Egg Freezing: A Solution For Women With Endometriosis – Greek Expert Explains What Age Is Right

Endometriosis is usually a painful disease with chronic inflammation. It is one of the most common benign gynecological diseases in reproductive age, with a frequency in the general population of about 10%. At the same time, the rate ranges from 30-50% in infertile women. The average age of diagnosis is 28 years, and it should be mentioned that the diagnosis is usually delayed because the symptoms are not correctly assessed.

Endometriosis has serious consequences, both in the social and professional life of the patients, as well as in their mental balance. The economic burden in the US is estimated at $49 billion annually.

Endometriosis is when endometrial tissue sensitive to estrogen is found outside the endometrial cavity. A biopsy confirms the diagnosis.

There are several theories about the appearance of endometriosis:

• The retrograde flow of blood from the fallopian tubes during menstruation and the implantation of endometrial cells in the peritoneal cavity. However, this happens to all women; therefore, there should be some individual predisposition.
• The metaplasia of the visceral epithelium where some peritoneal cells turn into endometrial cells.
• Mullerianosis occurs when some cells develop in the wrong areas of the body during the embryonic period.
• The theory of hematogenous and lymphogenous spread could justify remote foci of endometriosis, such as in the chest cavity.

There are three types of endometriosis: superficial foci of endometriosis (15-50%), endometriosis cysts (endometriomas up to 45%) and deep endometriosis (about 20%).

Symptoms of endometriosis

Endometriosis can present with symptoms such as severe period pain (dysmenorrhoea).

Typically, in endometriosis, dysmenorrhoea is particularly intense and usually occurs several years after the onset of menstruation. Many women report persistent hypogastric pain, which is not attributable to another pathological entity. Dyspareunia, i.e. pain on contact, is a major symptom of the disease.

Bowel symptoms include painful bowel movements, pain during defecation, and pain during urination. These women often have ovarian cysts, which in this case are called endometriomas and cause infertility in a significant percentage.

Endometriosis is thought to negatively affect fallopian tube function through the formation of adhesions, egg quality, fertilisation and embryo implantation. 50% of patients with this disease will need to undergo IVF to be able to have a child.

In particular, there is evidence that endometriosis, as a disease, impacts ovarian reserves. Compared to the general population, levels of the markers AMH, the number of small follicles, and InhibinB, which assess fertility, are reduced.

Pathophysiologically, endometriotic cysts are believed to contain substances, such as free iron, that may be toxic to the follicles. Also, chronic stretching of the ovarian cortex due to cysts can have negative effects.

It has also been found that the primordial follicles are overactive, which can lead to their faster exhaustion.

Endometriosis diagnosis

A patient's medical history raises suspicion of the disease. Experienced doctors will perform a thorough ultrasound examination to identify endometriotic cysts and foci of endometriosis in other organs. The blood test Ca -125 is a useful auxiliary marker.

Magnetic resonance imaging is also used for diagnosis.

The disease is confirmed after a laparoscopy operation, during which tissues are taken for histological examination—biopsy.

The treatment of endometriotic cysts (>4cm) is laparoscopic surgical removal. Unfortunately, there are also negative consequences, even for the most experienced surgeons, such as the reduction of ovarian reserves after the operation.

A statistically significant decrease in AMH and AFC has been found, reflecting a decrease in a woman's fertility potential. Disease recurrence rates of 20% at two years and 40% at five years have also been reported.

Egg freezing

In the past, egg freezing, due to the low success rates of previous techniques, was a solution of necessity and limited to selected cases, such as fertility preservation before the start of anticancer treatment or the unavailability of sperm on the day of egg retrieval in IVF cycles.

Introducing modern techniques, such as vitrification, shows excellent chances of success after oocyte thawing, with pregnancy rates of 35-65%. Egg freezing is just as effective as fresh eggs and does not increase the risk of genetic or chromosomal abnormalities.

So, thousands of women choose egg freezing for social or medical reasons.

Studies show that women with endometriosis who undergo egg freezing have a greater number and better quality of eggs, ideally if they undergo an egg collection procedure before age 37 and before surgery to treat endometriosis.

Endometriosis is a disease directly related to infertility.

It is also an evolving disease, and for these reasons, women who would like to have children in the future should be informed by doctors about the effects of the disease and about the possibility of egg freezing when they are diagnosed with endometriosis and before undergoing surgery.

Christodoulos Papanikopoulos is an Obstetrician – Gynecological Surgeon, Specialist in Assisted Reproduction, IVF Embryogenesis HEALTH Unit. Translated by Paul Antonopoulos.

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