Free Information Session 8th May 2013: Endometriosis and Infertility - Treatment Options


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Dr Jodie Semmler presented about the treatment options available for sufferers of Endometriosis. She outlined what they entail and how fertility treatment is individualised to provide the best possible outcomes.

Dr Semmler is one of Adelaide's leading gynaecological surgeons. She has had extensive experience in laparoscopic keyhole surgery treating fertility issues including the excision of endometriosis. Dr Semmler is also a sitting member of the Australian IVF Directors group. For more information on Dr Semmler, please follow this link

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Free Information Session 8th May 2013: Endometriosis and Infertility - Treatment Options

  1. 1. Endometriosis and InfertilityTreatment OptionsPresented byDr Jodie Semmler
  2. 2. 1. Healthy diet and exercise2. Natural remedies3. Medical management4. Surgical management5. Fertility treatment options – IUI, IVF6. Importance of individualising fertility treatments7. Future possible treatmentsSummary of Treatment Options
  3. 3. Normal Pelvis
  4. 4. Severe endometriosis (stage 4)
  5. 5. Minimal and Mild endometriosis (stage 1 and 2)
  6. 6. Endometriosis in Pouch of Douglas
  7. 7. Endometriosis over bladder
  8. 8. Endometriosis on surface of uterus
  9. 9. • Maintaining healthy weight is of paramountimportance• Higher weight (BMI) leads to higher oestrogenlevels which encourages growth of endometriosis• Lack of ovulation will exacerbate – eg PCOS• Exercise has been shown to reduce symptoms,pain and recurrence ratesHealthy diet and exercise
  10. 10. • Healthy diet and plenty of aerobic exercise• Co-Enzyme Q10 – may reduce fatigue• Vit B6, vit E, Copper, magnesium, acupunture - mayreduce menstrual pain• Chinese herbs – safety NOT proven, specificingredients often unclear (quality), no proof for benefit• Progesterone cream – may act as a mild contraceptive(as may herbs that claim to regulate hormones)Natural Remedies
  11. 11. • Hormonal therapies all effective in pain reduction butdo NOT improve fertility• Examples include – OCP, progesterone tablets,Mirena device, GnRH agonists (zoladex, synarel)• Most work by preventing ovulation and stoppingperiods• Useful for reducing pain and preventing recurrenceof endometriosis when NOT trying to conceiveMedical Management
  12. 12. • Ablation (burning the lesions)- Includes laser, diathermy, microwave- Technically easier but bigger nodules often under-treated, higher chance of recurrence• Resection/Excision (cutting out)- scissors, diathermy, laser, harmonic scalpel- Technically more challenging, reduces chance ofrecurrence, need to be careful to spare as much ovariantissue as possibleSurgical treatment for endometriosis
  13. 13. Surgical Excision using Harmonic Scalpel
  14. 14. • Laparoscopic treatment of minimal to moderateendometriosis (stage 1,2 and 3) has been proven toincrease chance of natural conception by 25-40% overthe following 2 years• Laparoscopic treatment before IVF- Unfortunately studies have NOT been able to provethat surgical excision of endometriosis leads to anyimprovement in IVF success ratesDoes surgery improve fertility
  15. 15. • Indications for surgical excision of endometriosis- Pain- A desire to maximise chance of natural conception- Large endometriosis cysts (endometriomata) in ovaries- Recurrent unsuccessful IVF cyclesHowever, repeated excisional surgeries have NOT beenshown to improve pregnancy rates and may furtherreduce egg supply so careful consideration requiredWhen should we operate?
  16. 16. • IUI – Intrauterine insemination• IVF – Invitro Fertilisation• IVF with donor eggsFertility Treatment Options
  17. 17. • Involves inseminating partners sperm through the cervixinto the uterus• Need to have normal fallopian tubes and pelvic anatomy• Pregnancy rates reduce in women with endometriosisprobably because endometriosis and adhesions interferewith function of fallopian tubes, sperm and eggs• May still be reasonable option if mild endometriosis +anovulation, mild sperm issues, sexual difficultiesIUI – Intrauterine insemination
  18. 18. • IVF often the best option for conception in women withendometriosis• Chance of success with IVF is slightly reduced inwomen with endometriosis conpared to other causes ofinfertility (eg male factor, blocked tubed)• Success rates with IVF are directly related to severity ofendometriosis (more severe = lower success rates)IVF – Invitro Fertilisation
  19. 19. • Women with endometriosis may do better when we suppresshormone production (which switches off the endometriosis)prior to starting the stimulation injections- This is called a long down-regulation cycle• Studies showed no clear difference between standard longdown-regulation cycle (2 weeks of suppression) and short cycle(antagonist) IVF• Studies HAVE shown improved pregnancy rates whenhormones are switched off for 3-6 months before IVF cycle(Ultra long down-regulation cycle).Tailoring IVF treatments for endometriosis
  20. 20. • May need to be considered if recurrent IVF failure,low egg supply, poor quality eggs, advanced femaleage etc• When eggs from a healthy donor are used live birthrates rates in recipients with endometriosis = live birthrates in control recipientsThis shows endometriosis does NOT affect theability to carry a pregnancyIVF with donor eggs (oocytes)
  21. 21. • Couples with endometriosis as a fertility factorwill often have other contributing factors/issues• Pain and other symptoms need to be considered• The couples preference, including time frames,desire to avoid surgery or IVF are paramount• Individualisation of treatments to suit eachcouple will lead to best outcomesImportance of individualizing fertility treatment
  22. 22. Consulting Clinic345 Carrington StreetAdelaide SA 5000Phone 8100 2900e