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Treatment Options/Choices for endometriosis associated with infertility.

Endometriosis is a condition that generally affects 6 – 10 % of the female population. In women with infertility, endometriosis might be the underlying reason in about 25 – 50% of the cases.

Inflammation caused due to endometriosis damages the eggs and can also interfere with its movement through the fallopian tubes and uterus. Adhesions or scar tissues, which is the byproduct of inflammation can also block the fallopian tubes in certain severe cases of endometriosis.

Treatment of infertility in endometriosis: –
Below we list down the treatment options for the management of endometriosis.

1.Pain medication: Pain-relievers can help reduce pain intensity in endometriosis. However, certain pain killers need to be stopped during pregnancy as it can affect the fetus.

2.Hormonal medications: Synthetic estrogen, progestin, or both may be used to slow down endometrial tissue growth. But symptoms can return after treatment is stopped.

3.Surgery: Surgery does increase the chances of getting pregnant. Laparoscopy or Laparotomy procedures are performed to remove the endometrial lesions leaving the surrounding healthy tissues intact.

4.Infertility treatment: In vitro fertilization (IVF) is the best option, especially in those cases where they could not conceive after laparoscopy.

5.Hysterectomy: Performed in women who do not wish to become pregnant. However, it might not be a complete cure for endometriosis, as there is a chance of recurrence after surgery.

6.Nutraceutical therapy: Natural anti-inflammatory and anti-oxidants are being researched and developed for the successful management of endometriosis. They have been highly effective and safe and have been backed by several clinical studies.

SURGERY
A conservative surgical approach plays an important role in the treatment of endometriosis- associated infertility. Surgery aims to remove endometriosis implants and helps restore normal pelvic anatomy.

In women with early stage endometriosis, the goal of surgery is to destroy or remove all or most of the endometriotic implants. It has been observed that post the laparoscopic surgery, the monthly pregnancy rate and 36-week cumulative probability increased twofold.

Certain pieces of evidence suggest that pregnancy rates can improve if endometrial tissues can be removed surgically in Stage I or II but, some conflicting data shows that it does not.

Therefore, it is best to seek advice from your doctor with regards to the treatment option that is best for you. In women with late stage endometriosis, the goal is to restore the normal anatomical functions of the pelvis and remove large endometriomas. The pregnancy rates in these cases are higher after surgery is performed. However, a woman needs to get pregnant within a reasonable time frame after the surgery. If pregnancy does not occur within 6 months after surgery then other fertility treatments should be considered.

Cysts once removed can reoccur after surgery and if cysts are removed over and over, it can cause loss of eggs from the ovaries, reducing the chances of the woman getting pregnant.

In-vitro fertilization (IVF)
IVF is a successful treatment option for the endometriosis-associated infertility. IVF preempts the deleterious effects of endometriosis as it eliminates the oocyte–sperm interaction within the peritoneal cavity and is not dependent on the function of the fallopian tube.

It requires a woman to take small injections of fertility medications which supplements the growth of eggs in the ovaries within fluid pockets called follicles. After these follicles achieve a certain size, the eggs are removed from the ovaries using an ultrasound-guided needle and passed through the vaginal wall into the ovaries. This process takes about 10 minutes. The eggs are then placed in dishes with donor sperm in the fertility laboratory. Most of these eggs will fertilize and grow into embryos. Then, a few embryos are placed into the uterus with the help of a thin tube, through the cervix. After a certain period, one of these embryos will grow into a baby.

The chances of getting pregnant in one try range from 50% or higher for women in 20s to only 10% for women in their 40s. Some studies show that in mild endometriosis the chances of conception and live birth/cycle in women improved when the surgery is performed before IVF.

The above treatment options are good but also have certain demerits such as the host of side-effects associated with them.

Other than surgery, IVF and other conventional treatment options, the acceptance for novel, natural ingredient based nutraceutical supplements is gaining a lot of focus. These ingredients are from natural sources and are well-established for their effectiveness, safety and quality. Novel technologies are being employed to further improve the bioavailability and solubility of these ingredients. Such therapies are opening doors to better and more effective management and treatment options for women who suffer from endometriosis.

Beyond Conventional Treatment Approaches for Endometriosis
Other than surgery, IVF and other conventional treatment options, the acceptance for novel, natural ingredient based nutraceutical supplements is gaining a lot of focus. These ingredients are from natural sources and are well-established for their effectiveness, safety and quality. Novel technologies are being employed to further improve the bioavailability and solubility of these ingredients. Such therapies are opening doors to better and more effective management and treatment options for women who suffer from endometriosis.

Some of the natural ingredients that may be beneficial for the effective management of endometriosis are listed below:

Curcumin
Curcumin is the most active constituent of turmeric, a spice found in Indian saffron. It can be used in the prevention and treatment of endometriosis. Besides, curcumin can slow down disease progression by inhibiting the invasion, attachment, and angiogenesis of endometrial lesions. Curcumin is also recognized to be safe for use by the US Food and Drug Administration.

Curcumin has strong anti-oxidant properties: –
Studies have reported that the administration of curcumin significantly:
1.Reduces ROS production.
2.Prevents lipid peroxidation and protein oxidation.

Curcumin counteracts oxidative stress induced-DNA damage and optimize the egg quality as well as minimize symptoms associated with endometriosis and PCOS.7

Most of the conditions affecting women who are trying to conceive are characterized by inflammation and pain. In such cases, turmeric can help improve fertility because of its anti- inflammatory properties. It is also effective in infertility-related conditions such as PCOS, endometriosis, uterine fibroids, and pre-menstrual tension.

Additionally, curcumin inhibits the growth of endometrial cells by regulating the secretion of estrogen which is essential for the menstrual cycle and fertility in women. Research has shown that turmeric may be helpful for women dealing with fertility health issues such as endometriosis, uterine fibroids, ovarian cysts, premenstrual pain, amenorrhoea, and polycystic ovarian syndrome (PCOS). This restores the uterus to its proper shape and function.

Resveratrol
Resveratrol is a natural polyphenolic flavonoid found in grapes, mulberries and red wine. It is an anti-aging, antioxidant, anti-inflammatory, and insulin-sensitizing natural polyphenolic compound. Resveratrol prevents the progression and development of endometriosis.

Growing evidence is now suggesting that resveratrol has potential therapeutic effects in infertile women with diminished ovarian function, PCOS or endometriosis.

Resveratrol up-regulates sirtuin (SIRT)-1 expression in ovaries, which helps in protection against oxidative stress. It also initiates telomerase and mitochondrial function thus, also improving ovarian function and protects against age-associated ovarian infertility.

N-acetylcysteine (NAC)
N-acetyl cysteine (NAC) is a thiol antioxidant and a precursor of glutathione. Evidence suggests that NAC inhibits the proliferation of endometrial cells through MMP-9 reduction.

Elevated ROS and/or low antioxidant activities are related to the damage to gametes and embryos in the peritoneal fluid or follicular fluid of patients with endometriosis. NAC through its antioxidants decreases the rate of gamete and embryo damage.

The anti-inflammatory property of NAC is exhibited by inhibiting COX-2 which in turn reduces the estrogen. An added crossover effect of NAC is that it reduces prostaglandin E2, which is known to stimulate aromatase.

NAC is effective in improving fertility, insulin control, and in reducing pain associated with endometriosis. Additionally, NAC can also improve egg quality.

Reference:
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