Infertility and Endometriosis

1. INFERTILITY AND
ENDOMETRIOSIS
Dr. Shazia Iqbal
Assistant Professor (Obstetrics &
Gynaecology)
Director of Medical Education Unit
Vision College of Medicine, Riyadh

2. OUTLINE
oInfertility
oMen Causes, Risk
oLifestyle Changes to Improve Fertility
oWoman Causes, Risk
oEndometriosis

3. INFERTILITY
oWhat is infertility?
• In general, infertility is defined as not being able to get pregnant (conceive) after one year (or
longer) of unprotected sex.
oIs infertility just a woman's problem?
• No, infertility is not always a woman’s problem. Both men and women can contribute to
infertility.

4. CAUSES INFERTILITY IN MEN
A specialist will study the movement, shape, and number of sperm in
a semen sample to determine if a male factor is involved.
Some risk factors for abnormal semen include:
Disruption of testicular or ejaculatory function, such as through
trauma to the testes, heavy alcohol or drug use, cancer treatment.
Hormonal disorders caused by improper function of the
hypothalamus or pituitary glands, which maintain normal testicular
function.
Genetic disorders such as Klinefelter’s syndrome, Y-chromosome
microdeletion, myotonic dystrophy, or other, less common genetic
disorders.

5. WHAT INCREASES A MAN’S RISK OF
INFERTILITY?
oCouples in which the male partner is 40 or older are more likely to
report difficulty conceiving.
oBeing overweight or obese.
oExcessive alcohol use.
oExposure to testosterone, radiation, certain medicines, or certain
environmental toxins.
oFrequent exposure of the testes to high temperatures.

7. DIAGNOSIS
oSemen analysis.
oHormone testing.
oGenetic testing.
oTesticular biopsy.
oImaging.

8. CAUSES INFERTILITY IN WOMEN
oDisruption of ovarian function (presence or absence of ovulation
(anovulation) and effects of ovarian “age”)
• Hormonal imbalances
• Scarring of the ovaries
• Premature menopause
oFollicle problems
oUterine or Cervical Complications
oFallopian Tube Damage
oCancer & Cancer Treatment

9. WHAT INCREASES A WOMAN’S RISK
OF INFERTILITY?
oAge. About 1 in 6 couples in which the woman is 35 and older have
fertility problems.
oSmoking.
oExcessive alcohol use.
oExtreme weight gain or loss.
oExcessive physical or emotional stress that results in amenorrhea
(not having periods).

11. DIAGNOSIS
oOvulation predictor test.
oVaginal mucus.
oHysterosalpingogram.
oUltrasound. An ultrasound reveals
the shape and size of the uterus.
oHysteroscopy and laparoscopy.

12. ENDOMETRIOSIS
-Presence of endometrial tissue
(both glands & stroma) outside the uterus.
-Tissue is morphologically and functionally
similar to endometrial tissue responds to
hormones in cyclical manners.

13. RISK FACTORS
◇Genetics- It has been proposed that endometriosis results from a
series of multiple hits within target genes, in a mechanism similar to
the development of cancer. In this case, the initial mutation may be
either somatic or heritable.
◇Environmental toxins- Some factors associated with endometriosis
include:
-not having given birth (nulliparity)
-prolonged exposure to estrogen; for example, in late menopause or
early menarche
-obstruction of menstrual outflow; for example, in Mtillerian anomalies

14. CLINICAL MANIFESTATIONS
-Dysmenorrhea- painful, sometimes disabling cramps Lime
(progressive pain), also lower back pains linked to the pelvis
-Chronic pelvic pain- typically accompanied by lower back pain or
abdominal pain
-Dyspareunia- painful sex
-Dysuria - urinary urgency, frequency, and sometimes painful voiding

16. DIAGNOSTIC TESTS
-A health history and a physical examination Visual analogue scale
(VAS); VAS and numerical rating scale (NRS) were the best adapted
pain scales for pain measurement in endometriosis.
-Vaginal Ultrasound
-Laparoscopy
-Immunohistochemistry- Immunohistochemistry has been found to be
useful in diagnosing endometriosis as stromal cells have a peculiar
surface antigen, CD10.

17. MEDICAL MANAGEMENT
-Hormonal birth control therapy.
-Progestogens.
-Danazol(Danocrine) and Gestrinone (Dimetrose, Nemestran)
,suppressive steroids inhibit the growth of endometriosis but their use
remains limited as they may cause masculinizing side effects such as
excessive hair growth and voice changes.
-Gonadotropin-releasing hormone (GnRH) modulators.
-Aromatase inhibitors.

18. MEDICAL MANAGEMENT
-NSAIDs (Anti-inflammatory)-They are commonly used in conjunction with
other therapy. For more severe cases narcotic prescription drugs may be
used. NSAID injections can be helpful for severe pain or if stomach pain
prevents oral NSAID use.
Examples of NSAIDs include ibuprofen and naproxen.
-Opioids: Morphine sulphate.
-Pentoxifylline, an immunomodulating agent.
-Angiogenesis inhibitors

19. SURGICAL MANAGEMENT
-Conservative treatment consists of the excision of the endometrium,
adhesions, resection ofendometriomas, and restoration of normal
pelvic anatomy as much as is possible.
-A hysterectomy (removal of the uterus) can be used to treat
endometriosis in women who do not wish to conceive.
-For women with extreme pain, a presacral neurectomy may be very
rarely performed where the nerves to the uterus are cut. However, this
technique is almost never used due to the high incidence of
associated complications including presacral hematoma and
irreversible problems with urination and constipation

20. TREATMENT OF INFERTILITY
-Surgery is more effective than medicinal intervention for addressing
infertility associated with endometriosis. Surgery attempts to remove
endometrial tissue and preserve the ovaries without damaging normal
tissue. In-vitro fertilization (IVF) procedures are effective in improving
fertility in many women with endometriosis.
-During fertility treatment, the ultralong pretreatment with GnRH-
agonist has a higher chance of resulting in pregnancy for women with
endometriosis, compared to the short pretreatment.

21. SUMMARY

22. SUMMARY

23. REFERENCE
https://www.cdc.gov/reproductivehealth/features/what-is-infertility/
https://www.mayoclinic.org/diseases-
conditions/infertility/symptoms-causes/syc-20354317
https://www.fertilitysa.com/infertility-treatments/male-factor-
infertility
https://www.fertilitysa.com/infertility-treatments/causes-of-
infertility
https://www.health.harvard.edu/a_to_z/female-infertility-a-to-z

24. THANK YOU