ENDOMETRIOSIS

A frequently encountered ,entity in my day today practice.i wil describe it as when endometrium grows outside uterus,i.e ovary,fallopian tubes and peritoneal cavity.It affects 20-30% of infertile women.

how it effects-this ectopic endometrium has tendency to erode and damage the organ on which it falls-ex ovary–endometrioma-a cyst which reduces eggs producing capacity of ovary 2)Fallopian tube where egg and sperm meet-get scarred 3)makes peritoneum toxic for egg and sperm.

symptoms -infertility and pain

CURE-NO PERMANENT CURE.

As it grows under the hormone Estrogen ,a hormone produced by ovarian follicle,most important hormone of female ,so we cant afford to stop it.we can reduce its effect and moderate its effect by hormone progesterone..

management of infertile patient-

INTERNATIONAL GUIDELINES ON SURGICAL TREATMENT IN ENDOMETRIOSIS IN INFERTIITY

ESHRE 2005          ASRM 2006   RCOG    2006   RCOG

1)Minimal-mild endometriosis            R                                     R                          R

stage 1 & 2disease

unproven benifit              R                     Uncertain2

2)Moderate to severe

Stage 3 to 4

3)Surgery before IVF                       If endometrioma>4 cm      R                Endometrioma> 4 cm

4)Recurrent endometriosis           NR                                            NR               NR

R-Recommended                                NR-not recommended.

CAUSES OF INFERTIITY IN ENDOETRIOSIS

1)It distorts normal pelvic anatomy,reduces quality of growing follicles and developing oocytes

2)stage 3 & 4 has poorer outcome because of reduced no.& quality of oocytes

3)altered cellular and humoral immuity decreases endometrial receptivity.

IVF-ET is 1st line t/t for women more than 38 yrs with grade 3 & 4 endometriosis.

VALUE OF LAPAROSCOPIC SURGERY .-Patient should immediately try to conceive as the disease is in maximally suppressed at that point of time.

conclusion:There is no permanent cure of endometriosis as it is hormone dependent.

Early management of infertiity is cornerstone of treatment.