ARTICLE
Endometrioma and Infertility When To Operate By Dr. Mazen Bashtawi, FRCOG FACOG, Consultant in Obstetrics and Gynaecology, Subspecialist in Gynaecological Oncology and Advanced Laparoscopy at Al-Ahli Hospital / Qatar
E
ndometriosis has been estimated to affect up to 10% to 15% of reproductive-age women. Most women with endometriosis have a delay on average of 7 years from the onset of symptoms until the diagnosis is made, the symptoms could be irregular bleeding, menstrual dysfunction, pain and infertility.
The association between endometriosis and infertility is well supported throughout the literature, but a definite cause-effect relationship is still controversial. The prevalence of endometriosis increases dramatically to as high as 25% to 50% in women with infertility, and 30% to 50% of women with endometriosis have infertility. The fecundity rate in normal reproductive-age couples without infertility is estimated to be around 15% to 20%, whereas the fecundity rate in women with untreated endometriosis is estimated to range from 2% to 10%. Women with mild endometriosis have been shown to have a significantly lower probability of pregnancy during a period of 3 years than do women with unexplained fertility. Ovarian endometriomas have always been subject for controversy, controversy on pathogenesis and controversy on treatment. We see many patients coming with endometriomas and infertility, these patients usually get conflicting advice whether to go for surgery and remove endometrioma or proceed for IVF. Ovarian endometrioma affects 17-44% of
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IF SURGERY IS TO BE CONTEMPLATED, LAPAROSCOPY IS THE SURGERY OF CHOICE, AS IT OFFERS QUICKER RECOVERY AND RESUMPTION OF EVERYDAY ACTIVITIES. SURGEON'S EXPERTISE AND TECHNIQUE IS OF PARAMOUNT IMPORTANCE TO MINIMIZE DAMAGE TO THE OVARIES.
women with endometriosis, endometriomas also known as chocolate cysts containing thick old hemorrhage that appears as brown fluid. In 50% of cases the endometriomas are bilateral, they are more frequently located in the left ovary. Pathogenesis still controversial many theories trying to explain the nature and the cause of this disease. The most acceptable theory is invagination of ovarian cortex secondary to implant of metaplastic cells in the coelomic epithelium. Pelvic ultrasound is usually enough to make the diagnosis of endometrioma, however MRI is the gold standard. The causes of infertility in women with endometrioma can be attributed to many factors such as adhesions and blockage of the fallopian tube, inflammatory response may participate in degradation of oocyte and sperms. Endometrioma might lead to poor embryo quality, poor ovarian reserve and inflammation affecting endometrial receptivity. Management ovarian endometrioma can be complex and should be individualized, the optimal treatment will depend on the patient age, severity of pain, characteristics of the
