Endometriosis and Fertility: Over 50% of Women with Endometriotic Lesions Unable to Conceive – Dr. Julia Tümmers Helping

00:00:12: Welcome to Primo-Medico Expert Physicians Talk, health explained in an understandable way.

00:00:18: In this podcast channel we talk about selected medical topics – in collaboration with leading medical specialists.

00:00:27: The following content comes directly from the respective specialist and is presented by a digitally recorded voice expertly scrutinized clearly explained.

00:00:43: Today we are talking about a topic that affects millions of women and is often diagnosed much too late.

00:00:49: Endometriosis & Fertility.

00:00:52: Around ten percent all women of childbearing age suffer from endometriasis, And among women struggling with infertility it's as high as fifty per cent.

00:01:02: Many do not know for long time this disease behind pain cycle problems or infertilty.

00:01:10: Today we are talking about it with Dr.

00:01:13: Julia Tumas, an endometriosis specialist and senior physician at Highlig Geist Hospital in Cologne.

00:01:21: It's great to have you here Doctor Timmas.

00:01:24: Thankyou for the invitation to this conversation.

00:01:30: The word endometriosis already contains the word Endometrium, which is a technical term for uterine lining.

00:01:38: This means that cells similar to the uterin lining occur elsewhere in their body.

00:01:44: This is primarily in the abdominal cavity on the peritoneum ,which lines the organs from outside and from there it can penetrate deeper into organs or also affect ovaries where then leads to endometriosis.

00:01:58: A special feature of endometriosis occurs in the uterine muscle.

00:02:02: It is then called adenomyosis and causes severe bleeding disorders, these endometrium-like cells swell cyclically and can also bleed.

00:02:11: this results in severe pain and bleeding disorders.

00:02:15: at The same time that disease causes adhesions In the abdomen which in turn Can cause pain or restricts the mobility of their organs among each other.

00:02:26: Who can actually get endometriosis, every woman?

00:02:30: Simply put one could say that all women of childbearing age Can develop endometriosis.

00:02:35: more precisely.

00:02:36: One would say all women who have or can't have their period.

00:02:40: So it can now start at a very young age even in children At nine or ten years old and go beyond the fifty year-old patient.

00:02:50: The typical endometriosis patient is around thirty and it can also run in families.

00:02:56: That means if my mother already had severe pain during her period, It could be assumed that the risk of having endometrialysis was relatively high.

00:03:14: There are many different reasons for this, although the exact development of endometriosis is not yet clear.

00:03:20: It's assumed that there're genetic clusters which why it often runs in families.

00:03:26: but environmental factors certainly play a role as well.

00:03:30: We tend to have our first children later in life as women, which means we experience more cycles in our lives where we are not pregnant.

00:03:40: And every cycle increases the risk of developing endometriosis.

00:03:45: It is assumed that for example blood does not only flow out vaginally but also goes back through the fallopian tubes into their abdominal cavity and That's when these cells can settle and promote Endometrioses.

00:03:57: Why can endometriosis make getting pregnant more difficult?

00:04:01: You can divide this into three areas.

00:04:04: For one, there are supposedly trivial reasons.

00:04:08: Women with endometrioces often experience pain during opulation or during sexual intercourse.

00:04:14: This means the process of getting pregnant itself has already become more difficult.

00:04:19: In addition There is also a loss of libido or pronounced fatigue meaning a weakness and tiredness which certainly makes life as much harder.

00:04:28: Furthermore, I just mentioned that endometriosis can cause adhesions.

00:04:32: If this affects the fallopian tubes and ovaries The eggs cannot be released into the abdominal cavity which makes fertilization by sperm much more difficult.

00:04:43: Beyond obvious reasons there are also biochemical effects.

00:04:47: endometriosis causes chronic inflammation.

00:04:50: This restricts the mobility of the fallopian tubes and there are inflammatory cells in the peritoneal fluid located between the organs.

00:04:59: these inflammatory cells can damage egg cells, and sperm making fertilization less likely.

00:05:05: Furthermore, there are hormone receptor disturbances which can lead to cycle changes.

00:05:11: The uterine lining itself is also affected by the hormonal shift... ...which makes it more difficult for embryos to implant and

00:05:20: survive.".

00:05:21: And how do women notice that something's wrong?

00:05:24: That they might have it!

00:05:26: A clear sign of endometriosis is severe pain during your period.

00:05:30: This is not normal, as we were often told in the past.

00:05:32: In particular, a pain that starts before menstruation perhaps few days or even during ovulation can be an indication of endimetriosis.

00:05:41: Additionally there are characteristics like pain during intercourse and bowel movements while urinating which also can be warning signs for endometriosis.

00:05:50: Also, an unfulfilled desire to have children that last longer than one year can be an indication of endometriosis even if there is perhaps no pain at all.

00:06:00: So...one should definitely get checked out If One Wants To Have Children And pregnancy just doesn't happen right?

00:06:08: Yes!

00:06:08: Anyone who's not pregnant after a year despite regular intercourse around ovulation and normal partner checkup Should Be Examined Preferably By Someone Who Is An Expert In This Field.

00:06:21: For

00:06:26: one thing, it always takes at least two people when trying to conceive.

00:06:29: That means the sperm analysis itself is important to start with.

00:06:32: if there are any abnormalities here a fertility clinic for example gets involved much sooner.

00:06:37: Otherwise, the next step for this patient is local gynecological practice where initial basic diagnostics are performed.

00:06:43: If endometriosis is a possibility then patients come to us at our specialized endometriosis center.

00:06:50: Here, we try to find out during the consultation whether there are certain signs that point to endometriosis.

00:06:56: This is followed by a clinical examination meaning I perform a palpation check-to see if i can see or feel any endometrioces lesions and press on specific points.

00:07:11: During the examination, there are various pressure points.

00:07:14: For example, ligaments of uterus are relatively often affected and should normally feel a bit of pressure when touched but not be painful.

00:07:23: We also palpate pelvic floor muscles because they're very tense due to chronic pain the patient herself experiences And then I check if patients can relax.

00:07:34: or is it a state of constant tension as an indirect sign of endometriosis?

00:07:39: Following the physical examination, we then perform a detailed endometriosis ultrasound.

00:07:45: We do not just examine the organs themselves although look at those too but primarily spaces between the organ for example between vagina and bowel to see if deeper endometriosis nodules are hiding there.

00:07:58: very rarely an MRI can also be useful.

00:08:02: However, we only do this at our centre when planning major surgeries for instance.

00:08:08: When collaborating with surgeons to clarify the extent of

00:08:15: endometriosis

00:08:21: It is not an either or situation, but rather intended to be complementary.

00:08:28: Basically the primary treatment is hormonal therapy and surgical treatment only comes into play when hormones are not enough meaning pain continues or they're not an option For example because there's no tolerated at all.

00:08:45: patients aren't allowed to take hormone for certain reasons or as is our topic now, there's a desire to have children even after surgical therapy.

00:08:54: We always recommend hormonal therapy unless it has the desire of having children so that endometriosis does not return.

00:09:02: Well... Endometrioses cannot be cured by surgery!

00:09:07: Endometriosis is chronic condition which means you can't say this is definitely curable.

00:09:14: In principle, you can expect that symptoms will no longer occur during menopause although there are exceptions.

00:09:20: For example if I have already reached the stage of chronic pain and my brain knows nothing other than that i am in pain.

00:09:28: but this offers some hope.

00:09:30: endometriosis does not return after surgery for all patients.

00:09:35: That

00:09:36: certainly also depends on the patient's age.

00:09:40: And does surgery improve the chances of a pregnancy?

00:09:45: There is no blanket answer to that, because endometriosis can have such wide range of manifestations.

00:09:53: Especially with superficial endometriosis lesions, cauterization or removal can increase the chance of pregnancy.

00:10:01: It's assumed that the chances becoming pregnant increased by about one point seven times

00:10:07: But...

00:10:08: Deeper nodules also increase the chance of getting pregnant spontaneously.

00:10:13: In addition, this surgery gives us an opportunity to release adhesions and for example restore mobility in fallopian tubes so that we can transport fertilized eggs back into uterus.

00:10:28: Even if endometriosis cysts larger than three centimeters are present removing these cysts increases the chances of becoming pregnant afterwards.

00:10:36: However, this only applies to the attempt to conceive naturally.

00:10:40: Otherwise one must always keep in mind that removing ovarian endometriosis also destroys ovariant tissue.

00:10:47: we know that endometriocesis larger than three centimeters can also lower the pregnancy rate.

00:10:53: This means that removal can be beneficial here.

00:10:57: During

00:10:57: the surgery itself however We also damage ovarient tissues.

00:11:02: That means especially for women with a lower egg reserve, caution is advised so that we do not damage the remaining eggs during operation.

00:11:11: There's no really good data on this but it also assumes that with deeply infiltrating endometriosis chances of success are increased after surgical therapy.

00:11:27: So when exactly you recommend fertility treatment?

00:11:31: Of course, on one hand if the partner is also affected and we have an abnormal sperm count but also If We See During The Surgery That The Fallopian Tubes Are Not Patent.

00:11:40: This Means That Conceiving A Pregnancy Spontaneously Is Made More Difficult As A Result.

00:11:45: Even If Surgery Isn't Desired Fertility Treatment Is An Alternative!

00:11:51: This Applies Especially If The Patients Have Few Symptoms Or Such Extensive Endometriosis That Surgery Is Very Risky.

00:12:00: then one can consider doing fertility treatment first and only operating if it is not successful.

00:12:08: But even I have performed surgery, no pregnancy occurs after half a year or a year... It certainly makes sense to contact the Fertility Center.

00:12:17: You are in contact with various fertility centers aren't you?

00:12:21: As the center we cooperate with a fertility clinic ourselves.

00:12:26: this means we are in consultation regarding certain patients but for many patients their visit to the endometriosis center happens at same time as there own search for a fertility clinics so we're relatively flexible about who we consult with.

00:12:43: Let's move on to topic of lifestyle.

00:12:46: what can one do to positively influence disease so-to speak, so that it perhaps doesn't even reach such a severe form.

00:12:54: Is there anything

00:13:08: for?

00:13:13: Patients should then follow a low sugar diet, consume as many omega-three fatty acids possible and in some cases a gluten free diet is also recommended.

00:13:22: Alcohol and nicotine should be avoided if at all possible!

00:13:25: It's important to remember that as an endometriosis patient you already face many daily limitations so you certainly have to weigh the pros & cons of these dietary restrictions.

00:13:36: Exercise always helps with chronic pain but shouldn't avoid it entirely.

00:13:42: But endometriosis patients in particular should also focus on relaxation.

00:13:47: The pain leads to severe tension, especially in the pelvic floor which sometimes cannot be released at all!

00:13:53: The recommendation is therefore more towards relaxation yoga rather than doing Pilates for example where you have a constantly tense abdomen and lot of tension during exercise.

00:14:04: How high are chances of success for significant improvement?

00:14:09: or even yes, for a pregnancy to occur after you have performed the treatment.

00:14:16: We already see a clear improvement in most patients' after-the surgery regarding their pain and fortunately we have quite few patient who returned us after the surgery are then pregnant.

00:14:30: I must admit that even after very extensive surgeries where ourselves perhaps did not had much hope The patient still returned to our delivery room a year later.

00:14:43: As a center, we always conduct the follow-up after one year to see what has changed for their patients and who have become

00:14:51: pregnant.".

00:14:53: And there are already many encouraging figures.

00:14:55: however it must also be said that especially when the pain is already chronic and perhaps no longer cycle dependent or Purely surgical therapy sometimes no longer achieves the results one had hoped for.

00:15:11: If that is the case, then multimodal therapy is more likely to be used.

00:15:16: This means talking to pain therapists To see how further treatment plans can improve patient's quality of life.

00:15:27: Every endometriosis patient has surely heard the phrase, that is normal at some point and I do feel things are getting a little better lately.

00:15:37: Overall in my opinion women's health have been treated rather neglectfully over last few decades.

00:15:44: Cancer therapy might be an exception but everything beyond was certainly often dismissed as normal.

00:15:51: Most prescriptions for the pill or hormonal IUDs as a basis for hormonal therapy still have to be paid by women themselves.

00:15:59: In recent years, however, this topic has gained importance.

00:16:03: In twenty-twenty two France became second country in the world after Australia announced that it wants develop national strategy against endometriosis.

00:16:12: In Germany exact same motion failed in twenty three so there is certainly room improvement.

00:16:20: In the same year, an endometriosis working group was formed in Germany within The German Society for Gynecology and Obstetrics which is now showing more commitment.

00:16:32: And will certainly also influence policymakers.

00:16:36: More and more specialized centers of Endometrioses are emerging in Germany and research Is constantly being conducted in Vienna.

00:16:44: That's part of a requirement to be a center.

00:16:47: And in October, twenty-twenty three a new drug for endometriosis was approved which acts on the different part of the hormonal axis.

00:16:55: This means things are slowly improving but unfortunately I think it will still take some time until we have fully researched Endometrioses and found other therapeutic approaches.

00:17:07: Something urgently needs to be done.

00:17:33: What advice would you give to women who, for example have a desire.

00:17:37: I

00:17:39: think the most important thing for women with endometriosis who want to have children is patience.

00:17:45: That does not mean they should wait a long time to start trying, but rather that they need to know it might take longer for them to get pregnant than other women.

00:17:56: It's said that healthy couples one in five or six women gets pregnant per cycle With endometriosis.

00:18:03: there are more like one in ten to twenty.

00:18:05: That does not mean it will not work.

00:18:07: It just means that should take longer, but is also important anyone who isn't pregnant after one year to visit a specialised centre.

00:18:15: and the older I am ,the sooner i get started.

00:18:19: We offer a second opinion consultation service.

00:18:23: This means once patients have seen their gynecologist they can get referral for our clinic.

00:18:30: we simply take another look.

00:18:36: My pleasure.

00:18:36: Thank you, too.

00:18:40: This has been the specialist physician talk brought to you by primo medico Which is the premier choice for medical specialists and expert physicians?

00:18:50: thank You very much for taking the time out of your day to listen to our program.

00:18:55: For more comprehensive and detailed information concerning the topic of medical specialists Please visit us online at primomedico com.

00:19:05: Join us again next time when we return with our popular segment, which is called Medicine for Your Ears.