ART seen as most efficient management of endometriosis, infertility

With endometriosis causing infertility in up to 50 percent of women affected by the condition and making it harder for women to get pregnant; global experts in the world of gynecology, says that assisted reproductive technology (ART) is the main treatment for women with endometriosis-associated infertility who want to get pregnant.

Gynecologists, at the second part of a two-day international conference on Endometriosis, held on the 10th of October, 2020 with the Themed: ‘Recent Advancements In Endometriosis Diagnosis and Management’ organized by the African Endometriosis Awareness Support Group, in conjunction with the Society of Gynecology and Obstetrics of Nigeria (SOGON), said there is no doubt ART represents the most efficient and successful management of endometriosis and infertility.

Abayomi Ajayi, chief executive officer (CEO) of Nordica Fertility Centre said ART is highly recommended for patients who have infertility and Endometriosis especially when the patient’s tubal function is compromised and the patient is above 38 years.

According to Ajayi, the decision to do In vitro fertilization (IVF) is easier in the presence of the following when the tubal function is compromised. That is why it is important to do a comprehensive fertility assessment. When a patient has blocked tubes, then there is no point in waiting, the patient needs to go for IVF.

“Also, when there is a male factor that is already compromised. There is no point waiting at all. If the woman is over 38 years, when other treatments have failed and when the endo is on stages III and IV, then you do not need to wait any longer, you have to go for IVF, because IVF is the main treatment for endometriosis and infertility.”

“We have also seen reduced ovarian, which may be related to the endometrioma.

“There is no doubt ART represents the most efficient and successful management of endometriosis and infertility. When we have a patient who has endometriosis, associated with infertility, the first thing we do is the comprehensive fertility assessment, which involves semen parameters, ovarian reserve, tubal status and uterine cavity assessment.

“There are so many controversies when discussing endometriosis with infertility, but one thing everybody agrees on is that in fertile women with endometriosis, clinicians should not prescribe hormonal treatment for suppression of ovarian function to improve fertility,” he said.

The way forward, according to Abayomi, who spoke on ‘Endometriosis and infertility’ said it is important to individualize treatment based on symptoms.

“We do not treat lesions, we treat patients, we treat symptoms and also when there is infertility, IVF can be used in all stages of endometriosis, preferably as the first option and six to 12 months after surgery.” he said.

The gynecologist advised that repeated surgery should be avoided as much as possible stating that counseling is very important as cycle cancellation is more common and multiple cycles may be needed.

“Avoid endometriomas at OPU to reduce risk of pelvic infection,” he said.

In the same vein, a gynecologist, Olarik Musigavong, chairman Subcommittee continuing professional development at the Royal Thai College of Obstetricians and gynecologists, speaking on Management of Endometriosis: To Remove or Not to Remove; said endometriosis should be viewed as a chronic disease that requires a life – long management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures

While management of Endometriosis is also a challenge in the treatment of the condition, Musigavong said endometriosis is a medical disease with surgical backup. Individuals with chronic superficial or presumed disease should be treated medically, reserving surgery for those having large endometrioma or palpable disease that fails to respond to the treatment.

“Do not remove small ovarian endometriomas of diameter less than 4 centimeter with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF.

“Do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception with post-operative long term treatment with estrogen- progestin,” he cautioned.

Femi Olarogun, Reproductive medicine and surgery sub-specialist at HART fertility clinic, Cape Town, South Africa, while discussing Fertility Preservation In Endometriosis; said fertility preservation should happen at several levels including careful selection of surgical candidates and careful intra- operative techniques.

Other speakers who spoke are Juwon Alabi, consultant and obstetrician at South Shore Womens and Children Hospital, Nigeria, spoke on Impact Of Endometriosis On Obstetric and Neonatal Outcomes in women with Endometriosis, Lian Zhang, a professor at Chongqing Medical University from China, spoke on High Intensity Focused Ultrasound In Management Of Endometriosis and Franciso Carmona, a professor at Barcelona’s department of obstetrics and gynecology, University of Barcelona from Spain spoke on Association of Endometriosis and infertility: Do we have any Evidence?.