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Endometriosis and eco what are the chances of reviews. Endometriosis with IVF and intrauterine insemination: tactics. Features of IVF for endometriosis

Article outline

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

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

Influence of endometriosis on conception

Despite the fact that medicine has achieved great success, the causes of endometriosis are not fully understood. There is also very little information about the development of the disease and its effect 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 small pelvis);
changes occurring with the hormonal background. The 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. The affected foci violate the local immunity in the uterus, as a result, the embryo implantation is suppressed, and the process of sperm advancement inhibits;
pain syndrome. If intercourse is accompanied by pain, this is a characteristic symptom of pathology.

Due to the fact that endometriosis has such a negative effect 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 method of combating infertility around the world. Each of its forms is effective. This technology has been in demand for over forty years. More than seven million people live on Earth who were born thanks to IVF. Its essence is as follows - sperm and eggs are found in a test tube, after which they are inserted into 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 in 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 sperm injection is very painful, moreover, there is a risk that the woman will get some kind of infection, and the pregnancy will not occur.

Is it possible to do IVF for endometriosis

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

In the case when pregnancy does not occur, it is recommended to turn to in vitro fertilization. When the age of a woman with such a diagnosis has overcome the threshold of 35 years, IVF is done immediately, preliminary expectant tactics are not needed. With the help of hormonal therapy, it is impossible to eliminate the foci of the disease; if the hormone intake is canceled, the possibility that the disease will resume is very high.

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

How to prepare properly

Endometriosis negatively affects the uterine muscles, this leads to the germination of endometrial tissue through the fibers, as a result, blood supply is disturbed, and the uterus may be deformed. Therefore, preparation for IVF with endometriosis involves the following activities:

laparoscopy is performed on the basis of individual indications. The operation is provided when striking foci are formed on the abdominal organs;
to temporarily suppress the production of estrogen, they resort to hormone therapy. This will help prevent the growth of foci of the disease, and also cause its regression;
with such a diagnosis, long protocols of in vitro fertilization are used (the use of extra-long ones is possible). Daily administration of Dipherelin stimulates ovulation. Stimulation takes place under ultrasound control;
if you had to turn to an ultra-long IVF protocol, the introduction of hormonal injections occurs for six months, when this stage is completed, ovulation is stimulated. This method suppresses ovarian function, blocks menstrual function, increases the number of healthy eggs and increases the likelihood of embryo implantation.

Features of IVF

The choice in favor of a particular IVF program is made based on:

ovarian conditions;
the period during which pregnancy did not occur;
the level of the disease;
the age of the woman.

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

If attempts to conceive a child are unsuccessful, then a relapse of the disease should be excluded. If it manifests itself again, then it will be accompanied by the same symptoms. When the sensations are too painful, then a second laparoscopy should be considered. 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 under 35. For women of a more mature age, the procedure is prescribed immediately, after such stages as:

hormonal treatment;
laparoscopy.

The opinion that if the degree of development has reached 3 or 4 stages, the procedure cannot be performed, 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 should be noted that IVF is not performed with a thin endometrium. The reason for this is the too low chances of a successful outcome. If the thickness of the endometrium is insufficient, IVF will need to be delayed.

Benefits of long and super long IVF protocols

Eco for endometriosis implies the choice of one protocol or another. This is the name of the sequence of administration of drugs. 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 in whom the volume of the ovarian reserve is at an average level. The scheme of long protocols starts from the 20th day of the menstrual cycle, the procedure for the introduction of Dipherelin and Decapeptyl occurs every day. Then you need to wait for your period and prescribe a stimulant medication 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 result are higher, about 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 small, the possibility of getting pregnant with tubal-peritoneal factor is much higher. But even if pregnancy has come, a woman must be under the supervision of a doctor.

Endometriosis lesions reduce the chances of pregnancy with 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 3-4 stages, the chances of pregnancy after IVF are reduced to 8-14%. Chances are significantly reduced if the patient has an endometrioid ovarian cyst, which must be removed. The low efficiency is due to the fact that with endometriosis, due to many negative consequences, the quality and ability of the egg to fertilize and implant are reduced.

The initial deficiencies of the ovum, which it receives, is difficult to compensate for even through in vitro fertilization with conduction. But with such seemingly low chances for the success of the procedure, the effectiveness of IVF in endometriosis is superior to that in the tubal-peritoneal factor of infertility.

Possible ART methods for endometriosis

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

A mild degree of the disease (external endometriosis of 1-2 degrees) requires expectant tactics, 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 should again be examined for the appearance of foci of endometriosis, which is expressed in the appearance of pain, cysts and the growth of CA 125 tumor markers. In order to relieve pain, the woman may undergo repeated laparoscopy. Unfortunately, it will not increase the chances of natural conception, therefore, the most correct solution in such a situation would be an urgent IVF.
If the foci of endometriosis have not affected the fallopian tubes, after clinical confirmation of their patency, stimulation of ovulation and subsequent sperm from the husband may be an effective method. With healthy ovaries and fallopian tubes in 13-50% of cases, this procedure is successful. However, if the result is negative, it makes sense to resort to IVF.
If the patient is over 35 years old, IVF together with ICSI should be performed immediately after the endometriosis treatment ends. This is due to the fact that, in addition to the negative effect of the disease on the eggs, their quality and quantity for natural reasons suffers with age.
Time should not be set aside 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 affected, possible complications make the operation too dangerous or the quality of the partner's sperm is not high enough.
Low ovarian reserve or numerous unsuccessful IVF attempts in the past are the reason for offering the patient IVF using.

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

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

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

One of the causes of female infertility is a chronic disease -. It is an overgrowth of tissue outside the uterine cavity, which is very similar to the endometrium. Endometriosis can be multifocal 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, it was found to be associated with hormonal imbalance and immune disorders that occur in women of reproductive age. Endometriosis - in half of the cases. But you shouldn't panic, because the specialists of our clinic know how to act in such situations.

Endometriosis as a cause of infertility

In order to understand whether it can decide with endometriosis, it is necessary to understand its features:
. At first, 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 to the formation of dense tissue adhesion and disruption of the ovulation process, the movement of eggs.

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

With unsuccessful attempts at conception, a 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 second one is prescribed, if the pain can be tolerated, then IVF is prescribed.

However, there is an exception - the confirmed patency of pipes. In this case, the next one 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 only possible if your age is not more than 35 years old. If we are talking about a more mature age, then it is prescribed literally immediately after hormonal treatment and laparoscopy. Can also be used a method of fertilization of an egg called, which involves the introduction of a sperm cell into the egg using a special needle.

If you think that 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 passing a full examination and passing a large amount. The protocols in this case are prescribed long, from two weeks to three months, because with their help you can get healthy eggs in larger quantities.

IVF efficacy for endometriosis

Uterine endometriosis (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 embryo implantation failures.

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

Operative treatment cannot solve the problem of endometriosis of the body of the uterus, operations on embolization of the uterine arteries in women in the reproductive period and planning pregnancy are not desirable. Since there is insufficient nutrition of the ovarian tissue.

Exists several preparation tactics women with endometriosis to the IVF program. The tactics depend on the patient's follicular reserve. We determine the follicular reserve not only by AMH (anti-Müllerian 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.

Doppler ultrasound 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 the deposited drugs.

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

After 2 blocked cycles with good follicular reserve, you can safely start stimulating ovulation.

For those who have a small follicular reserve, we carry out treatment with Vizanne. 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 has appeared on the pharmacological market quite recently.

We have many interesting and complex case histories of patients with adenomyosis who ended in pregnancy.

Is it difficult to endure pregnancy after treatment for adenomyosis? Yes, there are difficulties with bearing, so it is important to follow the doctor's recommendations, choose the right dose of progesterone and estrogen drugs, and correctly cancel them.

IVF for endometriosis

Endometriosis is a fairly common gynecological disease, which is accompanied by the appearance of areas of the endometrium in atypical places.

Depending on the localization, the pathology can be genital (endometrial foci remain within the genitals) and extragenital (localization is outside the genitals).

Let's talk about whether it is possible to do IVF for endometriosis.

Endometriosis is a common cause of infertility. It is detected in about 50% of women who go to the doctor about the inability to conceive a child. In vitro fertilization (IVF) is one of the ways to overcome infertility in patients with this diagnosis.

Influence of endometriosis on reproductive function

The exact cause of the disease has not been established. It is believed that genetic factors, disorders in the functioning of enzyme systems, and hormonal imbalances play a role in the development of pathology.

Typical complaints of patients who turn to gynecologists for endometriosis are:

Pain in the lower abdomen. Most often they are pulling in nature and are associated with menstruation.
Smudging dark spotting before and after menses.
Discomfort or pain during intercourse.
Fertility disorders.

Infertility with endometriosis is a fairly common problem. The reproductive function depends on the localization of the pathological site, its vastness.

The main causes of impaired fertility in patients with an appropriate diagnosis are the following:

Pathological changes in the genital organs of women against the background of endometriosis can cause the formation of an adhesive process, which leads to obstruction of the fallopian tubes. The possibility of egg migration into the uterine cavity disappears.
Endometriosis is a hormone-dependent disease. It is accompanied by an imbalance of biologically active substances in a woman's body. The amount of prostaglandins, interleukins increases. The process of oocyte maturation may be disrupted.
The disease also negatively affects the patient's immune system. Accordingly, fertilization of the egg may not occur even with preserved ovulation and passable fallopian tubes.
When ovarian endometriosis occurs, a decrease in ovarian reserve is characteristic.

These pathogenetic mechanisms cannot always be eliminated by hormonal therapy or surgery. Therefore, natural fertilization sometimes becomes impossible. IVF in such cases is the best way out of this situation.

Is IVF done for endometriosis?

One of the indications for the use of ART is endometriosis. Conservative treatment is usually used before IVF. At the initial stages of the development of the disease, hormonal therapy can level the symptoms of the disease and restore reproductive function. But treatment aimed at normalizing fertility is used for no more than 1 year. If pregnancy does not occur, IVF is recommended.

If the patient is over 35 years old, then she can do IVF for endometriosis immediately, without prior expectant tactics.

Endometriosis often requires surgical treatment. It is necessary if the patency of the fallopian tubes is impaired, there are endometrioid ovarian cysts, foci of endometriosis on the peritoneum are found. If pregnancy does not occur in the coming months after the operation, IVF is indicated.

Hormone therapy does not eliminate the foci of endometriosis; at the time of its administration, the spread of endometrioid foci stops. With the abolition of hormones, there is a risk of relapse of the disease.

In vitro fertilization in patients with endometriosis is carried out according to the standard scheme. Previously, fertility specialists preferred long protocols. However, it is now clear that the presence of endometriosis in a woman does not affect the choice of protocol.

If a woman is diagnosed with endometriosis, after IVF, she needs support for the luteal phase to reduce the risk of spontaneous abortion.

Endometriosis with IVF - what are the chances?

Different clinics show different effectiveness of IVF for endometriosis. The chances of a successful pregnancy with IVF in patients with endometriosis at VitroKlinik are about 48%. But this is an average figure. It depends on a number of factors.

Every fifth has signs of endometriosis. It is believed that this is a sign of our time: environmental degradation, decreased immunity, repeated abortions, chronic stress lead to the onset of this disease or its rapid progression.

Endometriosis is a hormone-dependent disease that appears against a background of impaired immunity. Symptoms of the disease depend on where the endometrial tissue (the lining of the uterus) begins to grow - in the tubes, on the cervix, on the ovaries, on the peritoneum, etc.

Diagnosis and treatment of endometriosis

According to modern medical standards, for an accurate diagnosis of endometriosis, laparoscopy or hysteroscopy is necessary to see the lesions, do a biopsy and conduct a microscopic examination. But often the complaints and the course of the disease are so specific that the diagnosis is quite reasonably made according to the clinical picture.

Endometriosis often reduces the chances of pregnancy and pregnancy. This is due to various complications that accompany or are part of endometriosis. In 80% of patients, there is an adhesive process and deformation of the fallopian tubes. More subtle changes include a decrease in the level of LH in the blood and the follicle itself. In addition, the level of the female sex hormone estradiol increases, which impairs the function of the corpus luteum.

In addition, numerous studies carried out in patients undergoing IVF against the background of endometriosis have shown that during IVF in women with endometriosis, the quality of oocytes (eggs), their ability to fertilize and the ability of the resulting embryos to implantation are reduced.

IVF protocols for endometriosis

In endometriosis, "long" or "extra-long" protocol schemes are usually used, although, as usual, the approach to choosing a scheme remains strictly individual.

With a "long" stimulation protocol, agonist administration begins on the 21st day of the previous one. Use as daily injections, for example, Dipherelin at a dose of 0.1 mg, and a single injection of Dipherelin-depot at a dose of 3.75 mg under the skin of the abdomen. Stimulation of superovulation begins from 3-5 days of the menstrual cycle. Daily intramuscular injections of gonadotropins are used in individually selected doses. Stimulation is carried out under the control of hormone levels and ultrasound, until the leading follicles reach a diameter of 18-20 mm. On this day, an ovulatory dose of hCG is prescribed. In 35-36 hours after the administration of hCG, a puncture and collection of oocytes are performed. Their fertilization, incubation and embryo transfer are carried out according to the usual rules.

In the "ultra-long" protocol, gonadotropin-releasing hormone agonists are administered over several months (2 to 6). Prescribe several (according to the clinical picture) injections, for example, Dipherelin-depot or Decapeptyl-depot every 28 days, and then stimulate superovulation. At the same time, the activity of the ovaries is suppressed more deeply, which is of great importance precisely for patients with endometriosis.

Unfortunately, statistics show that with endometriosis, embryo implantation occurs somewhat less frequently than with other forms of infertility, for example, tubo-peritoneal. This even applies to patients with grade 1-2 endometriosis. The reasons may be a decrease in the quality of oocytes (eggs) or due to the fact that endometriosis has disrupted the structure of the uterine mucosa and caused the accumulation of substances toxic to the embryo in the uterine cavity.

Despite the urgency of the problem of infertility in women with endometriosis, especially during IVF treatment, there is still no consensus on how to carry out hormonal and laparoscopic treatment before IVF, on immunocorrection, on the features of the IVF protocol, etc.

However, many IVF clinics conduct both clinical and laboratory studies to optimize the achievement of IVF pregnancy in women with endometriosis.

Discussion

Good afternoon, I wanted to ask if such a diagnosis is possible to get pregnant uterine ademinosis

02/17/2019 18:39:09, Angela Briceag

you consoled me. There was even hope. If I manage to get pregnant naturally, I will be beside myself with happiness.

It is important to have the operation performed in a good center and with a good surgeon. One should not be afraid of the operation, since very often treatment is impossible without it. With endometrioid cysts, it is dangerous to delay the operation.

Girls, if you are being treated with medication, then you are still not so bad. I will be operated on Wednesday. I am worried about this, but it is necessary.

06/18/2013 19:02:37, Fishkare

Girls, and I got pregnant successfully, although I also have Endometriosis. Carried out the baby. Now my son is two years old))) Endometriosis began to progress again, they also said to drink Vizannu for the time being. At first, Janine was prescribed, but the drug did not suit me, so they changed to Vizanne.

Where does this stuff come from. Horror alone! I also suspect that this Endometriosis is. I'm going to take tests and they told me to do an ultrasound scan to say for sure if there is Endometriosis.

06/18/2013 18:28:11, Anastasia566

Very good article. thanks, great clarification!

06/16/2013 12:45:24 PM, Annushka232

My cousin with endometriosis also suffered, they made her a lapar, treated her for a long time. We thought that only IVF would help, but after a year she was able to get pregnant. Still, much depends on the doctors, she was treated in Mother and Child, good doctors were caught, for a long time she was examined, digging into every little detail, here's the result. Not like in other clinics, they immediately offered IVF to cure without any preliminary tests.

A useful article, everything is true. Only to me, after laparoscopy, the menses were turned off for 6 months, then 6 months of independent attempts, with no result. Again laparoscopy and for 4 months menses were turned off, then IVF, without result, but in the next cycle an independent pregnancy began, and three years later the second. In addition to endometriosis, the diagnosis also included antiphospholipid syndrome.

06.06.2008 11:52:16, Maruha

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