Endometriosis, major cause of infertility

Amritha (name changed) and her husband Vinod (name changed), a couple who were married for close to four years, were unable to have a child even after a year of trying. They approached a fertility expert, when the cramps during menstrual cycle turned into chronic pelvic pain and profuse bleeding for Amritha. She was diagnosed with stage 2 endometriosis. Endometriosis among the reproductive age group is worrying, say doctors, as it has a direct impact on the eggs reserve. The common symptoms for the same are severe lower abdominal pain, heavy menstrual bleeding and infertility when ignored in the long run.

Amritha is among the 30-40 per cent women with fertility issues being diagnosed with the condition, according to recent findings by a fertility centre in the city. Talking to DTNext, Krithika Devi, fertility consultant, NOVA IVI Fertility, said that endometriosis was the most common condition seen among the patients’ sample that also included those who came from the neighbouring districts. She added, “As such, the condition accounts for 15 to 20 per cent among other groups, but since we are a tertiary centre we see advanced cases and it is as high as 30-40 per cent.” 

Incidence of this condition is more in the infertile group — it is more like petrol and fire, said Dr Krithika. “Young women are more at risk, owing to the nature of the condition. A woman who is pregnant will not have periods for a while till delivery, and the disease goes into remission. Infertile women don’t have this absence so they are more prone,” she explained. 

There are many theories concerning the causes — from the lack of immunity to genetic reasons and menstrual blood getting implanted in the wrong place. 

The treatment modalities for endometriosis depend on the size of the cyst. Dr Krithika said, “If the cyst is small then we can go with medications. However, if it is the size of an orange, surgery is the only option. But there is a higher chance of recurrence, even after surgery.” 

As a result, doctors say that among infertile women, the treatment can be most effective, if they undergo fertility treatment. In fact, for Amritha, In Vitro Fertilisation (IVF) helped her conceive in the first attempt. Dr Krithika said, “After having her first baby through IVF, she managed to conceive the second time naturally. I have had four patients, who have been through the same modality for other reasons and have managed conceiving the second time without any intervention.” 

But with women unwilling to seek treatment, the problems are manifold, added Dr Krithika. “As many as 50 per cent of the women with the condition want to try and have a baby the natural way. When the cysts become bigger, surgeries can affect the ovaries,” she added.