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Endometriosis is a condition that can be painful and may lead to infertility.
But a multidisciplinary endometriosis unit at Mediclinic Kloof, the most modern of its kind in the Southern Hemisphere, provides treatment to boost the chances of getting pregnant.
Understanding endometriosis
Dr Abri de Bruin, a gynaecologist specialising in deep endometriosis, endoscopy, and fertility treatment, heads the advanced endometriosis unit at Mediclinic Kloof. He explains that endometriosis occurs when the cells lining the uterus grow outside of it.
“Each month, inside the uterus, the glands build up in preparation for a pregnancy. If you do not fall pregnant, you have a period, and that menstrual blood contains the cells that house those glands. If those glands grow outside of the uterus, that indicates endometriosis,” he says.
So, what causes some women to be affected by endometriosis? Dr De Bruin says although the exact mechanism that causes endometriosis to grow in certain individuals isn’t yet fully understood, doctors do have some theories. Contributing factors include stress, as well as the foods we eat and the hormones they contain, he explains. “Endometriosis is a disease of the 21st century. It’s more prevalent today than it was 20 years ago and is becoming increasingly prevalent in younger girls.”
When endometriosis could cause infertility
Endometriosis occurs in four stages, ranging from minimal to severe. Each stage has a different impact on infertility, yet even patients with stage four endometriosis can conceive without medical intervention. “It doesn't mean that if you have endometriosis, you can't fall pregnant or that you have to have in-vitro fertilisation (IVF),” stresses Dr De Bruin. “You can have endometriosis without ever knowing it and have a baby.”
However, there are various cases in which the disease can cause infertility, he says:
If endometriosis spreads extensively and causes adhesions that stick the ovaries and tubes together, or the ovaries to adhere to the pelvic sidewall, it can lead to infertility. This happens because the tube can't reach the ovary to collect the egg during ovulation, which is crucial for fertilisation to occur.
In cases where the endometriosis occurs inside an ovary, it can prevent or decrease the chances for the ovary to ovulate (produce eggs). Without ovulation, you cannot conceive.
When endometriosis develops inside the uterus and grows into its wall, it causes a condition called adenomyosis. During conception, the egg is fertilised in the fallopian tube. After fertilisation, the embryo travels through the tube into the uterus where it needs to implant. If you have adenomyosis it can negatively affect the embryo's implantation in the uterus.
When endometriosis occurs in the pelvis, it creates a hostile environment that lowers the quality of the egg produced. This affects the tube's ability to pick up the egg, impacting fertilisation, embryo development, and implantation.
Treatment options to boost fertility
Treatment is tailored to patients based on whether they present with only pain, only infertility or both pain and infertility, says Dr De Bruin. “This is a very important differentiation to make. For example, if a patient doesn't have any symptoms, except infertility, and endometriosis is found on ultrasound, then we can do fertility treatment without performing surgery.
“But if a patient presents with both infertility and pain, then we need to perform surgery to treat the endometriosis. That’s because even if a patient manages to conceive, her quality of life is still diminished by the disease. And if she cannot conceive, surgery to remove the endometriosis can boost her chances of falling pregnant.”
Open surgery is never indicated for endometriosis, Dr De Bruin emphasises. “It must be laparoscopic and excisional – the endometriosis needs to be cut out and removed. Burning or laser treatment of endometriosis is not accepted treatment.”
He explains how surgery can help address infertility: For instance, if your endometriosis causes adhesions, removing them can restore a normal relationship between the tube and the ovary, improving the chances of becoming pregnant. He adds that removing endometriosis from inside the ovary eliminates its negative impact on egg quality. “Removing endometriosis in the pelvis also takes away the hostile environment it creates.”
Hope for endometriosis patients
In addition to Dr De Bruin, who specialises in both endometriosis and fertility, the unit has a colorectal surgeon, a urologist, physiotherapists, and other expert staff. “What sets the fertility clinic apart is that we have four registered subspecialists in reproductive medicine in our unit, something that is very rare. We have access to all available fertility treatment options.”
Dr De Bruin shares encouraging statistics based on his experience: “Even in patients with stage four endometriosis, the chances of falling pregnant are more than 60% either following surgery, or IVF, or a combination of the two.”
To find a gynaecologist or fertility specialist near you, go to www.mediclinic.co.za