Fertility preservation for women with endometriosis - is there a role?

Roger Hart CREI, Professor of Reproductive Medicine, University of Western Australia &

Medical Director of Fertility Specialists of Western Australia

 

What are some of the ways we can help preserve fertility?

 

 Endometriosis is a common gynaecological condition that, in addition to causing pelvic pain,

can also be associated with difficulty in getting pregnant. The great news is, that most women

with endometriosis can successfully have a baby. However a small number of women will take

a little longer to conceive, and some will require IVF treatment to get pregnant.

 

IVF treatment is a form of fertility treatment that requires a woman to take some injections

to increase her hormone levels, and after a couple of weeks she will undergo a minor surgical procedure to take eggs from her ovaries through an ultrasound probe in the vagina. This is a

minor procedure, but understandably is associated with some period like discomfort and

hormonal side-effects. These eggs can then be mixed with a woman’s partner’s sperm to grow

an embryo. An embryo can then be placed in the uterus a few days later to help her conceive.

 

The success of the treatment depends on the age of the woman, and how many eggs are

collected. Women with endometriosis who are concerned about their fertility are encouraged

to seek the advice from an expert in infertility, such as a specialist who holds the extra training

certificate in the field of infertility (CREI). It is important to realise that thousands of women

all over the world with endometriosis have been able to successfully have their families due

to IVF treatment.

 

Now, sometimes women may not be in a relationship, but their disease is getting worse.

Under the expert guidance of their infertility specialist they may be encouraged to ‘freeze

their eggs’ for them to use later, as a form of ‘insurance’. The reason for this suggestion is

that some women with advanced endometriosis frequently get ‘chocolate cysts’

(endometriomas) in their ovaries. Although not all endometriomas are a problem, if the

woman has to have several operations on her ovaries there is a risk of her ‘running out of

eggs’. Therefore her fertility doctor, or her endometriosis doctor, may suggest she ‘freeze’

her eggs to preserve her future fertility. In this situation the IVF treatment may qualify for

some re-imbursement by Medicare, unlike so-called ‘social egg-freezing’ which is done by

women who are not (for whatever reason) ready to start a family.

 

The reason is, women who are undergoing egg-freezing with advanced endometriosis, are

doing it for fertility preservation reasons, not for so-called ‘social’ reasons. There will probably

still be a significant ‘out-of-pocket’ cost, so it is important for her to discuss with the treating

doctor, or her GP. Egg –freezing is basically an IVF cycle, without mixing the eggs with sperm,

and just freezing the eggs immediately they are collected. There may be annual storage costs

for the eggs from that point onwards. It is important that a woman who is considering eggfreezing

for advanced endometriosis, discusses her situation with an expert in the field, and

that the process and costs are thoroughly explained. Many women with advanced

endometriosis will derive substantial reassurance that they have ‘put some eggs on ice’. As,

unfortunately, the life course of advanced endometriosis can lead to a woman undergoing

several operations over her reproductive life-span, and not all operations improve her chance

of conceiving, as some procedures can lead to damage to the ovaries despite the skill of an

expert surgeon. Indeed there is even evidence that women with advanced endometriosis

have a reduced number of eggs in the ovary, despite not having undergone surgery. Again a

chat with an expert in infertility and / or endometriosis will assist a woman in her decision

making.

 

Therefore a young woman with significant advanced endometriosis who is not planning a

family in the near future should probably have a chat with their GP, or their endometriosis

expert, to see whether thinking about ‘egg-freezing’ is a good idea.

 

 

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