Cleveland Clinic Fertility Fellows

What is endometriosis and why is it important?

Endometriosis is a condition where the endometrium (the lining of the uterus) is found outside the uterus. Common areas of endometriosis involve the ovaries, fallopian tubes, the space behind the uterus known as the posterior cul-de-sac, and the lining of the abdominal cavity, known as the peritoneum. Less often, endometriosis may affect the bladder and bowel.
Like the endometrium, this tissue responds to hormones and can grow and bleed during the menstrual cycle. This process can cause inflammation and scarring to the surrounding areas.

Because of the inflammation and irritation that endometriosis causes, the most common symptom of endometriosis is long-term pelvic pain, especially before and during the menstrual period and during sexual in*******se. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Many women with endometriosis have no symptoms.

Endometriosis occurs in about 1 in 10 reproductive age women and is most commonly diagnosed during a women's 30s-40s. Almost 40% of women with infertility have endometriosis. It is thought that the inflammation caused by endometriosis may damage the s***m or egg and potentially interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by scar tissue.

If you have questions or are worried that you have endometriosis, reach out to your infertility doctor about your symptoms. We are here for you!

Source: https://www.acog.org/womens-health/faqs/endometriosis

Hysterosalpingography (HSG)
A hysterosalpingogram (HSG) is part of the basic infertility evaluation. It is an x-ray study that is used to describe the fallopian tubes and the uterus. Ideally, we are looking for both tubes to be normal in shape and size, and open allowing for the flow of dye. We are also looking to make sure your uterus is normal in shape and size.

An HSG must be timed around your menstrual cycle. Once you and your fertility physician have discussed and decided that an HSG is the right test for you, you should call to schedule the test on the first day of your period (with full flow bleeding). This is what we consider "cycle day #1". The study should be performed between cycle day 5-11 with the hope being that you have the study done after you stop bleeding, but before you ovulate. These appointments fill quickly so make sure to call on cycle day 1 to ensure enough time to schedule your appointment.

The study is done in the radiology department. You'll undergo a speculum exam (similar to a pap smear) and then have dye injected through the cervix using a small cannula. This study can be associated with some cramping that quickly subsides, but for this reason we recommend taking 600mg of ibuprofen (if you are able to take ibuprofen) approximately 30-60 minutes prior to the procedure. Most women tolerate this study very well and without issue.

Once the study is completed, the physician performing the study will be able to discuss what was seen for immediate results. There are no restrictions following the procedure and women are able to go back to work without issue.

Of note: if you are allergic to contrast dye please make sure to let your doctor know!

What should you know about egg freezing?

What is egg freezing?
Egg freezing, also known as oocyte cryopreservation, is a technology that allows women to store eggs for future use. The eggs can be stored in the embryology lab for years until a woman is ready to use them. At that point, the eggs are fertilized with s***m in the embryology lab, and an embryo transfer is done.

Who should consider egg freezing?
The impact of age-related infertility falls disproportionately on women. Whereas men continuously generate new s***m, women are born with all of the eggs they will ever have. The number of eggs in the ovaries is highest in utero at 20 weeks of gestation and gradually decreases until menopause. Menopause occurs once the pool of eggs is gone. Although the average age of menopause in the United States is 51, fertility begins to decline long before menopause. For most women, fertility begins to decline in the early 30s (see the graph below from the CDC). For women who have a genetic predisposition towards early menopause or have undergone chemotherapy, this decline can happen even earlier.

If you are considering delaying childbearing, know you have a genetic tendency towards early menopause, or are planning to undergo chemotherapy, you may wish to talk to your fertility doctor about egg freezing. Some women with endometriosis, particularly those planning major surgeries, may also benefit from egg freezing. Egg freezing is primarily for women who do not have a partner or do not wish to create embryos. If you have a partner with whom to create embryos, frozen embryos are more likely than frozen eggs to create a baby in the future.

What is involved in egg freezing?
The process of freezing eggs is very similar to that of in vitro fertilization (IVF). You will go through the process of ovarian stimulation, meaning that you will give yourself injections of fertility medications to stimulate many eggs to grow. After approximately 7-14 days of stimulation, you will have an egg retrieval. This is a short procedure under anesthesia during which the eggs are aspirated using a transva**nal ultrasound probe and a needle through the va**na. The eggs are then frozen in the lab.

Once the eggs are retrieved and frozen, they do not age, so your fertility is “preserved” at the age you freeze the eggs.

How successful is egg freezing?
While egg freezing can be an empowering method of preserving fertility, it is important to understand that it does not guarantee a baby. For the average woman under 38, freezing 15-20 eggs provides a 70-80% chance of at least one live birth. For women 38-40, freezing 25-30 eggs provides a 65-75% chance of a live birth. Generating more than 15 eggs can sometimes require several IVF cycles, so it is important to consider success rates and cost when making decisions about egg freezing.

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