Endometriosis




Hysteroscopy



Overview

Endometriosis is presence of endometrial tissue (inner layer of uterus) outside the uterus. When a lady menstruates, there will be bleeding in the extrauterine tissue also, which will cause severe pain during periods, excessive bleeding. If it is inside the ovary- causes chocolate cyst, affects the egg quality and destroys the eggs too. When these bleeding spots heal, it will cause adhesions between 2 organs, affecting the movement of tube. All this will lead to a problem of infertility.



Why it’s Done

Pregnancy is the best cure for endometriosis, since there is no periods for 9 month and no bleeding too. Endometriosis is a vicious cycle, lady with endometriosis have lower probability to get pregnant and this problem of infertility will increase endometriosis. Endometriosis intern causes infertility. This cycle needs to be broken down at certain point. That is where the fertility treatment aid in.


Endometriosis
How You Prepare

With patient symptoms and scan findings, we can tentatively make a diagnosis of endometriosis. The confirmation is done only by surgery. Here we will put a camera attached to the scope inside the tummy through navel and see whether this disease exists, in the same sitting we will grade the severity of the disease, treat the disease by excision of ovarian cyst or separation of adhesions, excision of disease spots then and there. Based on the severity, further fertility treatment is planned.


What can you expect?

The case will be individualised and the treatment is planned accordingly

Surgical therapy: when there is need for surgery, operative laparoscopy is done. If there is chocolate cyst, it will be removed. Other endometriotic spots will be excised. The tubal status at surgery is noted.

Medical therapy: Post surgery or when the doctor feels the disease is still in a preliminary state, hormone injections once a month can be administered. There is also a hormonal tablet which needs to be taken every day. These medications prevent her periods and keep the disease in check, also the disease symptoms.

Fertility treatment: For a lady with endometriosis, it’s better to conceive as early as possible. Postsurgery 6 month is the golden period where fertility will be at its peak. Depending on the surgical finding, your doctor will decide which mode is better for you to conceive faster. And pregnancy itself will be cure for the disease too.



Results/Post Procedure

Post-surgery depending on the extent of the surgery done, they may need rest for 1-3 days. After which they can resume their usual work. After discharge, if there is severe pain abdomen, vomiting, giddiness, or heavy bleeding per vagina, they need to report immediately to the hospital.

If it’s a mild disease and tubes are open, one can try naturally or with IUI. If its a severe disease and/or tubes are blocked, better to go ahead with IVF, as IVF has the maximum pregnancy rate per cycle among all the procedure done.



What Are the Risks?

First and foremost thing is ovarian reserve, disease by itself will destroy the ovaries. During surgery; if there is a chocolate cyst which is excised, many number eggs are destroyed. Hence ovarian reserve decreases. It is not a procedural complication, rather the consequence of the disease itself.

During surgery because one organ will be attached to other, while separating there can be bleeding. If bowel or bladder is adherent there can be injuries, which is the rarest but known complication.

During IVF, due to the disease process, the egg quality may not be good. This is reflected on the embryo and also on the pregnancy.

On a final note endometriosis is a disease, which intervened at a proper time with a proper method of treatment gives a good success rate.

 


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