Endometriosis and fertility

March was recognised as Endometriosis Awareness Month, where women were encouraged to end the silence against the potentially debilitating condition.

Below is a feature on the condition from Shauna Fuller Clarke, executive director of BASE Foundation, the local endometriosis awareness group.

WHEN tissue similar to the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed endometriosis. Endometriosis may grow on the outside of your uterus, ovaries, tubes, the bladder, intestines, and uncommonly on the lungs and the brain. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.

Categorised as one of the top ten most painful diseases, endometriosis is estimated to affect approximately 176 million women worldwide or one in every 10 girls and women in their reproductive years ­— aged 15 to 49. This estimate is relatively crude as many patients are misdiagnosed with pelvic inflammatory disease (PID), and therefore do not benefit from the correct diagnostic tests.

Chronic pelvic pain is the most common symptom; specifically pain before, during, and after a period, painful intercourse and pain during urination and defecation. Fatigue, severe bloating, and infertility are also symptoms.

Infertility refers to the failure of a couple to get pregnant after a year of frequent (two to three times weekly) unprotected sex. Up to 30 to 50 per cent of women with endometriosis may experience infertility. Even those without severe pelvic pain may have infertility.

Endometriosis can affect fertility in several ways: scarred Fallopian tubes, adhesions leading to distorted anatomy of the pelvis, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment within the ovaries, tubes and uterus resulting in decreased quantity and quality of eggs, and impaired implantation of a pregnancy.

The only way to definitively diagnose endometriosis is by doing a surgical procedure called a laparoscopy and based on the amount, location and depth of endometriosis, the doctor will determine whether a woman has minimal (stage 1) mild (stage 2), moderate (stage 3) or severe (stage 4) endometriosis. Women with severe endometriosis may experience the most difficulty becoming pregnant because of considerable scarring, blocked Fallopian tubes and damaged ovaries.

For patients who desire to become pregnant, a combination of surgical and medical therapy may be beneficial. While the chances of becoming pregnant are improved after surgical treatment, there is no guarantee one will become pregnant and so assisted fertility technologies such as Intrauterine Insemination (IUI) and in vitro fertilisation (IVF) can be considered as viable options.

IUI is a simple assisted conception method where the patient is required to have at least one healthy Fallopian tube. The treatment involves taking laboratory prepared sperm and placing it directly into the womb at the time the egg is released. The process of IVF is an option if there are blocked Fallopian tubes and involves collecting eggs from the ovary and combining them with sperm in a dish. If they fertilise, embryos are returned into the womb to, hopefully, produce a healthy baby. Overall, symptoms and treatment options for women with endometriosis will vary. While there is currently no known cure for the disease, it can be managed effectively through the right combination of therapy.

IS SPEAKING ABOUT ENDOMETRIOSIS TABOO?

For hundreds of years, young girls and women have suffered from chronic pelvic pain conditions — where pelvic pain has often been downplayed as “normal”, or “a woman’s cross to bear”. It is quite astounding especially in Jamaica where females account for approximately half of the population, that many suffer in silence or shame.

While women and men are confronted with gender-specific health risks and diseases which need to be adequately addressed in medical research and health services, it is widely recognised that gender-based inequalities are present in the healthcare system.

In the case of endometriosis which is one of the top three causes of female infertility, its profound impact relating to a female’s emotional and psychological well-being, her productivity levels at school or work, and her personal relationships is often ignored.

Even though we are more open in our discussions as a society, there is still some societal taboo when topics such as (symptoms of) menstruation and fertility issues are raised. This, along with other difficulties that a woman might experience as a result of endometriosis such as painful intercourse and infertility, can contribute to broken relationships and depression.

It takes an average of six to 10 years from a female first exhibits symptoms to be properly diagnosed. And it is not uncommon for a woman to see on average five physicians before she is diagnosed. These statistics, by any standard, need to improve. Although strides have been made,