Endometriosis and undesirable conditions (complications) due to endometriosis are one of the biggest causes of female infertility. Endometriosis is a hormone-dependent disease that occurs as a result of the migration of the tissue called the endometrium, which covers the inside of the uterus and is shed with menstruation (menstrual bleeding), out of the uterus. When this tissue leaves the uterus, it most commonly spreads to the ovaries (ovaries) and tubes (fallopian tubes, tuba uterina) and then to the bladder and intestines through the neighborhood. When it reaches the outer surfaces of these organs, it develops with the effect of hormones called estrogen and progesterone, which enable the woman to fulfill her menstrual function. This development shows a scar tissue-like healing in the following process and causes adhesions (thin or dense adhesions) that cause the adjacent organs to stick together, disrupting the functions of the mentioned organs, often causing pain. It prevents the meeting of sperm and egg, especially with its effect in the tubes, may impair egg quality with excessive or different secretion of some substances secreted from normal tissue (TNF-alpha, interferon-gamma), and impair the functions of the endometrium (uterus membrane) that provide embryo attachment. As a result, pregnancy emerges as an obstacle to development.
Endometriosis is observed in 1%-5% of women; It causes infertility-subferility in 30%-50% of these patients with the disease. Treatment and management of the disease depend on the extent of endometriosis, the symptoms in the patient, and the severity of the disease.
Symptoms of endometriosis can be painful menstruation (dysmenorrhea), pain in the lower abdomen, especially in the groin, waist and rectum during menstruation, painful sexual intercourse (dysparenu), and failure to develop pregnancy (infertility) despite 1 year of unprotected intercourse. In most cases, there are no symptoms; It is detected incidentally or during gynecological examinations.
The gold standard method for diagnosing endometriosis is diagnostic laparoscopy. During this laparoscopic (closed surgery) procedure, the disease is graded into 4 stages using the most widely used revised American Society for Reproductive Medicine (rASRM) classification system. (minimally, mildly, moderately and severely). ESPECIALLY IN THE CASE OF INFERTILITY, THE STRENGTH OF THE EFFECT OF THE DISEASE CAUSES INTO CONCEPTION CAN BE DETERMINED BY THE COMMON INTERPRETATION OF THE EFI (endometrial fertility index) EVALUATION BY THE RARM CLASSIFICATION, THE MULTI-INTERPRETATION OF THE INTERPRETATION OF INFERTILITY IS MULTIPLE DETERMINED. IT HAS GREAT IMPORTANCE. (In patients with endometrioma (chocolate cyst), a diagnosis can also be made by ultrasonography, but the extent of the disease in the abdomen cannot be evaluated.) In this procedure, a camera is inserted into the abdomen through a small incision made in the navel while the patient is under general anesthesia and the presence of the endometriotic focus, its spread, its location in the organs, the path It is evaluated whether the adhesions it opens, whether the tubes are affected by the disease, whether the space between the uterus and the last part of the large intestine (Douglas cavity, cul-de sac, excavatio rectouterina) is occupied by the disease, whether there are foci on the intestines, bladder and peritoneum. In the same session, the organs where the disease has settled, the adhesions that have made and that impair the organ functions, especially the disease that completely occludes the Douglas cavity with nodular and dense adhesions (which can cause painful sexual intercourse, painful defecation and chronic constipation) can be intervened within the surgical principles. Endometriomas located outside of the area can be removed. Although it seems very simple, endometriosis surgery is the most difficult and most experienced area of gynecological laparoscopy. It should definitely be done by experienced gynecologists. When surgical intervention is made especially in deep infiltrative endometriosis and endometrioma cases, a very meticulous surgery should be performed in terms of intestinal injuries and in order to preserve ovarian reserve. If damage to the tubes has impaired the function of the tubes, the tubes should be removed in order to increase the chance of success (in vitro fertilization) in future treatments. THERE IS NO TREATMENT BY DRAINING THE ENDOMETRIOMAS WITH THE ASSIST OF A NEEDLE. IF IT IS DONE, IT MAY CAUSE MANY UNDESIRED CONDITIONS INCLUDING PELVIC ABSE.
Minimal and mild endometriosis can be managed with medical treatment, taking into account the woman’s desire for pregnancy. However, in moderately severe and severely graded cases, surgical intervention is often preferred for both increasing the quality of life and preserving fertility. In any case, a woman with endometriosis should be informed about her condition in a way that she can build her own life plan and should be informed about possible treatments. Endometriosis is a serious disease that requires close and regular patient-physician communication. Both evaluation and treatment should be planned in the light of contemporary guidelines, especially in the case of a woman who is planning to have a child or in a patient with deep infiltrative endometriosis who has pre-existing pain complaints.
Endometriosis and infertility
