Endometriosis lowers fertilization, implantation and pregnancy rates compared with tubal factor. Women with endometriosis have reduced fecundity. In many cases it distorts the ovaries and the oviducts. In pelvis especially around oviducts adhesions are found that hinder the approach of ova to enter the oviducts.
Diagnosis is usually based on clinical evidence. These are best assessed by pelviscopy which visualizes all the pelvic structures and areas around oviducts. Sonography may give some idea.
Management: There is no agreement on standard treatment. Various forms of medical treatments have been tried over the years. GnRH agonists reduce endometriosis to great extent. Medical therapy provides no benefits & delays the conception. Surgery is recommended which can be extensive.
Women with mild endometriosis are usually treated similarly to women with unexplained infertility. Super ovulation followed by IUI or IVF is favored treatment.
If there are adhesions in the pelvis between the ovaries and the fimbrial ends of the tubes, they require surgical removal. Pelviscopic surgery is preferred. In multiple dense adhesions IVF is the choice.
Obstruction and Non functioning Oviducts The female reproductive passages should be patent for the ova and sperms to reach site of fertilization, the oviducts. The oviducts should be healthy to perform all its functions; nourishment of ova, sperms and embryo and propulsion of embryo towards uterus. Non-functioning and semi functional oviducts present a difficult problem to solve.
Restoring patency of distorted Fallopian tubes does not ensure their proper function because the disease causing the blockade destroys the physiological function of the particular part of reproductive organs.
Tests of Female Reproductive Passagesare.
- Methylene Blue (Dye test).Colored liquid detected by direct vision through Pelviscopy. Dye test is superior to other methods and is the first choice.
- Hysterosalpingography (HSG) radiopaque dye is seen by X-rays.
- Hysterocontrast Sonography (HyCoSy) using sonopaque dye is detected by ultrasound.
Management of Obstruction & Non functioning OviductsCorrection of blocked oviducts is difficult problem. In past surgical procedures were done but results were disappointing. Mostly the subsequent healing process closes them again. Even if the obstruction is cleared for the sperms and ovum to come in contact there may be no further progress because of the loss of tubal function.
In vitro fertilization & Embryo Transfer (IVF-ET) and surgical correction are the two choices.
Surgical correction is no longer favored. The procedure is cumbersome, time consuming with extensive surgical trauma & poor outcome. Success of treatment depends on severity of tubal damage, age of woman, specialized surgical services, and IVF. In view of the disappointing results of surgery, IVF-ET
is the choice. IVF should not be delayed too long in the hope that other treatments may work or there can be spontaneous conception. The condition may further deteriorate and wife’s advanced age may add to the misery.