IVF and Endometriosis

Endometriosis is a common gynecological condition that affect approximately 10-15% of the female population.

Endometriostic ovarian cysts may be present in up to 20-40% of women with endometriosis scheduled for IVF and on both sides in 19-28% of the cases.

The best medical approach to treat endometriotic ovarian cysts is controversial, as it may delay the fertility, the lady desires.

Should we remove the endometriosis by surgery is matter of debate.

With surgery , there are great chances that it may affect the ovarian reserve and impairs the responsiveness to treatment, and also does not offer any additional benefit in terms of fertility outcomes.

In addition, surgery is great risk to women, as it is mostly a complicated surgery.

The laparoscopic removal of bilateral endometriomas prior to IVF should be limited to those cases with normal ovarian reserve, presence of pain symptoms, rapid growth or sonographic features of malignancy.

Conversely., in the absence of the above-mentioned features, patients with bilateral endometriomas should be encouraged to proceed directly to IVF to reduce time to pregnancy, to avoid potential surgical complications and to limit costs.

The retreival of oocytes may be less in endometriotic cases, compared to normal, but the quality of oocytes may be same and pregnancy rates may be comparable, if lady goes for IVF as early as possible, when all conservative approaches are exhausted

Blastocyst transfer may help in repeated IVF failure cases

Recurrent implantation failure may identified after three failed IVF cycles or after transfer of 10 high grade embryos. There are many different factors which may contribute for this recurrent IVF failure, such as parental chromosomal translocations, abnormal uterine anatomy , hydrosalpinx, or inadequate  culture conditions or embryo transfer techniques.

Failure may be due to factors with the “Seed,Soil or the Cultivator”

Some studies have suggested that local injury of the endometrium by means of a catheter or hysteroscopy can induce an inflammatory response that may facilitate the preparation for implantation.

Artificial rupture of the covering of the embryo ( Zona pellucida) may improve implantation: Assisted Hatching, but is still not proved.

Pre-implantation genetic screening of the embryos is now a day used to get and select best embryos. But this strategy did not show any improvement in patient outcome  and did not show any significant difference on clinical pregnancy rates.

A few studies have reported that congenital and acquired prothromotic conditions are more prevalent in women with recurrent implantation failure. Therefore use of low molecular weight heparin (LMWH) and mini dosage of aspirin on patients with thrombophilia and recurrent implantation failure has been discussed, but large studies are required to prove them .

Finally, another possible strategy is to extend embryo culture to blastocyst stage, aiming to improve embryo selection and uterine receptivity

Luteal Phase support in IVF treatment, can we make it little comfortable for female partner

When  IVF  is performed, in many centers, after egg retrieval, they start injection Progesterone daily for at least 15-20 days till the day of pregnancy confirmation. It is really a painful phase of fertility treatment. Injections of progesterone are usually  oil based and they dissolve slowly. When you inject it , it makes a small lump in the muscle, either in buttock or arm. It is very painful experience for the female partner.

Can we make this luteal phase little pain free, or can we make Fertility treatment little bit more comfortable.

Female partner suffers the most in IVF treatment, even if the fault may be in male partner, She has to receive injections for the growth of the eggs , undergo egg retrieval, and then injections for luteal phase support. And if she achieves pregnancy, then she might have to receive this injection may be for three months.

Here at Ideal Fertility center , we use vaginal progesterone and we usually or mostly do not use injections of progesterone for luteal support, and our pregnancy rate is at par with the best centers in world performing infertility treatment.

We try to make the IVF treatment comfortable as far as possible for the female partner. We try to make it more user friendly. Minimum visits, minimum blood tests, minimum injections, without compromising the outcome