deep infiltrating endometriosis and pregnancy

Obstetric complications in women with endometriosis

Image courtesy of imagerymajestic at FreeDigitalPhotos.net

Image courtesy of imagerymajestic at FreeDigitalPhotos.net

Obstetric complications in women with endometriosis

By I.Soussis MD

Women with endometriosis present an increased chance of complications during pregnancy, compared to those without.

A large Swedish study comprised of 8.922 women with endometriosis, who gave birth to 13.090 children (single pregnancies) was compared to 1.4 million births of children obtained from the National Birth Records Office.

When women without endometriosis were compared to women with endometriosis, it was found that the latter were at increased risk regarding:

Premature labour.  The risk is increased 1.24 times in women that got pregnant with IVF and 1.37 times in those with spontaneous conception.

Preeclampsia.  Increased risk by 1.13 times.

Placental abruption- haemorrhage.   Increased risk 1.76 times

Caesarian section.  Increased risk by 1.47 times

This study found no relation between endometriosis and underweight babies or intrauterine death.

Professor P.Barri from the University of Barcelona, presented his results at the 6th National Conference IVI in Alicante 2015.

The complications of pregnancy of 118 women, who had gotten pregnant with IVF due to endometriosis, were compared to 118 women who got pregnant with IVF due to male factors and 10.633 spontaneous pregnancies.

The percentage of gestational diabetes mellitus, fetal macrosomia and Caesarian section rates, showed no significant differences in the three groups.

It remains to be seen, if the increased risks that were mentioned are due to endometriosis itself, infertility or IVF.

Sebutal et al. carried out a systematic retrospective review of  studies, regarding complications of pregnancy in women with deep infiltrating endometriosis. They found 12 articles describing the spread of deep infiltrating endometriosis during pregnancy and one article describing six cases of bowel obstruction during IVF.

Despite the fact that traditionally, pregnancy was regarded as a treatment for endometriosis, this is not the case in some women.

The mentioned complications are severe, but rare. Although the chance of their occurrence can not be ruled out.

Fertil Steril. 2014 Feb;101(2):442-6. doi: 10.1016/j.fertnstert.2013.11.001. Epub 2013 Dec 18. Bowel complications of deep endometriosis during pregnancy or in vitro fertilization. Setúbal A1, Sidiropoulou Z2, Torgal M3, Casal E3, Lourenço C4, Koninckx P5.

Hum Reprod. 2009 Sep;24(9):2341-7. doi: 10.1093/humrep/dep186. Epub 2009 May 12. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Stephansson O1, Kieler H, Granath F, Falconer H.

BARRI.P, 6th International Congress IVI Alicante Spain 23-25 April,2015 Reproductive Medicine and beyond

Natural conception in women with deep infiltrating endometriosis

By I.Soussis MD

How high is the percentage of natural conception and pregnancy in women with untreated colorectal endometriosis?

Erasmo et al. from Genova, Italy attempted to answer this question. Their study was presented at the ESHRE annual conference in Lisbon in 2015.

The study involved 55 patients with colorectal endometriosis, attempting to get pregnant, between 2009 and 2014.  Their partners all had normal sperm count.  All patients with a bowel stenosis (narrowing) greater than 60% and those who had undergone surgery for endometriosis, were excluded from the study.

 

Results:

The average age of patients was 33 years.  Natural conception happened in 17 patients(30.9%).  The average time to conception was nine months(2-32).

Twelve patients conceived with IUI or IVF(21.8%) over an average of 21 months (2-54).  After the first pregnancy, 3 out of 7 patients conceived naturally the second time.

The total percentage of pregnancies was 52.7% (29/55 women) with an average follow up of 21.5 months (2-54).

 

Conclusion:

At least half of women (50%) with deep infiltrating endometriosis can spontaneously conceive following IUI or IVF without having to undergo surgery for the removal of endometriosis.

P-324,ESHRE 2015. Fertility in patients with untreated colorectal endometriosis.

I. Erasmo, F. Sozzi, A Racca, U. Leone Roberti Maggiore, P. L. Venturini, V. Remogida, S. Ferrero

University of Genoa

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