Protection of Fertility in Endometriosis Disease

The presence of the endometrium layer, which is normally found in the inner tissue of the uterus, in areas outside the uterus such as the ovarian tissue or the peritoneum is defined as “Endometriosis” or “chocolate cyst disease”. It is a condition that affects 10% of women of reproductive age. The most common symptoms include painful menstruation, chronic pelvic pain, and painful intercourse. In addition, 30% to 50% of cases diagnosed with endometriosis have problems with infertility.

Among the mechanisms affecting fertility in endometriosis, the most important reason is the negative effect of ovarian reserve from endometriosis. In addition, the deterioration of the mobility of the tubes due to adhesions in the pelvic region and the decrease in the adhesion of the embryo by cytokines produced from the endometriosis tissue are other reasons.

Surgical removal of ovarian endometriosis (endometrioma) for any reason significantly affects ovarian reserve. Unlike other cysts, endometriomas do not have a distinctive capsular structure, and the ovarian tissue may be damaged by the effect of electrocauterization, which is used to stop small bleeding areas during surgery. As a matter of fact, studies show that ovarian reserve before and after surgery is significantly reduced, especially in cases where endometrioma is removed from both ovaries or in cases that have undergone more than one surgery.

Another remarkable situation is that the presence of “endometrioma” causes a decrease in ovarian reserve after a certain period of time, even in cases that have not undergone surgery. Fibrosis created by endometriomas in the surrounding tissues of the ovary is thought to cause this condition.

 

It has been shown in many studies that the decrease in ovarian reserve with advancing age is more pronounced in cases with endometriosis than in cases without. Therefore, it may be possible to offer these patients one of the methods related to fertility preservation as an option.

 

In fertility preservation, one of the options for freezing oocyte (egg), embryo or ovarian tissue according to the age of the person and the existing egg reserve, whether he is married or single or whether surgery will be performed, together with the advantages and disadvantages of each method, should be discussed in detail with the cases.

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