Endometriosis, pharmacological therapies and PMA: the situation in 2018

WE ART MERCK took place in September 2018 in Padua,   an event conceived by Merck, a leading company in the scientific and technological field and which saw the participation of  experts in Medically Assisted Procreation  to illustrate a state of the art of PMA to the new generations of clinicians and biologists with a view to continuous scientific progress.

The first theme dealt with was that of endometriosis , infertility in couples and the personalization of therapy .

Endometriosis causes infertility in 15-20% of cases and about half of patients with endometriosis are infertile.

Endometriosis is an often painful disease in which the tissue that normally surrounds the inside of the uterus, the endometrium,  grows outside the uterus. Endometriosis usually involves the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue can spread into the pelvic organs.

In those suffering from endometriosis , the endometrial tissue outside the uterus behaves like it was in the uterus, in the sense that it thickens, flakes and bleeds with each menstrual cycle. When endometriosis involves the ovaries, cysts called endometriomas can form. Surrounding tissues may become irritated, possibly developing scar tissue and adhesions: these are bands of fibrous tissue that can cause pelvic tissues and organs to stick together.

Endometriosis can cause pain – sometimes very severe – especially during menstruation. Fertility problems may also develop. Fortunately, effective treatments are available.

Treatments for endometriosis

According to Prof. Edgardo Somigliana – Professor at the University of Milan and Head of the Medically Assisted Procreation Center at the Ospedale Maggiore Policlinico in Milan   “Today it is possible to live with endometriosis by keeping symptoms under control and maintaining a good quality of life. The first important step is for patients to accept the disease and understand that it can be well treated even if there is no immediate and definitive cure. In recent years, the therapeutic approach to the disease has totally changed compared to the past in which surgery prevailed: where possible, through pharmacological therapy (pills or progestins) we now try to create a stable hormonal environment which actually allows us to have excellent results in most patients. The pain that often afflicts affected women manifests itself, in fact, mostly as a consequence of physiological hormonal fluctuations. By abolishing them, the vicious circle that causes pain is interrupted. If the patient then wants a child, she can suspend treatment and try to conceive naturally; a pregnancy generally also has a positive impact on endometriosis since it produces the same stabilizing benefits that are obtained with the pill or progestogens, thus keeping the hormonal fluctuations typical of the disease constant. After pregnancy, as after the suspension of any hormonal therapy, hormonal fluctuations start again and the symptoms reappear – concludes Prof. Somigliana – so it is good practice not to “forget” about the disease and resume the hormonal therapy previously taken a pregnancy generally also has a positive impact on endometriosis since it produces the same stabilizing benefits that are obtained with the pill or progestogens, thus keeping the hormonal fluctuations typical of the disease constant. After pregnancy, as after the suspension of any hormonal therapy, hormonal fluctuations start again and the symptoms reappear – concludes Prof. Somigliana – so it is good practice not to “forget” about the disease and resume the hormonal therapy previously taken a pregnancy generally also has a positive impact on endometriosis since it produces the same stabilizing benefits that are obtained with the pill or progestogens, thus keeping the hormonal fluctuations typical of the disease constant. After pregnancy, as after the suspension of any hormonal therapy, hormonal fluctuations start again and the symptoms reappear – concludes Prof. Somigliana – so it is good practice not to “forget” about the disease and resume the hormonal therapy previously taken”.

The help in endometriosis from PMA

Also present at the event was Dr. Filippo Ubaldi, Director of the PMA GENERA Center and vice president of SIFES (Italian Society of Fertility and Sterility).

According to Dr. Ubaldi help to women with endometriosis comes from assisted fertilization techniques:   “The course of treatment depends on several factors such as the woman’s age, ovarian reserve, how long she has been trying to become pregnant and whether or not she is in pain. In fact, in the presence of pain, any infertility symptom must take a back seat and the doctor must first think about treating the pain symptom. Age is of fundamental importance: in a 39-40 year old woman with endometriosis who has been looking for a child for more than a year, subjecting the patient to in-vitro fertilization can represent a valid therapeutic approach. Conversely, in a woman with more reproductive time available, for example at age 30, with a good ovarian reserve and without other couple infertility factors, who has been seeking a child for more than a year, you should try to treat endometriosis medically and/or surgically and then let her try to conceive spontaneously for at least 6-12 months. In the case, however, of those younger women, aged less than 35-36 years, who have to undergo the surgical removal of voluminous endometriotic cysts (endometriomas), especially if bilaterally – concludes Dr. Ubaldi – the cryopreservation of oocytes is highly recommended because bilateral ovarian surgery carries a 2.6% risk of early menopause and in any case causes a significant reduction in ovarian reserve”.