MP’s call for urgent government action to support women with endometriosis

MP’s call for urgent government action to support women with endometriosis

The All-Party Political Group (APPG) published the findings of its inquiry into endometriosis.

The inquiry surveyed over 10,000 women with endometriosis in the UK and interviewed healthcare practitioners about their experiences.

The APPG is calling on all Governments in the UK to commit to a series of support measures for those with endometriosis including a commitment to reduce average diagnosis times to 4 years or less by 2025, and a year or less by 2030.

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

This report is vital in understanding how women living with endometriosis in the UK continue to be let down when it comes to their diagnosis, treatment and the support they receive to manage their condition.

“While endometriosis costs the UK economy billions of pounds per year in treatment, loss of work and healthcare costs, the impact on women’s wellbeing and mental health is much greater.

“The long diagnosis times and poor patient experience could be attributed to the significant gap in data when it comes to women and girls. What the RCOG would like to see is medical research in this area prioritised to ensure they get the advice and treatment that’s right for them so they can lead happy and healthy lives.”

Endometrioma affects fertility parameters but not embryo quality

Endometrioma affects fertility parameters but not embryo quality

Researchers sought to investigate the effects of endometrioma and the impact of bilaterality on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

A Turkish study has found that that presence of endometrioma in patients with endometriosis negatively impacts fertility parameters, but has no effect on embryo quality, clinical pregnancy rates (PR), or live birth rates (LBR).

The study in the Journal of Gynecology Obstetrics and Human Reproduction also concluded bilaterality does not influence any fertility parameters or pregnancy rates.

Done retrospectively, the researchers sought to investigate the effects of endometrioma and the impact of bilaterality on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

A total of 159 women who underwent IVF/CSI cycles at Zekai Tahir Burak Women’s Health Education and Research Hospital in Ankara, Turkey, between March 2015 and March 2018, were recruited for the study.

Patients were divided into two groups: the study group (n = 73) of infertile women with either unilateral or bilateral ovarian endometrioma with any IVF indication; and the control group (n = 86) without endometrioma.

Basal follicle-stimulating hormone (FSH) levels and total gonadotropin doses used during ovarian stimulation were significantly higher and antral follicle count (AFC) was significantly lower in the study group compared to the control group.

But the differences in these variables between the unilateral (n = 43) and the bilateral (n = 30) endometrioma group were non-significant.

Anti-Müllerian hormone (AMH) levels for unilateral and bilateral endometrioma were also comparable: 1.4 ng/ML and 1.23 ng/mL, respectively.

However, the number of endometriomas > 4 cm was significantly higher in the bilateral than in the unilateral group.

The study also found that the number of dominant follicles at trigger day and total oocyte retrieved were significantly higher in the control group than in the study group. But when compared between the unilateral and the bilateral endometrioma group, these differences were insignificant.

Still, the number of metaphase II (MII) oocytes was significantly higher in the control group compared to the unilateral group, whereas the difference was non-significant between the control group and the bilateral group.

For all procedures, sperm was obtained via ejaculation, and there were no cycles cancelled in the control group. However, in the study group, 12 cycles were cancelled because fertilized embryos could not be procured: 6 cycles each from the unilateral and bilateral group.

There were also four patients in the study group with no dominant follicle development, two each from the unilateral and bilateral group.

In addition, there were eight total fertilization failures, four each from the two groups.

Given the higher cancelling rates, the prognosis for patients with endometrioma seems to be worse than in patients without endometrioma,” wrote the authors.

On the other hand, the number of embryos achieved and blastocysts obtained were similar between the three groups (no laterality, unilateral and bilateral), as were rates of pregnancy, live birth, and early pregnancy loss.

There was also no statistically significant difference between the control and the unilateral groups for all grades of embryo.

However, the number of grade 2 embryos was significantly lower in the bilateral group compared to the control group. But for blastocyst and grade 1 embryo numbers, the bilateral group had comparable findings to the other two groups.

Based on our results, we speculate that bilaterality doesn’t exert additional damage on ovarian reserve more than unilateral endometrioma does,” wrote the authors.

Read more: https://www.sciencedirect.com/science/article/abs/pii/S2468784720301835

Endometriosis fertility index predicts if a woman needs IVF

Endometriosis fertility index predicts if a woman needs IVF

The Endometriosis Fertility Index (EFI) is a good indicator for predicting pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis of 17 studies involving 4,598 women.

Patients with low Endometriosis Fertility Index (EFI) scores may not have a strong chance of a pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis from BJOG.

The Iranian authors of the review in BJOG noted that study results to evaluate the EFI score for predicting non-ART pregnancy have been inconsistent.

The cumulative rate of non-ART pregnancy at 36 months was 10% for women with an EFI of 0 to 2, which significantly increased to 69% for women with an EFI of 9 to 10. Furthermore, compared to women with an EFI of 3 to 4 combined cumulative non-ART pregnancies were 44% for women with an EFT of 5 to 6, and 55% for women with an EFI of 7 to 8. A significant difference existed between all categories.

The odds ratio (OR) for EFI was 1.33 and the summary area under the curve (AUC) was 72%.


The authors stated that the existing revised American Fertility Society (rAFS) score for staging endometriosis has considerable limitations, including arbitrary point scores and wide score ranges within the categories. There is also the “potential for observer error because of numerous morphological presentations, some subtle and microscopic and the timing of the laparoscopy, and whether the staging is performed at laparoscopy or laparotomy,” they wrote.

Furthermore, there is poor correlation between the extent of disease and pelvic pain and rAFS stages align poorly with infertility. For these and many other reasons, EFI has been proposed as having greater predictive power than rAFS for a successful pregnancy, with or without ART, in endometriosis patients.

Specifically, patients with an EFI score of 0 to 3 should be informed as to the low likelihood of non-ART pregnancy; therefore, ART should be strongly recommended.

Women unlikely to achieve non-ART pregnancy or spontaneous pregnancy, based on their EFI score, might be candidates for earlier in vitro fertilization and embryo transfer to prevent treatment delays and increase their chances for pregnancy.

The non-ART pregnancy rate might be linked with duration before attempting ART. For fertility management, EFI can be used as a predictive factor for a spontaneous second pregnancy.

Despite the review concluding that the EFI score is a good predictor for non-ART pregnancy, “these findings should be considered with caution due to the substantial heterogeneity between studies,” the authors said.

Read more: https://pubmed.ncbi.nlm.nih.gov/31967727/

Fresh donor eggs appear to be better for IVF than frozen

Fresh donor eggs appear to be better for IVF than frozen

Donor eggs provide the best chance of success for many women undergoing IVF. But it wasn’t clear whether using fresh or frozen donor eggs in IVF improves the chances of success, so a team from the University of Colorado and Duke University analyzed nearly 37,000 IVF cycles using donor eggs over three years.

According to the largest comparison of donor egg IVF cycles to date, using fresh donated eggs for IVF leads to slightly better birth outcomes than frozen.

Data from nearly 37,000 IVF cycles in the US between 2012 and 2015 showed that fresh eggs resulted in a slightly greater chance of a good birth outcome, which the researchers defined as a single, non-premature baby delivered at a healthy birth weight.

‘Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference’, says lead author Dr Jennifer Eaton, of Duke Fertility Centre in North Carolina.

When the quality of fertilised eggs and the age of both mother and donor were taken into account, the team found that fresh eggs led to good birth outcomes in 24 percent of cycles compared to 22 percent of the cycles with frozen eggs.

Fresh eggs had a much higher likelihood of implantation and birth than frozen eggs, the study found. Compared to frozen eggs, fresh eggs were associated with almost 25% better chance of live birth and a 10% higher odds for good outcomes.

The rates of embryo implantation, pregnancy and live birth were all significantly higher among the women using fresh eggs compared to frozen, but fresh eggs also led to a 37 percent higher chance of multiple births, which could pose greater risk for both mothers and babies.

Donor eggs are often used for older women or women who have a decreased egg supply. This has led to an increased demand for frozen donor eggs which are a cheaper and faster option than fresh donor eggs. But it was previously unknown which type provides the best birth outcomes.

Although this study is the first to show an advantage of fresh donor eggs over frozen, the researchers say that doctors should take the other benefits of using frozen eggs into account when discussing the best option with patients.

‘Given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician’, said Dr Eaton.

In Greece, we do not have egg banks. Therefore, the fresh donor eggs are fertilised by the husband’s sperm. We then proceed to either fresh embryo transfer if the recipient is synchronised with the donor. Otherwise, we perform embryo transfer after thawing the frozen embryos in the future, once the recipient is ready. Success rates are similar in both cases.

The study was published in the journal Obstetrics and Gynaecology: https://journals.lww.com/greenjournal/Abstract/2020/03000/Prevalence_of_a_Good_Perinatal_Outcome_With.27.aspx

Underweight women with endometriosis at higher risk of preterm birth after IVF

Underweight women with endometriosis at higher risk of preterm birth after IVF

Endometriotic patients who were underweight before conception had a significantly higher rate of preterm birth (PTB) than underweight women without endometriosis, according to the findings of a new study publised in Reproductive BioMedicine Online.

Researchers examined the impact of preconception maternal body mass index (BMI) on neonatal outcomes in women with endometriosis who used in vitro fertilization (IVF). They did not find such a difference with other BMI categories.

The retrospective research, performed in China, included of 7,086 women who delivered a singleton live birth via IVF between December 2006 and December 2017 at the Department of Assisted Reproduction of Shanghai Ninth People’s Hospital, which is affiliated with Shanghai Jiao Tong University School of Medicine.

Of the cohort, 1,111 women were diagnosed with endometriosis by laparoscopy or laparotomy, with 45% having ovarian disease and 55% having pelvic endometriosis. The indication for IVF in 74% of the endometriosis group was endometriosis, with the remaining 26% of patients having concomitant male factor infertility.

In the control group of 5,975 women without endometriosis, the indication for IVF was tubal factor infertility in 77% of patients and male factor infertility in the remaining 23% of cases.

Women in both groups were assigned to one of three predefined BMI groups: underweight (< 18.5 kg/m2); normal weight (18.5 to 24.9 kg/m2); or overweight/obese (≥ 25 kg/m2).

All comparisons were between women undergoing cryopreserved embryo transfer, with all embryos transferred into a more natural uterine environment than would have occurred with fresh transfers after ovarian stimulation. This allowed for the precise role of endometriosis to be determined in subsequent neonatal outcomes.

Following stratification by BMI, underweight women with endometriosis had higher rates of PTB (delivery before 37 gestational weeks) than underweight controls: 14.61% versus 3.28%; P < 0.001. However, normal weight and overweight/obese endometriotic women had PTB rates comparable to normal weight and overweight/obese controls.

One possible explanation as to why endometriosis results in higher PTB rates only in the underweight group is the difference in leptin concentration.Leptin, a product of adipose tissue and responsible for regulating lipid metabolism, can reduce body mass by inhibiting food intake and stimulating energy expenditure,” wrote primary author Yun Wang, PhD, and her colleagues from Shanghai Ninth People’s Hospital.

Leptin signaling can also affect the formation of endometriosis though different pathways and is linked with inflammation in endometriosis.

As is well known, inflammation has been implicated in the mechanisms responsible for term and preterm parturition,” the authors wrote.

Genetics is the other mechanism by which a low BMI impacts incidence of PTB. In addition, the genetic factors affecting BMI might be connected to the pathological process of endometriosis, which could result in preterm delivery.

Another finding of the study was a significant interaction between endometriosis and maternal BMI and PTB (P for interaction < 0.05). However, after accounting for potential confounding factors, the PTB rate remained consistently higher in the low BMI subgroup of women with endometriosis: adjusted odds ratio (aOR) = 4.66; 95% confidence interval (CI): 2.54 to 8.57.

Furthermore, the study detected no differences in the rate of early PTB, low birthweight, macrosomia, small for gestational age and large for gestational age between women with endometriosis and controls for any preconception category of BMI.

Overall, the findings underscore the importance of maintaining normal weight in women with endometriosis.

Read more: https://pubmed.ncbi.nlm.nih.gov/32171707/

Source: https://www.contemporaryobgyn.net/endometriosis/maternal-bmi-and-neonatal-outcomes-endometriotic-women-undergoing-ivf

Endometriosis and migraine strongly linked

Endometriosis and migraine strongly linked

There is a significant association between migraine and endometriosis, according to a French case-control study.

They suggest that in clinical practice, women of reproductive age who suffer from migraine should be screened for endometriosis criteria in order to optimise the medical and therapeutic care of this condition.

Studies have shown a significant association between migraine and endometriosis, but no study had explored the relationship between migraine and endometriosis phenotypes: superficial peritoneal endometriosis, ovarian endometrioma, and deep infiltrating endometriosis.

The researchers conducted a case-control study using data collected from 314 women aged 18 to 42 years who had undergone surgery for benign gynecological conditions between January 2013 and December 2015.

All women completed a self-administered headache questionnaire according to the IHS classification. Cases: 182 were women with histologically proven endometriosis and 132 controls were women without endometriosis.

According to the study results:

  • Migraine prevalence in cases was significantly higher compared with controls (35.2% vs. 17.4%).

  • The risk of endometriosis was significantly higher in migrainous women (OR = 2.62; 95% CI = 1.43–4.79).

  • When endometriosis phenotypes were taken into account, the risk of ovarian endometrioma and deep infiltrating endometriosis were significant (OR = 2.78; 95% CI = 1.11–6.98 and OR = 2.51; 95% CI = 1.25–5.07, respectively).

  • In women with endometriosis, the intensity of chronic non-cyclical pelvic pain was significantly greater for those with migraine (visual analogic scale (VAS) = 3.6 ± 2.9) compared with the women without headache (VAS = 2.3 ± 2.8, p = 0.0065).

With an estimated global prevalence of 14.7%, migraine is the most disabling neurologic disorder and the third most common illness worldwide

Like endometriosis, women in their reproductive and most productive years are more commonly affected with migraine.

Increased exposure to menstruation is a known risk factor for endometriosis just as menstrual migraine and menstrually-related migraine (with prevalence varying from 4%-70%) are common subtypes of migraine in women.

Danazol (a synthetic androgen for managing endometriosis) has been reported to reduce the frequency of migraine attacks.

Read more: https://journals.sagepub.com/doi/10.1177/0333102419893965

Is endometriosis hereditary?

Is endometriosis hereditary?

Women with endometriosis may be more likely to have a close relative with the disease. However, research into the potential link is still developing.

Endometriosis is a complex condition. Many factors beyond heredity may increase a person’s risk of developing it.

Is endometriosis hereditary?

More research is necessary to determine if endometriosis has a hereditary component.

Preliminary research suggests that endometriosis may have a hereditary component. However, it is unlikely that genetics are the only or the most influential risk factor.

A 2010 study included 80 participants with endometriosis and 60 without it. Those with endometriosis were more likely to have a relative with the condition.

About 5.9% of participants with endometriosis had a first-degree relative with the condition, compared with just 3% of those without the disease.

While the likelihood of having a relative with the condition was almost doubled in the endometriosis group, the absolute risk was very low.

The study did not find significant differences in symptoms when they compared women with endometriosis and a family history of the disease and those with endometriosis but no family history.

There are many complicating factors. For example, many doctors were ill-informed about endometriosis until recently, and they often missed the diagnosis. Research indicates that as many as 70% of cases in the 1970s were undetected.

This means that mothers and other relatives of people with endometriosis may have had the condition but never received a diagnosis.

Is there an endometriosis gene?

Researchers continue to look for specific genetic causes of endometriosis.

One potential target is a variant of a gene called transforming growth factor β1 gene-509C/T. However, a 2012 meta-analysis of prior research did not find a significant link between this gene and the condition.

A 2019 review has listed more than two dozen genes that various studies have linked to endometriosis. The researchers have failed to demonstrate that any specific gene inevitably causes the condition.

Instead, researchers suggest that interactions between genes and the environment may play a role. According to a 2016 review, epigenetic factors may play a role in endometriosis. These are factors that regulate gene expression.

A person with a gene that increases the risk of endometriosis may not develop the disease without exposure to certain epigenetic risk factors, such as stress or pollution.

Because family members often live in similar environments, epigenetic risk factors may be shared within a family.

Other endometriosis risk factors

A woman with endometriosis may experience periods that occur unusually frequently and last longer than 7 days.

Women with endometriosis may be more likely to have had their first periods before the age of 11 and more likely to experience infertility.

Beyond the potential genetic link, a range of factors may increase the risk of developing endometriosis, including:

  • alcohol use

  • advanced age

  • lifestyle and environmental factors, such as stress, exposure to pollution, and exposure to hormone-disrupting chemicals

The risk of endometriosis increases with age. This may stem from accumulating effects of lifestyle and environmental factors. Or, it could be that genes linked with endometriosis change with age.

Severe pain during your periods and sex could be a signal of endometriosis

Severe pain during your periods and sex could be a signal of endometriosis

The cramps you get during your period can be tough. If you suffer from endometriosis though, the pain could be so strong that it could affect your daily routine. Severe pain during intercourse could also be a sign of endometriosis. In both cases, you should speak to your doctor.

Could endometriosis be the cause?

For many years, women thought that strong pain during their periods or during intercourse is normal, but it is not.

Two of the most common symptoms of endometriosis are:

  • severe pain during your periods (dysmenorrhea)

  • painful intercourse (dyspareunia), meaning persistent or recurrent pain that occurs during or after intercourse.

Endometriosis is notoriously difficult to diagnose. The symptoms of endometriosis are similar to other gynecological conditions.

One in 10 women have endometriosis and many are not diagnosed

One in 10 women are affected by endometriosis and often there is a delay of diagnosis for 7-12 years, as endometriosis’ symptoms are similar to other gynecological conditions. Many women with endometriosis remain undiagnosed.

What is endometriosis?

Endometriosis is a gynecological disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus. The right tissue at the wrong place.

In endometriosis, the endometrial-like tissue acts as endometrial tissue would. It thickens and then breaks down and bleeds in each menstrual cycle.

The ectopic endometrium has no way to exit your body, so it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form.

Surrounding tissue can become inflamed, eventually developing scar tissue and adhesions (abnormal bands of fibrous tissue that cause the internal organs to stick to each other).

Endometriosis can cause strong pain, especially during menstrual periods and very often during the sexual act. Another common symptom of endometriosis is infertility. Fortunately, effective treatments are available.

Endometriosis or normal menstrual cramps?

Menstrual cramps are common and usually can be treated with over-the-counter medication or home remedies. Endometriosis is associated with pain that women call “killer cramps”. Some women say it feels like “their insides are being pulled down”.

Endometriosis pain often stops young women from going to school or having a social life. In adulthood often the pain gets worse and in many cases, they miss days from work.

Endometriosis or “normal” pain during sex?

Painful intercourse can occur for different reasons, ranging from structural problems to psychological concerns. But is also the cardinal symptom of endometriosis. Especially deep dyspareunia.

If dyspareunia is persistent, you should talk to your doctor.

Other symptoms of endometriosis include:

  • Very long or extremely heavy periods

  • Migraines

  • Bleeding between periods

  • Fatigue

  • Nausea

  • Diarrhea

  • Infertility. Surgery can remove the extra tissue, which may make it easier to get pregnant. You may decide to use assisted reproductive techniques like in vitro fertilization(IVF) to help you conceive

  • Painful bowel movements

  • Leg pain that can make it hard to walk. Endometriosis can affect nerves that connect to your groin, hips, and legs.

  • Severe backache. The uterus and ovaries are near your back and endometriosis pain can affect your back too.

Diet has rapid effects on sperm quality

Diet has rapid effects on sperm quality

Diet can influence sperm quality after just a few weeks. This is the conclusion of a study by researchers at Linköping University, in which healthy young men were fed a diet rich in sugar.

The study reinforces the link between nutrition and male reproduction and could have important implications for those undergoing fertility treatment. The study, which has been published in PLOS Biology, gives new insight into the function of sperm, and may in the long term contribute to new diagnostic methods to measure sperm quality.

Sperm quality can be harmed by several environmental and lifestyle factors, of which obesity and related diseases, such as type 2 diabetes, are well-known risk factors for poor sperm quality.

We see that diet influences the motility of the sperm, and we can link the changes to specific molecules in them. Our study has revealed rapid effects that are noticeable after one to two weeks”, says Anita Öst, senior lecturer in the Department of Clinical and Experimental Medicine at Linköping University, and head of the study.

In the study, 15 non-smoking men aged 20-27 followed a specific diet for two weeks. In the first week they ate a healthy diet as recommended by the Nordic Nutrition Recommendations. During the second week, the men ate an extra 375g of sugar per day, which is equivalent to about 3.5 litres of sugary drinks or 450 grammes of confectionery.

The sperm quality and other indicators of the participants’ health were investigated at the start of the study, after the first week (during which they ate a healthy diet), and after the second week (when the participants had additionally consumed large amounts of sugar).

At the beginning of the study, one third of the men had low sperm motility. Motility is one of several factors that influence sperm quality. The researchers were surprised to discover that the sperm motility of all participants became normal during the study.

The study shows that sperm motility can be changed in a short period, and seems to be closely coupled to diet. This has important clinical implications. But we can’t say whether it was the sugar that caused the effect, since it may be a component of the basic healthly diet that has a positive effect on the sperm”, says Anita Öst.

The researchers found that the small RNA fragments, which are linked to sperm motility, also changed. Τhey discovered that tsRNA levels were increased in some of the men after they had eaten a high sugar diet for a week.

They are now planning to continue the work and investigate whether there is a link between male fertility and the RNA fragments in sperm. They will also determine whether the RNA code can be used for new diagnostic methods to measure sperm quality during in vitro fertilisation (IVF). 

Read more: https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000559

Source: https://liu.se/en/news-item/kosten-har-direkt-paverkan-pa-hur-pigga-spermierna-ar

4 diet tips to help you fight endometriosis

4 diet tips to help you fight endometriosis

Endometriosis is a challenging condition to deal with. Chronic pain has a physical and emotional toll on your well-being.

One in 10 women are affected by endometriosis and many do not have a diagnosis for 7-12 years, as endometriosis’ symptoms are similar to other gynecological conditions. Many women with endometriosis remain undiagnosed.

Fortunately, there are steps that can be taken to help with the pain of endometriosis and improve your quality of life. Simple changes in you diet can make you feel better.

Eating the right foods may provide some protection against endometriosis. The role of diet in endometriosis has been investigated in recent years due to the influence of diet on some of the processes linked to the disease, such as inflammation, prostaglandin metabolism, and estrogen activity.

Eat more fresh fruits and vegetables and less red meat

Add more fresh fruits and vegetables in your diet. Stocking your refrigerator with pre-washed and cut fruit and vegetables can help you eat more of both.

Cut down red meat. Research has shown a link between endometriosis and diets that are low in fruits and vegetables and high in red meat.

Some experts think the high amount of fat in meat like beef encourages your body to produce chemicals called prostaglandins, which may lead to more estrogen production. This extra estrogen could be what causes excess endometrial tissue to grow.

A higher intake of fresh fruit and green vegetables reduced the relative risk of endometriosis by 40 percent, while a high consumption of beef, other red meat, and ham increased relative risk by around 80 to 100 percent.

Boost omega-3 fatty acids intake

Eat more foods high in omega-3 fatty acids like salmon, mackerel, flaxseeds

and walnuts. A study showed that women who ate the highest amount of omega-3 fatty acids were 22% less likely to develop endometriosis compared to women who ate the least amount.

Reduce trans fats

Eat less trans fats. Research has shown that women who ate the most trans fats had a 48% higher risk of developing endometriosis than those who ate the least, so the type of fat you eat matters.

Avoid alcohol and caffeine

Drinking caffeinated coffee and soda seems to increase your chances of developing endometriosis, although researchers aren’t sure why. If you find that caffeine worsens your symptoms, switch to decaf.

Women who drink a lot of alcohol may be more likely to get endometriosis. Drinking might also make your symptoms worse. Alcohol raises estrogen levels, which could lead to more painful symptoms.

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