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Treating endometriosis with medicines has definite limitations. Medication usually controls mild or moderate pain and may eliminate small patches of the disease. But large chocolate cysts in the ovary are less likely to respond, and drugs cannot remove scar tissue. This is why surgery may be needed to improve fertility by removing adhesions, lesions, nodules or endometriomas.
As described earlier, laparoscopy can be used as a therapeutic tool. For example, fluid can be drained; adhesions freed; and small patches of endometriosis destroyed using a laser or electrical current. Even large endometriomas can be removed through the laparoscope by a skilled surgeon, so that today most cases can be successfully treated through the laparoscope. Open surgery (laparotomy) is needed only very rarely.
Treatment cannot "cure" endometriosis - but it can control it. If an infertile woman afflicted with endometriosis fails to conceive even after surgical treatment, the next option is superovulation with intrauterine insemination, since the fallopian tubes in these patients are usually open. If this fails, then IVF (in vitro fertilization) can be very useful. However, the ovarian response in some of these patients can be poor, especially if they have large chocolate cysts, or have had surgery for these cysts. Fertilization rates in some patients with endometriosis can be a little lower than for other patients, perhaps because of an intrinsic oocyte abnormality.
Endometriosis is a disease affecting millions of women throughout the world. For many, the condition goes unnoticed. But for others it demands professional attention, especially when fertility is impaired. The best strategy to maximize chances of conception is to select a specialist who is familiar with the latest developments in endometriosis management.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
