Is it possible to become a mother with endometriosis? How to treat inflammation and when to operate
The first step is the diagnosis, which must be timely. In favor of women also pharmacological therapies, specific treatments and minimally invasive surgery
Having a pregnancy is more difficult but not impossible for those suffering from endometriosis. This disease indicates the presence of tissue similar to the endometrium, the mucous membrane that normally covers the uterine cavity exclusively, outside the uterus. It can affect the woman from the first menstruation and accompany her to menopause. It affects 10-15% of the female population in the world and, according to the Ministry of Health, in Italy it concerns beyond 3 million women of fertile age. However, the data is underestimated, since only a low percentage of those who suffer from it knows they are affected by it. It is estimated that the diagnosis arrives 7- 10 years late, not infrequently when the woman manifests the desire for motherhood.
Pregnancy and discovery of endometriosis
«Today in Italy the average age in which the woman seeks pregnancy is 33 years old, when the fertility rate has already reduced. If he suffers from endometriosis but does not know, the disease and the lack of diagnosis can further impact on his fertility. In general30% of women with endometriosis has infertilitybut the remaining 70% no. When a couple has difficulty having children, usually after a year of null attempts, investigations begin and thus emerges the endometriosis, often precisely as a result of investigations for a pregnancy that does not arrive. If we calculate that on average the first menstruation reaches 12 years and the first pregnancy at 33, there is a period of about 20 years in which if the endometriosis is there but has not received a diagnosis, works undisturbed.
The patient will probably find out only when he went to a fertility center », explains Dr. Marcello Ceccaronidirector of Department of Obstetrics and Gynecology of the IRCCS Sacro Cuore-Don Calabria of Negrar of Valpolicella (Verona)creator of the « Negrar Method », the mini invasive award -winning technique and adopted all over the world.
Endometriosis, the importance of a timely diagnosis
«For many women the diagnosis of endometriosis comes with a delay up to 10 years, even in the presence of symptoms. The first years are lost in the family network, since they all around the patient, despite the painunderestimate the symptoms, but paradoxically other years they are lost in medical networks, with the general practitioner, the pediatrician, the gastroenterologist and even the gynecologist to whom the woman turns that do not recognize the symptoms or do not require a specialist consultation. Meanwhile, the disease advances. The first step is to reassure women. In a center like Negrar, we welcome patients every day from all over Italy and abroad. We are talking to them and often we discover that they are terrified and certain of not being able to have children: they have often received coarse information. It should be emphasized that endometriosis does not equate to infertilityeven if the main cause is. The difference makes the timeliness of the diagnosis », underlines the expert.
Pregnancy, inflammation must be stopped
« When diagnosed initially and faced with adequate therapies that contain its symptoms, there is a fair probability that the disease can remain under control and, consequently, that the patient may be pregnant. Otherwise the disease acts undisturbed: Create adhesions, sticking the organs, distorts or closes the tubes, creates inflammation chronic that frees cytokines. The latter go to hinder pregnancy in other way, since They reduce the number, the quality of the oocytes and their survival. THE’inflammation, then, creates problems for the fertilized egg And everything becomes much more complex. In the patient’s belly with endometriosis to every menstruation, therefore about every month, there is an inflammatory stimulus, the equivalent of a fire that the following month fits again on the ashes of the previous cycle. If we consider that a woman has on average 14 menstruation per year, let’s try to imagine the damage that the disease can do in 20 years (the period of time between the first menstruation and the first pregnancy): 280 fires inside the belly of the woman who will also impact on her fertility « , highlights Ceccaroni.
Endometriosis and pregnancy
« About 30% of endometriosis patients manage to get pregnantalso thanks to specific treatments. The medically assisted procreation (PMA) is not limited to in vitro fertilization, but includes exams, interventions and personalized paths to improve the chances of conception. Fresco techniques (Fivet) offer a success rate of 28-29%, with the average age of couples who turn to fertility centers currently 36 years old. A further positive aspect is that during pregnancy, the disease tends to stabilize or regress, thanks to hormonal changes « , continues the expert.
Endometriosis, when to operate
«Endometriosis should not be surgically treated but with pharmacological therapies. However, in About 10% of cases, the intervention is necessary when the disease causes damage to the organs, compromising the function of bladder, intestine and reproductive system. Targeted surgery removes cysts, corrects tubes and reduces inflammation, increasing the chances of pregnancy. In the past, invasive interventions could seriously affect the quality of life, causing urinary, intestinal and sexual dysfunctions in 36% of cases. Today, thanks to the Negrar method, this risk dropped to 4.5%. This nerve-spanning technique, adopted in many international centers, allows you to save the crucial nerve fibers for the functioning of the bladder, intestine and sexuality and returns to women a more normal perspective of life and the possibility of planning a pregnancy without feeling « chronic sick » », reassures Dr. Ceccaroni.
Endometriosis, a cultural revolution is needed
«Endometriosis is not only a gynecological disease, but a cultural and social challenge. Its impact on working and emotional life is enormous: over 30% of women with this pathology must change their life choices due to symptoms. Many girls experience severe menstrual pain from adolescence, which gradually worsen, forcing them to bed, to the use of drugs and serious psychological inconveniences. There positional dyspareunia, That is, the pain during relationships in certain positions is another common symptom, often underestimated. Scandinavian studies indicate that over 50% of the girls who remain at home for the cycle already suffer, without knowing it, of endometriosis. Teachers, families, boyfriends, doctors should be more aware of the alarm signals to facilitate timely diagnoses. Only a cultural gearbox can facilitate diagnosis. The timely treatment of endometriosis is essential to preserve fertility and guarantee pregnancy « , concludes Dr. Ceccaroni.
