Endometriosis Infertility- Treatments

Infertility simply put means that "you cannot make a baby (conceive)"

I realise this sounds a cold way to put it but believe it or not this is the definition you get when you search engine the word.

Some people are so scared of this word, that the stress alone makes them very ill. Couples cry when they hear the dreaded "you infertile" words. You already have Endo, isn't that enough?

I know how you feel because this is exactly what I went through, first being told at 18 I would never conceive to being 26 and another specialist saying "with fertility treatment, in my case Clomid, I could conceive". We went four rounds of Clomid last year without any conception. However, we have not given up hope. The stress endured from the rounds of treatment, not only exhausted us but took the please out of being intimate. At one point we had a "sex schedule". Oh I kid you not! It became an obsession, becoming pregnant. Everyone had something to say about it and that, in fairness was our saviour and our curse. 

We had support from family because they knew what we were going through and cut me some slack when I was especially hormonal. But it was also nearly a daily discussion and to be quiet frankly we got bogged down in the science and logic and tried to put our emotions aside. Every month, when a negative pregnancy test returned I felt my heart sinking. I became so focused on becoming pregnant, that I put myself under a ton of stress which did not help my cause whatsoever.

There is a body of thought out there saying that having "mild" Endo does not equal infertility. However, it has been shown that, Women who have what is considered to be mild Endo can be effected negatively regarding their fertility. Endometriosis affects fertility adversely in many different ways, though the most important seems to be it's effects on normal tubal function.

Infertility treatment in cases of Endometriosis requires specialised expertise. Fertility treatments involved often cause an increase in oestrogen levels. Oestrogen, however often "feeds/encourages" Endo and make it worse in some cases.


Finding the right balance between advantages and risks of different infertility treatments, therefore, is always of utmost importance in Endometriosis.



Investigations attempting to explain why patients with Endometriosis are often infertile suggest that:

• Their fallopian tubes may function abnormally, due to adhesion or scarring (so-called tubal infertility)
• Ovarian function may be adversely affected, possibly resulting in sub-par egg quality
• Endometriosis may release toxic substances which may harm embryos and/or their implantation capacity
• Patients with Endometriosis may be at a higher risk for miscarriages, lowering their live birth chances

Finally, there may be an immunological factor involved in Endometriosis. Norbert Gleicher, MD, CHR's Medical Director, was the first to report on the possible association of autoimmunity and Endometriosis, suggesting that Endometriosis, indeed, may be an autoimmune disease. It is now widely accepted that the immune system, indeed, plays an important role in Endometriosis-associated infertility.

{CHR}

Endometriosis and IVF (In Vitro Fertilisation)

Endo seems to affect IVF treatment with prejudice from reducing the number of eggs at the time of retrieval to poor egg quality, and lower implantation pregnancy rates. 

HOPE: Most patients with Endo may still be able to conceive with IVF treatment. 

What to expect from IVF?

IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. 

However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.

IVF is never the first step in the treatment of infertility. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one.You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. 

Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

• During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

• Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner's sperm, which he will have donated on the same day.

• While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

• Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. 

• To increase the chances of pregnancy, most IVF experts recommend transferring three or four embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.

In cases where the man's sperm count is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen -- or in some cases right from the testicles -- and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.

Endo and IVF Success Rates

Overall the success rate for IVF is 25% in a "normal healthy patient". In patient's with Endo this rate is lower although the reasons are unclear. 

You won't be offered drug treatment because the drugs used usually suppress ovulation for a period of time or they may be harmful to a developing embryo. It has been shown that there is no improvement in pregnancy rates after finishing them. 

The exception to this is gonadotrophin-releasing hormone (GnRH), which inhibits the production of hormones involved in ovulation. There is limited evidence that a 3-6 month course of GnRH prior to IVF can improve pregnancy rates for women with Endometriosis.

http://www.babycenter.com.au/a7211/what-you-need-to-know-endometriosis

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.

The Costs of IVF

The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine. This price will vary depending on where you live, the amount of medications you're required to take, the number of IVF cycles you undergo, and the amount your insurance company will pay toward the procedure. You should thoroughly investigate your insurance company's coverage of IVF and ask for a written statement of your benefits. Although some states have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, many states haven't.

Also be aware that some carriers will pay for infertility drugs and monitoring, but not for the cost of IVF or other artificial reproductive technology. Resolve: The National Infertility Association publishes a booklet called the "Infertility Insurance Advisor," which provides tips on reviewing your insurance benefits contract.

{WebMD}

Apart from fertility medications, injections and so on IVF is truly a "last resort" option for many couples. The stress and strain (emotionally and financially) can take it's toll so IVF is not something to be entered into lightly. 

New Research

As I was writing this post, looking for some decent information to share from Medical Professionals I stumbled across this article. I'm simply going to share it with you and make what you will of it. But I personally found it an interesting read. 

New Infertility Treatment Receives Patent Protection

A research group in Florida has received patent protection for a new infertility treatment. The therapy is a combination of physical therapy and 'site specific' massage. No drugs or surgery are used.

The investigating team was encouraged after initial studies showed a fifty percent success rate treating infertile women with a "hands on" treatment protocol. "With such a high preliminary success rate, we decided to conduct further research," said physical therapist Belinda Wurn.

The group was recently granted patent protection for the technique. Now, the group has reported another pregnancy.

"Staci had a history of three years of infertility, prior to therapy," said massage therapist Larry Wurn, co-director of Clear Passage Therapies. "Her physician found no known cause, but she fit the profile we were looking for, a history of either surgery, inflammation or trauma. About half of all infertile women fit this profile," Wurn said.

A massage therapist herself, Staci flew three thousand miles to spend a week receiving the treatment. Her therapy consisted of ten hours of massage and physical therapy treatment. Three months later, she discovered she was pregnant.

"I wasn't really that surprised," said Staci, "When the gynaecologists explained about adhesions and the fact that organs can get stuck or adhered anywhere in the reproductive tract, it made a lot of sense," she said. "In my own experience, I am used to freeing up tight, shortened muscles in my clients. It doesn't take much to make the transition to treating internal adhesions in organs."

The patent protected therapy, called the WURN Technique, involves no surgery or drugs. "Treatment consists of gentle, highly specific manual pressures over restricted areas," Wurn says.

"Medical literature suggests that 80 percent of abdominal and gynaecological surgeries cause adhesions," explains Marvin Heuer, MD, President of Florida Medical and Research Institute, and Research Director for the group. "Adhesions may form after inflammation such as bladder or yeast infections, Endometriosis or pelvic inflammatory disease. They may also form after trauma, such as back, hip or tailbone injury."

"Medical literature indicates that adhesions are a direct or contributing cause of infertility in about 40 percent of infertile women. In America, this represents over two million women," Heuer explains.

Richard King, MD, a gynecologist with the research group, helped design the present clinical trials. "If ongoing studies continue to produce results," he says, "there are positive implications for infertile women and patients with pain or dysfunction due to adhesions."

According to Dr. Heuer, "Patients appear to appreciate the more natural approach with this therapy. Since treatment is without surgery or drugs, there is a significant decrease in side effects and complications. The main side effect appears to be decreased pain. One surprising side effect appears to be increased orgasm, in some women."

http://www.endomagazine.com/articles/infertilitytreatment.shtml

It goes to show you that there are always options, keep you chin up. I know it's hard but there is always hope.