The presence of the endometrium layer, which is normally found in the inner tissue of the uterus, in areas outside the uterus, such as the ovarian tissue or the inner abdominal membrane (peritoneum), is defined as "Endometriosis" or "chocolate cyst disease". It is a condition that affects 10% of women of reproductive age. The most common symptoms include painful menstruation, chronic pelvic pain and painful sexual intercourse. In addition, 30% to 50% of cases diagnosed with endometriosis experience infertility-related problems.
Among the mechanisms affecting fertility in endometriosis, the most important reason is that the ovarian reserve is negatively affected by endometriosis. In addition, other reasons include impaired mobility of the tubes due to adhesions formed in the pelvic area and decreased adherence of the embryo by the cytokines produced by endometriosis tissue.
Surgical removal of endometriosis (endometrioma) in the ovaries for any reason significantly affects the ovarian reserve. Unlike other cysts, endometriomas do not have a distinct capsule structure, and ovarian tissue may be damaged by the effect of electrocauterization, which is used to stop small areas of bleeding during surgery. As a matter of fact, studies show that ovarian reserve before and after surgery decreases significantly, especially in cases where endometriomas have been removed from both ovaries or in cases who have undergone more than one surgery.
Another noteworthy situation is that the presence of "endometrioma" causes a decrease in ovarian reserve after a certain period of time, even in cases that do not undergo surgery. It is thought that the fibrosis caused by endometriomas in the surrounding tissues of the ovary causes this condition.
It has been shown in many studies that the decrease in ovarian reserve with advancing age is more pronounced in cases with endometriosis than in cases without endometriosis. Therefore, it may be possible to offer these patients one of the fertility preservation methods as an option.
In fertility preservation, oocyte selection is determined according to the person's age and current egg reserve, whether he is married or single, or whether surgery will be performed. One of the options of freezing (egg), embryo, or ovarian tissue should be discussed in detail with the cases, along with the advantages and disadvantages of each method.
Read: 0
