	Community

	Message Board Chat Forum

	Infertility

	Introduction Causes Of Infertility Age And Infertility PCOS Premature Menopause Miscarriage Investigating Infertility Preconception Care Counseling Treating Infertility Sex Selection

	IVF and ICSI

	Introduction IVF Procedure Risks Of IVF Outcome Of IVF Factors Affecting IVF Laws And Regulations UK IVF centers IVF League Tables Frozen Embryo Transfer Surgical Sperm Retrieval Electro-Ejaculation Assisted Hatching Blastocyst Transfer Genetic Screening ICSI

	GIFT and ZIFT

	GIFT And ZIFT Tubal Embryo Transfer

	Donation

	Introduction Sperm Donation Egg Donation Embryo Donation

	Insemination

	Introduction Vaginal Insemination Cervical Insemination Intrauterine Insemination Intratubal Insemination

	Surrogacy

	Introduction Guidelines And Protocols

	Adoption

	Introduction Adopting In The UK Children With Disabilities Overseas Adoption

	Resources

	Fertility Calculator Fertile Period Calculator Pregnancy Calculator FAQs Glossary Links And Contacts Bookstore Infertility News Feedback Advertising

Treatment options

Endometriosis

There are several treatment options available for patients suffering from endometriosis. Treatment should be tailored to individual women. It is worth remembering that there is a considerable spontaneous pregnancy rate in infertility associated with minimal and mild endometriosis. Treatments for endometriosis may include one of the following techniques: drug treatment, surgery, intrauterine insemination and IVF.

Drugs

Drug treatment allows the endometriosis to “dry up” and heal. There are a number of drug therapies. These are taken for several months. Each drug therapy has its own advantages and side effects. Some of the commonly used drugs include: contraceptive pills, progesterone, danazol and GnRh agonist e.g. nafareline, buserelin (these drugs need to be taken every day, without a break). Long-acting GnRh agonists such as zoladex can be given as a monthly implant. These drugs put a temporary stop to the production of certain monthly hormones. Obviously while the patient is taking the medication she can not get pregnant, but the aim of the treatment is to reduce the extent of endometriosis in the hope that the patient will conceive soon after she stops the medication. The main problems associated with suppressive drug therapy include: the length of time it takes (about 6 months), which could be a problem especially in infertile women. Treating endometriosis with drugs has its own limitations; large chocolate cysts are less likely to respond to medication and drugs will not remove scar tissues. In addition, there are unpleasant side effects. It is important to use cap or condoms for contraception while taking the GnRH agonist or Danozol, since pregnancy is not advised. There is no evidence to support the use of ovarian suppression drugs in the treatment of endometriosis-associated infertility (RCOG guidelines 2006)

Surgery

To destroy the endometriotic nodules and divide adhesions by either burning them using a fine metal electrode or laser them. This usually improves the fertility in the subfertile women with mild/minimal endometriosis (NICE Fertility Guidelines, UK, 2004; RCOG guidelines 2006). In women with large ovarian endometriotic cysts (4cm or more in diameter). Surgery may improve access for egg collection and the chance of pregnancy if IVF is considered. The procedure is done under a general anesthetic and can be done by laparoscopy and in certain cases by laparotomy. The procedure involves the endometriosis being cut away or burned, the adhesions divided. Chocolate cysts are removed (ovarian cysectomy) or opened and drained and their lining destroyed (coagulated) to prevent the cyst from reforming. There is evidence that ovarian cystectomy is better than drainage and coagulation (RCOG guidelines 2006).

Post-operative medical treatment does not improve pregnancy rates in women with moderate to severe endometriosis and so is not usually recommended (NICE Fertility Guidelines, UK, 2004; RCOG Guidelines, 2006).

Unlike drug treatment, the patient can try for a baby within two to three weeks of the operation and thus it is usually a better option for older women.

IUI

The technique intrauterine insemination with ovulation induction is effective treatment but only suitable for young women with healthy Fallopian tubes who ovulate regularly, have a minimal or mild endometriosis and where there is no severe male factor infertility. Up to 6 cycles of intrauterine insemination should be offered because this increases the chance of pregnancy (NICE Fertility Guidelines, UK, 2004).

IVF

The technique IVF is an effective treatment in all stages of endometriosis and is the treatment of choice in women with severe or moderate endometriosis. If the fallopian tubes are damaged or there is also a male factor infertility. There is evidence that IVF pregnancy rates are lower in women with endometriosis than those with tubal infertility (Barnhart et al. Fertility and Sterility, 2002). There is also evidence that treatment with GnRH agonist for 3-6 months before IVF treatment in women with severe endometriosis increases the rate of clinical pregnancy (Marcus et al. American Journal of Obstetrics & Gynecology 1994; RCOG Guidelines, 2006).

Previous | Next

Page:1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

User Contributed Notes

There are no user contributed notes for this page.

Last updated: Sat, 08 Sep 2007 - 4:58:26
Add Comments

Terms and Conditions