Endometriosis Disease Treatment, Endometriosis Infertility

Endometriosis - Lets beat the disease together!

Do you experience severe pain during your periods? Does it pain while having intercourse? Are you unable to have a baby? You could be suffering from a condition called endometriosis.

What is Endometriosis?

It is a condition in which the endometrium that normally lines the inside of the uterus, is present outside the uterus. It could be present at various sites like the ovaries (chocolate cyst - comments site), as peritoneal deposits, between the vaginal wall and the rectal wall, in the uterus (adenomyosis), in the bladder, over the gut. Few rare sites like it being present in the lungs have also been reported.

What explains the presence of endometriotic tissue outside the uterus?

There are many theories which attempt to explain the presence of endometrium outside the uterus. One of the most plausible theories is Retrograde menstruation in which there is flow of the endometrium outside the uterus into the pelvis, causing the endometrium to get deposited there and grow cyclically with every menstruation. Others include transformation of peritoneal tissue to endometrium through hormonal and/or immunological factors, which is termed as metaplasia. It is also posed to be initiated by genetic causes and presence of stem cells. Stem cells have the ability to regenerate themselves into any kind of cell, for example, deposits of undifferentiated cells which turn into endometriotic deposits.

What are the complains a woman with endometriosis may face?

When should one suspect endometriosis?

A classical triad of pain during periods, infertility and pain during intercourse strongly points in favour of endometriosis and it must be suspected and evaluated if you are experiencing these symptoms. Apart from these, women with endometriosis may also present with pain with bowel movements or urination, particularly of increased intensity during menstruation, depending on where the endometriotic deposits are located. There could also be bloating of abdomen which is a very non specific complaint. These deposits swell up during menses so any cyclical pain in the rectum or in lower abdomen goes in favour of endometriosis.

Why do these symptoms occur?

The cyclical hormonal changes of the menstrual cycle affect the misplaced endometrial tissue in the pelvis and elsewhere. This tissue also grows and thickens with estrogen and progesterone and bleeds when these hormones are withdrawn. This leads to inflammation and adhesions amongst the organs nearby. Old endometriotic deposits become fibrotic and can cause dense adhesions in the pelvis. These changes lead to pain. The severity, however, does not correlate with the pain. A woman with mild endometriosis may have severe pain and a woman with severe endometriosis may not have severe pain. The adhesions around the tubes and ovaries lead to difficulties in the sperm reaching the egg which leads to a pregnancy. Presence of endometriosis may also negatively affect the quality of eggs that the woman is producing as it produces a toxic environment. It may also also cause problems in the embryo attaching inside the uterus, a process called as implantation. These are the reasons of infertility in a woman with endometriosis. When the endometrium gets deposited in the ovaries and bleeds cyclically it leads to formation of a chocolate cyst. Presence of this chocolate cyst can lead to pain during intercourse.

When should you visit a doctor?

If you are experiencing any pelvic pain, pain during intercourse or infertility, you must visit your gynaecologist to evaluate the cause of your symptoms. You must also visit if you have excessive pain during passing stool that increases in intensity during menstruation.

How is endometriosis diagnosed?

A chocolate cyst will be visible on a pelvic ultrasound. It will also be picked up on a MRI. The gold standard test for diagnosis is a Laparoscopy. The procedure involves visualising the pelvis to look for any endometriotic tissue in the pelvis that may not be visible on ultrasound and or MRI. These deposits which are in the form of reddish blue deposits over the peritoneum, or thick nodules between pelvic organs or as fibrotic adhesions in the pelvis, can also be excised and sent for biopsy, which confirms the diagnosis.

How is it treated?

The treatments depends upon what the patient desires, whether she is infertile or predominantly wants pain relief.

Pain

Medication – drugs that suppress menstruation which suppress the growth of these endometriosis deposits and hence stall the disease process. These drugs offer temporary relief from symptoms. However ,they cannot be used long term as they have a side effect profile that prevents their use for long Dienogestcan be taken upto 5 yrs. It is a progestogen which acts by suppressing estrogen production hence suppressing endometrial growth GnRH Agonists – act by suppressing menstruation. Usually cannot be used more than 6 months Oral contraceptives – suppress menstruation and hence endometriosis growth Surgery – Laparoscopic excision of endometriotic deposits, chocolate cysts, endometriotic nodules Definitive surgery in a woman who has completed her child bearing process is removal of uterus and both ovaries via laparoscopy. This is sometimes necessary in very severe forms of endometriosis

Infertility

For infertility, these women may require additional treatment in the form of Intrauterine insemination or even In Vitro Fertilization as they are unable to get pregnant. This may need to be combined with a surgery that removes the endometriosis deposits and excises the chocolate cysts in order to pose the best chance for conception. GnRH agonists can be used for patients for infertility prior to IVF treatment. Other medications cannot be used while trying to get pregnant as most of these are contraceptives as they supress menstruation and hence will prevent a pregnancy. The best treatment for endometriosis is a pregnancy as no menses for 9 months keeps the endometriotic growth in check and does not allow progress of the disease.

The definitive treatment of the disease is removal of the uterus and ovaries and is sometimes necessary in severe forms of endometriosis. Ofcourse it can only be offered once child bearing is complete. However, the newer modalities of assisted reproduction treatment and skilled endoscopic surgeons that are able to remove these endometriotic deposits are a ray of hope in this feeling of despair. So fear not, we are here to help you !

Our Services

Fertility Treatment / IUI

We are happy to have treated more than 20,000 couples with fertility issues. IUI is simple treatment for couples with unexplained Infertility, PCOS, early endometriosis Know More

IVF Treatment

Indicated in couples with tubal blockage, repeated failed IUI and endometriosis. Results range across 40 -50% at our centre Know More

ICSI Treatment

Treatment of choice for male infertility with very low sperm count, obstructive azoospermia and for coupes requiring donor eggs. Know More

Fertility Preservation

Many young men and women have utilized our fertility preservation services in the form of sperm, egg and embryo freezing either for medical or social reasons Know More

Maternity Care

More than 3000 women have delivered at our centre. They have had an exceptional experience in antenatal care, delivery and postnatal care. Know More

Laparoscopy

We have been performing all Gynaec surgeries through Laparoscopy for the past 25 years. Advantages are it is safe, less painful Know More

Hysteroscopy

Hysteroscopy has many advantages over traditional D & C. We are equipped with small telescope to diagnose and treat pathologies inside the uterine cavity Know More

Fibroids

Fibroid causes infertility, pain and excessive menstrual blood loss. They can be operated through Laparoscopy or Hysteroscopy Know More

Endometriosis

Endometriosis causes infertility and painful periods. Best treatment is initiated by Laparoscopy surgery and drugs Know More

Hysterectomy

We have been performing laparoscopic hysterectomy for the past 25 years. It is a definitive treatment for heavy menstrual bleeding, fibroids, cancer Know More

Ectopic

Ectopic is a condition where the pregnancy gets implanted in the fallopian tube instead of the uterine cavity. We have operated many cases laparoscopically Know More

Post-menopausal Bleeding

Hysteroscopy helps in evaluating the cause of Postmenopausal bleeding Know More

Feedback of our Patients

-Very satisfied.
-Doc Support indeed was very good .
-Nurse Support was absolutely Beneficial and excellent.
-Cleanliness was upto the mark.
-Hospitality made the stay comfortable.
KEEP IT UP!

Harshita Chhajed

We were so ecstatic on 9thapril 2022 as we hold our baby boy in our hands. We are so grateful as we were in the bestest and safest hands. All this was possible because of the talented doctors like you all-Dr Sudha Tandon, Dr Aditi Tandon, Dr Amrita Tandon and Dr Sachin. Dr Sudha Tandon and DrAditi Tandon helped us in our pregnancy journey by making themselves available all the time on phone. All our queries/questions were answered in no time which is by far the best response we could have received during covid times.
All doctors have given us bestest suggestions during our pregnancy journey in which we always had an utmost faith. It was a great time spent with you all during this pregnancy.
Thankyou so much for all the help/assistance/suggestions. We will always recommend Dr Tandon to our friends and relatives.

Sheela C Potdar

Dr Sudha Tandon and her two daughters make you feel comfortable and at ease. The flow of the process was smooth without making the patients wait unnecessarily.

Ashrita Katyal

Staff very polite and cordial.
Clean and neat hospital.
Cheerful ambience.
Doctor was very cooperative understanding and most importantaly non-judgemental. Made talking easier.
Thankyou for this wonderful offer and for making these tests accessible to all.

Odette Fred

-Staff very pleasant and polite.
-Dr too very polite.
-No waste of time.
-Clean place.
-Gives a good feel and not a nervous hospital feel.

Rosa Fred

Dr Sudha Tandon is one of the most oldest and the bestgynac in Chembur. Very good initative taken by them to keep a watch on the womenshealth on the occasion of the womensday.glad to see her daughters doing the job same as their mom.
All the best to both of them.
Thankyou

Satpal Bhambri

Thankyou for arranging this camp and providing services at affordable prices. The entire doctors team and also everyone right from the front desk staff to the staff nurses are really very cordial and soft-spoken.
My mother literally has a OBGY phobia :-o yet when she stepped out of the consulting room,she only told me they are all really great especially Dr AditiMaam.
Keep up the good work! I always recommend your name whenever any relatives/friends ask for a good OBGY in town.
Thankyou
Regards,
Dr Aditi Prabhu

Pratima Prabhu

-Very well organized.
-The staff is very competent.
-Quick process without any difficulties.
-Excellent time Management.

Kavita Bhatti

It is always reassuring to talk to Dr Sudha Tandon, Dr Amrita and Dr Aditi. It is for their expert advise and their compassionate approach that makes me come back to them for all my health related concives. I know I am in good hands.

Sheetal Patil

Thank you for this camp. Was done professionally and good staff.
Thanks again.

Kavita R.

Got to hear from a friend about this women’s day camp. Very well organized camp by Dr Sudha Tandon.
The price works well for all.
Thank-you

Mrs. Harvinder Saggi

I was absolutely satisfied with Doctor Amrita’s Consultation.
She cleared all my queries.
Thank you for having this women’s day camp.
Its really helpful.

Gunwant Saggi

My mother has also been Dr Sudha Aunty’s patient and it was but natural for me to follow same.I would like too extend my gratitude and thanks to Dr Sudha aunty for being there for me at every step.My sincere thanks to Dr Aditi and Dr Amrita who have always had my back and responded to every query and doubt with great promptness. Dr Aditi has been my “go-to-person” in times of anxiety.
A big thank you to all three of there for everything. I couldn’t have pulled this off without your support.

Dr Jayeeta Verma

Any Queries?

What is infertility ?

If the couple has regular intercourse, does not use any contraception and still does not conceive within one year, they are said to be infertile. 80-85% of the couples conceive within one year of unprotected intercourse i.e. without the use of any contraceptive. However, the rest 15-20 % who are unable to conceive naturally are said to be infertile and these would require proper evaluation and help for getting pregnant.

Does fertility depend on age?

Yes, in a woman fertility does depend on her age. A young woman is naturally more fertile as she has more number of good quality eggs than a woman who is 35 +. Hence a woman who is 35 + should not wait for a long period for a natural conception and should seek help from a proper fertility expert. Also the chance of genetic abnormalities and medical complications like Hypertension and Diabetes increases with age.

When should a couple seek medical help for infertility?

If the woman is below 35 years and has normal menstrual periods, and the couple has tried for a conception for a year with a frequency of sexual intercourse 3-4 times a week during the fertile period and has yet not conceive, then they need to consult an Infertility expert.

How does body weight, diet & exercise affect fertility?

For increasing the chance of pregnancy, balanced body weight of the woman would be beneficial. Being obese or grossly underweight affects the maturation of eggs in the woman and hence may affect her fertility. Also, a grossly obese woman would have mechanical difficulty in having normal sexual relations. Regular, moderate exercise especially in the form of yogasanas, walking, swimming, or jogging prove beneficial for fertility. It has been observed that strenuous form of exercises for example jogging over 3 miles a day can hamper ovulation and hence may lead to decrease in fertility in the woman. Balanced and nutritious diet help increase the chances of conception and ensure proper growth of the fetus.

Is stress a major factor in infertility?

Chronic stress may interfere with the ovulation, may decrease the sexual desire and hence affect the frequency of sexual intercourse in the couple.

How would one know the cause of infertility?

A detailed history of both partners is very helpful in giving a clue to the cause of infertility. For e.g. anovulation is the cause of infertility in a woman who has irregular periods and who is also obese, blocked fallopian tubes in a woman with previous history of pelvic infection, low sperm count in a man with past history of mumps. Examination of both the partners, and getting the required investigations would give a complete picture.

What are the most stressful stages of IVF?

A natural conception is obviously what all couples desire and wish when they plan a pregnancy but when it does not happen and the couple is counselled for an IVF treatment, it creates lots of stress for them.

The most stressful part is the acceptance of the fact that IVF is the only best option for their problem. A good discussion with the doctor to understand about Human Reproduction and why IVF is the best option for them to conceive will help the couple .They should take their time to understand about what the treatment involves and always ask questions to get their doubts cleared. A session with the counsellor would definitely help. Speaking to friends and family who are knowledgeable is a good way to reduce the stress but at times it could be counterproductive especially if they only talk of the problems and are themselves not positive.

In an IVF treatment, the woman’s eggs and her partner‘s sperms are fertilised in a laboratory. To get her eggs, she needs to take hormonal Injections on a daily basis and at the same time every day. This could create some stress especially if she is in a demanding job. It is best that she confides in someone who is reliable and understands the intricacies of an IVF treatment. The best part is that these Injections are not painful as very fine needles are used and she could also self-administer it.

She needs to see her fertility specialist for the follicular tracking for about 4-5 times in a cycle. This could also be demanding and stressful. She should just take all this in her stride and not get unduly stressed. The follicular response may not be satisfactory especially in a woman with poor ovarian reserve and she could become stressed.

She could have stress on the day of egg retrieval because of the fear of pain but this is a small procedure which is done under safe anaesthesia. The procedure is done through the vagina and there are no cuts on her abdomen. This is simple and safe procedure, not painful. At times the male partner gets stressed and is unable to give his semen sample on the day of egg pickup. To avoid this problem, almost all fertility centres will freeze the semen sample beforehand as a backup.

Of course the other stressful point is to worry about the numbers and quality of eggs got at the time of pickup, the fertilization of the eggs, and the numbers of good quality embryos. All these are important form success point of view. A communication with the couple before the procedure will allay all their fears and will go a long way in taking care of the stress.

The most important step in IVF Treatment

The most important step in IVF is Embryo transfer for which the woman should relax. Generally it is done without anaesthesia. The woman‘s cooperation is so very important for favourable results.

After the embryo transfer one has to wait for about 10 days to know the results. It could be very stressful at this stage. She should try to be calm and not just keep thinking of the results. After the embryo transfer the woman has to use either progesterone vaginal tablets or Injections and the stress of finances adds to the stress of procedure.

All in all we do understand the stress that the couple undergoes for an IVF treatment cycle. Have trust in your doctor and you would definitely become a successful.

At our IVF Clinic in Mumbai and IVF centre in Navi Mumbai, we spend quite a lot of time to make you feel comfortable. Our entire support staff and our embryologist are in constant touch with the couple. We try to see that you do not have to wait for too long to see the doctor. We have all facilities of Hysteroscopy/ Laparoscopy / IVF treatment and Maternity at Dr Sudha Tandon centre and we take utmost care of our patients.