Carrying on with our WCE 2014 highlights, let’s have a look at some of the research into fertility issues and endometriosis. Reduced fertility is one of the major problems faced by women with endometriosis, yet there are still many mysteries surrounding how endometriosis affects fertility.
In order to shed at least some light on the issue an Italian research team investigated how ovarian endometriosis (endometrioma) can affect the viability of ovarian follicles in women undergoing IVF. What they found was that follicles closer to endometrioma showed higher levels of iron. Iron, of course, is important for your body but in endometriomas iron accumulates in high amounts, probably due to blood filling the inside of the cyst. These high levels of iron can be toxic to anything close by, in this case, ovarian follicles. This leads to impaired development of the follicle and perhaps partly explains why so many women with endometrioma/s find it hard to conceive.
If you have an endometrioma, chances are you’ll want surgery to remove it, but you’ll also want to know what the risk of recurrence is and what factors influence that risk. A team from Brazil looked at the records from 202 women undergoing laparoscopic excision of endometrioma between and 2003-2012 and analysed those records to see what influenced endometrioma recurrence. They found that the overall rate of endometrioma recurrence was 16.4% and that factors such as age, race, symptoms, exercise, number of children and type of surgical procedure had no effect on recurrence rates. However, they found that having a cyst larger than 6cm (which is pretty large) and stopping medical therapy after surgery significantly increased the chance of endometrioma recurrence (although the abstract didn’t specify which medical therapy was used). Because of the side effects associated with some of the medical treatments for endometriosis, it is unsurprising some women need to stop treatment. However, if stopping treatment means an increased risk of disease recurrence, then more work needs to be put into ensuring other, more tolerable medical options are made available.
Speaking of IVF, some women who suffer with fertility issues may consider IVF as a means of conception. It is therefore important for women with endo to know if their condition may affect their IVF outcome. A group from France compared 291 women with endo to 1316 women without to see what the effects, if any, endo made to the delivery rates after undergoing IVF. What the researchers found was that, in the women who had good ovarian stimulation response and high quality embryos, the total cumulative successful delivery rate for fresh and frozen embryos was 52.3% for women with endo and 45.8% for women without. Although women with endo had lower rates of good ovarian stimulation, the overall outcome was no different between women with and without endo. This suggests that having endo (regardless of stage) may not impact the success of IVF.
Although it appears that endo doesn’t affect the success of IVF, it would still be good to have some way of improving IVF outcomes. A group from New Zealand has been conducting a randomised, controlled trial to see if a drug called Lipiodol has any benefit on IVF outcomes, as their initial tests showed this treatment improved the fertility of women with endo much more than women who couldn’t conceive but didn’t have endo. Lipiodol can normally be used for hysterosalpingography (a procedure used to determine the shape of the uterus and fallopian tubes) and is injected into the uterine cavity so comes into contact with the endometrium. The authors of this study think that Lipiodol ‘bathes’ the endometrium, making it more receptive to a fertilized egg. Their results are still very preliminary so should be met with cautious optimism, but are still encouraging. The women who received IVF alone achieved a live delivery in 22.7% of cases, but the women who had Lipiodol treatment plus IVF achieved a live delivery 43.8%. These results are encouraging, but we’ll have to wait until the clinical trials have been completed and the results properly analyzed before drawing any firm conclusions.