis is in the first stage, the chances of a successful outcome are higher; approximately 20% of women still manage to get pregnant. If the form of the disease is much more severe, the percentage does not exceed 15%.

With endometriosis, the likelihood of IVF is low; the possibility of becoming pregnant with a tubal-peritoneal factor is much higher. But even if pregnancy has occurred, the woman must be under the supervision of a doctor.

Foci of endometriosis reduce the chances of pregnancy through IVF, but the severity of the disease is more important. So, with endometriosis of 1-2 degrees, IVF will be successful with a probability of 12-16%, when the disease is at stages 3-4, the chances of pregnancy after IVF are reduced to 8-14%. The chances are significantly reduced if the patient has an endometrioid ovarian cyst, which must be removed. The low effectiveness is due to the fact that with endometriosis, due to many negative consequences, the quality and ability of the egg to fertilize and implantation decreases.

The initial deficiencies of the egg that is stabbed are difficult to compensate even through in vitro fertilization with carrying out. But with such seemingly low chances of the procedure being successful, the effectiveness of IVF for endometriosis exceeds the effectiveness for tubal-peritoneal factor infertility.

Possible ART methods for endometriosis

The choice of a specific ART method or scheme before IVF is made based on the severity of endometriosis, the duration of infertility, the condition of the patient’s ovaries, and her age.

1. A mild degree of the disease (external endometriosis grade 1-2) requires expectant management, since the chances of natural conception remain at an acceptable level. But if pregnancy does not occur within a year after the end of conservative treatment of endometriosis or, the woman must again be examined for the appearance of foci of endometriosis, expressed in the appearance of pain, cysts and the growth of tumor markers CA 125. In order to relieve pain, the woman may undergo a repeat laparoscopy. Unfortunately, it will not increase the chances of natural conception, so the most correct decision in such a situation would be to immediately carry out IVF.
2. If the foci of endometriosis have not affected the fallopian tubes, after clinical confirmation of their patency, stimulating ovulation and subsequent sperm from the husband may be a fairly effective method. With healthy ovaries and fallopian tubes, this procedure is successful in 13-50% of cases. However, if the result is negative, it makes sense to resort to IVF.
3. If the patient’s age exceeds 35 years, IVF together with ICSI should be performed immediately after the end of treatment for endometriosis. This is due to the fact that in addition to the negative impact that the disease has on eggs, their quality and quantity naturally suffers with age.
4. Time should not be allowed for natural conception if the patient is diagnosed with a severe stage of endometriosis. IVF should be performed immediately if the fallopian tubes are severely damaged, possible complications make the operation too dangerous, or the partner's sperm quality is not high enough.
5. Low ovarian reserve or numerous unsuccessful attempts at IVF in the past are reasons to offer the patient IVF using.

If, of all possible ART methods, IVF is more preferable for a patient, to increase the chances of a successful procedure, it is necessary to determine a protocol. Depending on the severity of the disease, “long” or “super-long” ovulation stimulation protocols should be used (2 weeks or 1-3 months, respectively). This approach allows you to improve the quality and implantation capabilities of eggs, as well as obtain a larger number of oocytes suitable for fertilization.

Endometriosis, especially at a severe stage, becomes a serious problem for pregnancy. However, attention to your body and appropriate treatment, along with the use of modern medicine in the field of human reproduction, allow even women diagnosed with infertility to become pregnant and give birth to healthy children.

Demchenko Alina Gennadievna

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Endometriosis is a serious disease that often leads to infertility. But, fortunately, its detection is not a death sentence, and even stage 4 of the disease does not guarantee the absence of children. The main questions that concern a girl before eco are simple. How to treat this disease and are there any chances of getting pregnant? Should I choose a long or short protocol for endometriosis? Let's try to thoroughly understand this problem.

Causes of endometriosis

Endometriosis is the growth of the lining of the uterus (endometrium) onto other organs. Endometriosis can spread only to the reproductive organs or, in rare cases, to the abdominal cavity. This disease is extremely common and, according to statistics, approximately every tenth young woman is affected by it. The disease can lead to extremely unpleasant and dangerous complications: problems with conception, malignant degeneration of cells, etc.
Possible reasons why the disease can lead to infertility:

• An adhesive process in the pelvis, as a result of which the patency of the tubes is disrupted. Adhesions can appear inside the tube, preventing the sperm and egg from meeting. Also, adhesions can bend the tube, which also complicates the process of conception. The most dangerous consequence in this case is an ectopic pregnancy.
• Release of toxic substances from the degenerated uterine lining.
• Decreased egg quality.
• Uterine fibroids, scar tissue on the lining that makes it difficult for a fertilized egg to attach. In addition, this reason can lead to problems with pregnancy due to the low location of the placenta.

Diagnosis and treatment

Endometriosis is diagnosed by laparoscopy and hysterosalpingography, x-ray of the fallopian tubes and uterus. Ultrasound diagnostics in this case may not provide reliable information. You need to pay special attention to symptoms such as: severe pain during menstruation, heavy bleeding, spotting before or after the menstrual period, pain in the pelvis, prolonged inability to conceive.
Endometriosis is treated with hormonal therapy or surgery. If the disease leads to infertility, the woman may undergo hormonal therapy, intrauterine insemination, or cause artificial menopause. Recent research in this area has shown that intrauterine insemination is not very effective. After all, to achieve pregnancy with endometriosis, high-quality eggs are necessary, so now I most often offer women the procedure of in vitro fertilization.