Endometriosis & Infertility

Prof Dr Roszaman Ramli

Obstetrics & Gynaecology
Apa itu endometriosis

• Endometrial tissue (both glands & stroma) outside

the uterus

• Tissue is morphologically and functionally similar to

endometrial tissue, therefor responds to

hormones in cyclical manners
Endometriotic cyst
Pengesahan secara histology

• Endometrial glands
• Endometrial epithelium
• Endometrial stroma
• Hemosiderin- laden
macrophages
 Statistik

• 7-10% in general population.

• Infertile women – 30% endometriosis.
• Chronic pelvic pain – 78% endometriosis
Punca

• Retrograde menstruation
• Defect in local cell-mediated immunity
• Lymphocytic and vascular metastasis
• Metaplasia of cells of coelomic epithelium
 Gejala utama

• Dysmenorrhea

• Deep dyspareunia
• stretching of involved tissue during intercourse
• fixed retroverted uterus or involvement of uterosacral and
rectovaginal septum
Gejala lain

• cyclical rectal bleeding or hematuria

• umbilical endometriosis
• cyclical hemoptysis and hemothorax
Bagaimana mengesan endometriosis

• Clinical: dysmenorrhea, dyspareunia

• Pelvic scan
• Laparoscopy
• MRI – DIE and suspected malignancy
Pelvic ultrasound
MRI
 ENDOMETRIOSIS & INFERTILITY

• Ovarian: anovulation, cyst formation, ovarian

damage (poor ovarian reserve)

• Tubal: Tubal blockage & altered tubal motility

• Peritoneal factors: intraperitoneal inflammation

 Treatment

• Medical treatment
• Surgical intervention
• Fertility treatment

•Depends on pain/ infertility/ cyst

 Medical treatment

Medical
Analgesics – NSAID, COX2 inhibitor
Hormonal
COCP – preferably continuous over cyclical
Progestin
MPA (Provera),
Depoprovera
Dydrogesterone (Duphaston)
Danazol
effective
severe side effect: muscle weakness, acne, voice
changes

GNRH analogue
expensive, serious side effect e.g. irritability, hot
flushes
Vissane

• Dienogest (DNG) is a
progestin with highly
selective progesterone
activity
• Irregular bleeding mostly 1-
2 month, some amenorrhea
• Ohers – hair loss, imsomnia,
acne
• Min bloatedness
• 6-9 months. Up to 5 years
Cystectomy
Tubal surgery
IUI vs IVF