Being a mother has always been one of the biggest dreams of 29-year-old Sara Cardoso Fernandes. So much so that when she got married, in 2018, this arose naturally as the next step, in what she herself describes as a “pink life, surrounded by wonderful people and moments full of joy and happiness.” But the endometriosis diagnosis received the year before changed her life and made her doubt herself. There were many “questions, fears, uncertainties and moments of sadness” that she faced – in addition to the real difficulties in getting pregnant – but the answer came that allowed her to become a mother and, in 2021, the dream called Carminho was born. Therefore, faking endometriosis is possible, and for that it is necessary to “trust and believe”, she emphasizes.
Endometriosis is a chronic inflammatory disease that affects one in ten women and can cause pelvic pain and infertility and seriously affect the quality of life of women, as well as their partners and families.
But when we talk about endometriosis, what exactly do we mean? According to doctor João Cavaco Gomes, a gynecologist at CETI – Center for Studies and Treatment of Infertility, based in Porto, “endometriosis is a chronic inflammatory disease that affects one in ten women and can cause pelvic pain and infertility and seriously affect the quality of life of women, as well as that of their partners and families”. To fully understand how this disease manifests itself, it is important to realize that “in women with endometriosis there are cells similar to the endometrium -which is the inner lining of the uterus-, but they grow outside the uterus, causing inflammation and giving rise to the appearance of symptoms.
Endometriosis “most commonly affects the pelvic organs, namely the ovaries, fallopian tubes, the supporting tissues of the uterus, the large intestine, the bladder, and the ureters,” but can rarely develop in other locations as well. such as the diaphragm, lungs, or even the brain.
1 of 10
women have endometriosis, which causes pelvic pain and infertility and severely affects the
quality of life of women, as well as their partners and families.
When to suspect endometriosis?
The symptoms of endometriosis can vary, depending on where you are and how severe the disease is, but women often complain of painful periods (dysmenorrhea), pain during intercourse (dyspareunia), and pelvic pain. Other symptoms include heavy menstrual bleeding, pain, fatigue, blood loss between periods, digestion difficulties, changes in intestinal transit, among others.
According to João Cavaco Gomes, diagnosing endometriosis can take a long time, especially if doctors don’t know about the disease: “Women with endometriosis often go to several health professionals and it takes several years before they are diagnosed. Therefore, it is important that the woman is aware of her symptoms and that the health professional is aware of the recognition of endometriosis ”. Given the reports of signs and symptoms, it will be necessary to perform “a gynecological examination and some complementary medical tests, which will help to reach the diagnosis,” explains the clinician with experience in the treatment of this disease.
endometriosis and infertility
João Cavaco Gomes confirms that “infertility is one of the manifestations of endometriosis, but not all women with endometriosis will have difficulties getting pregnant”. In fact, “it is estimated that up to 30 to 50% of women with endometriosis have infertility and that a similar proportion of women with infertility have endometriosis,” says the expert.
There are several mechanisms that can explain the relationship with infertility, but these too “may vary depending on the location and stage of the disease in each woman.” First of all, “it is thought that the inflammatory environment that causes the disease in the reproductive organs can interfere with the normal development of the follicles, with the fertilization of the oocyte and with the implantation of the embryo,” the doctor points out. On the other hand, “in more advanced stages, endometriosis causes a distortion of the normal anatomy of the affected organs, which can become deformed and adhere to each other, which can compromise the ovulation process and the uptake of oocytes by the fallopian tube.” , preventing progression. sperm, cause dysfunctional uterine contractions and prevent fertilization and embryo transport.
infographic: Joana Figueiroa
Swap turns to sickness
When a woman who wants to be a mother is faced with a diagnosis of endometriosis – as happened to Sara Cardoso Fernandes – fortunately, there are several treatments available. Choosing the most appropriate one varies from case to case, and “depends on the age of the woman, the existence of other infertility factors, the stage of endometriosis and the symptoms presented”, explains João Cavaco Gomes. One of the existing treatments is laparoscopic surgery, which “may be the answer to improve symptoms, restore anatomy and improve fertility.” The scientific evidence to validate this option seems to be solid, since “studies show that, in these patients, the fertility rate can be doubled after surgery.”
Still, for other couples, “fertility treatments and medically assisted reproductive techniques may be the best option,” she admits. However, “when endometriosis develops in the ovaries in the form of cysts, also known as endometriomas, it may be necessary to treat them surgically before resorting to assisted reproductive techniques.”
There are still some specific cases where fertility preservation treatments are the most appropriate path. “With these treatments it is possible to cryopreserve oocytes, avoiding that later, when the woman wants to get pregnant, her fertility is already too compromised.”
Up to 35%
of infertile couples have both male and female factors contributing to infertility.
Safe and successful techniques
To decide which is the best therapeutic option to propose to a woman with endometriosis and infertility, the gynecologist indicates that “a complete study of the couple’s infertility must be carried out before assuming that the only or main cause of infertility is endometriosis.” ”. This is because “in up to 35% of infertile couples, there are both male and female factors simultaneously contributing to infertility.” In addition, “endometriosis must also be characterized, to define the location of the lesions and the stage of the disease,” she adds.
Regarding the success rate of medically assisted reproductive techniques, specifically in vitro fertilization (IVF), “it seems to be similar to that of women without endometriosis”, points out the CETI specialist, who warns, however, that “Women with more severe stages of endometriosis may have lower success rates.
Another important issue is related to the safety of these procedures, but here too women can rest assured, because “to the best of our knowledge, fertility treatments do not increase the risk of endometriosis recurrence and also appear to have no influence, or only a less effect on disease progression.
a success story
In an infertility consultation, endometriosis is detected again. And just like that, six months from now, I’m back where I started.”
Unlike many women, Sara Cardoso Fernandes did not present the symptoms usually associated with endometriosis, so the diagnosis she received in 2017 took her completely by surprise. She immediately began to look for solutions, since she really wanted to be a mother. “The surgery, in September 2018, resulted in the removal of an endometrial tumor on both ovaries,” she says, followed by “artificial insemination, in January 2019, but without success.” Then, in March 2019, “in an infertility consultation, endometriosis was detected again. And so, in six months, I am back where I started,” she recalls. The proposal presented by the team that accompanied her at that time implied the use of IVF, having performed two interventions, but both with negative results.
Without giving up, in November of the same year, she sought a second opinion, but the diagnosis was even worse: deep endometriosis and adenomyosis (thickening of the uterine wall), with “tests that confirm a very advanced disease and the intestines compromised with adhesions”. ” . The presented solution underwent further surgery, laparoscopically, to remove the tumors and the compromised part of the intestines. The intervention took place in January 2020 and, in July, a new IVF was performed, but this was finally successful.
Looking back, Sara Cardoso Fernandes advises all women going through the same situation to “trust and believe.” “I think it is very important that they are followed by an endometriosis specialist and that this problem does not last long”, recommends Carminho’s happy mother, now with a year and a half to live and a smile brimming with happiness.
Source: Observadora
