Monday, October 21, 2019

Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI

Background - Endometrial polyps, submucous fibroids, uterine septa, and intrauterine adhesions can be found by ultrasound (US), HSG, hysteroscopy, or any combined in 10–15 % of infertile women. Observational studies suggest a better reproductive outcome, when these anomalies are removed by operative hysteroscopy. The current Cochrane review assesses the effectiveness of hysteroscopy for treating these suspected anomalies in women with otherwise unexplained infertility or prior to intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI)

Methods

We searched electronic databases including CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE (1950 to 27 October 2012), and EMBASE (1974 to 27 October 2012) conference proceedings from the American Society for Reproductive Medicine through hand searching (from 2008 to 30 October 2012) and reference lists of retrieved articles. Eligible reports were parallel-design randomized trials (RCTs), comparing operative hysteroscopy with a control intervention in women with suspected uterine cavity abnormalities and otherwise unexplained infertility or undergoing IUI, IVF, or ICSI. The primary outcomes were live birth and hysteroscopy complication rates. Secondary outcomes were ongoing or clinical pregnancy and miscarriage rates. We expressed the dichotomous outcome measures as Mantel–Haenszel odds ratios (ORs) with 95 % confidence intervals (CIs) using a fixed-effect model.

Results

Only two studies met the eligibility criteria for inclusion in the review. One study included 94 women with otherwise unexplained infertility and not more than two submucous fibroids or one submucous fibroid combined with one intramural fibroid, all smaller than 40 mm [2]. The second trial [5] assessed the effectiveness of the hysteroscopic removal of endometrial polyps with a mean diameter of 16 mm diagnosed by Doppler US in 215 women bound to undergo gonadotropin treatment and IUI for unexplained, male or female factor infertility for at least 2 years. Both trials used computer-generated random number tables; in only one allocation concealment was adequate [5]. Blinding of patients, personnel, and outcome assessors was not assessed because these items are less relevant in the setting of a surgical trial with unequivocal outcomes and a long follow-up period. Both studies were at low risk for attrition bias but had some potential for selective outcome reporting; no data for live birth rates were available despite long follow up periods of 86 [2] and 50 months [5]. We could not do a formal assessment of publication bias, since only two RCTs were included in the current review.


Clinical pregnancy rates

Removal of not more than two submucous fibroids or one submucous fibroid combined with one intramural fibroid, all smaller than 40 mm, in women with unexplained infertility for at least 1 year tends to increase the odds of clinical pregnancy compared to regular fertility-oriented intercourse. The differences between both comparison groups fail to reach statistical significance (OR 2.4, 95 % CI 0.97–6.2) (Fig. 1). Our results are not in accordance with the calculation of the authors in the primary study report; they reported statistically significant differences between both comparison groups both in women with not more than two submucous fibroids only or one submucous combined with one intramural fibroid [2].


Conclusions

The only randomized study published in the literature on the hysteroscopic removal of fibroids in infertile women has claimed statistically significant differences in the clinical pregnancy rates between both comparison groups. Our own recalculation of the available data fails to demonstrate statistically significant differences. This statistical error raises concerns about the validity of the published primary data. Moreover, we judged the overall study quality study to be very low. This has implications for clinical research; additional RCTs studying the effectiveness of hysteroscopic myomectomy in infertile women are needed. The implications for daily practice are more controversial. The gynecological profession widely accepts that submucosal and intramural fibroids interfere with fertility in decreasing order of importance based on the results and conclusions of a large systematic literature review with a meta-analysis of observational studies [6, 7]. While conservative, medical, and surgical treatment are all considered as being appropriate for treating symptomatic fibroids, myomectomy seems the only reasonable treatment option for women who wish to become pregnant. Women treated by hysteroscopic myomectomy for submucosal fibroids might have similar reproductive outcomes as infertile women with normal uterine cavities [8]. According to one prospective study, the surgical removal of large intramural fibroids in women with otherwise unexplained infertility prior to IVF treatment might increase the likelihood of a successful reproductive outcome [4]. Our critical appraisal of the current evidence supports the conclusion published by others in the recent past; at the present, there is still evidence of uncertainty on the effectiveness of removing fibroids in infertile women [3].

The hysteroscopic removal of endometrial polyps in women bound to undergo IUI for unexplained, male, or female factor infertility for at least 24 months increases the odds of clinical pregnancy compared to diagnostic hysteroscopy and biopsy only. The level of evidence of this single study was graded as high.

More well-designed pragmatic RCTs are needed to assess the effectiveness of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septa, or intrauterine adhesions in women with otherwise unexplained infertility or prior to IUI, ICSI, or IVF, preferably measuring live birth and adverse events as primary outcomes. The effects of the number, size, and location of the intrauterine pathology as well as the relationship between the timing of the hysteroscopy and subsequent fertility treatment should be addressed by predefined and sensible subgroup analyses.


Mohak Infertility Center is one of the Best IVF centre in Indore, India. Mohak Infertility Center is provide the Best treatment for IVF, IUI, Infertility, test tube baby and ICSI treatment in indore. The further development in IVF has originated the way of ICSI (Intracytoplasmic Sperm Injection) treatment. The ICSI treatment has revolutionized the treatment of male infertility in recent years as a result male with poor quality of sperm has got a chance to become a proud parent. Intracytoplasmic sperm injection is a technique in which the embryologists take one healthy sperm and physically injected it into the matured egg. ICSI treatment is effectively used in the process of IVF to cure male infertility issues, especially the ones who have had their IVF done without any positive outcome. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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Friday, October 18, 2019

Test tube baby centre in Indore

The IVF technology or Test tube baby is the most advanced and highly recommended assisted reproductive technology. Visit Mohak IVF Center when you are looking for a highly equipped IVF centre with all modern and world-class facilities. Mohak IVF is one of the Best Test Tube Baby Centre in Indore, Madhyapradesh.

Having India’s most renowned doctors and with their experiences, Mohak IVF has managed to register itself in the list of best Test tube baby centres in India. Here in Mohak IVF, you will get International Standard Infertility Treatment and assisted reproductive technologies like IVF, ICSI, IUI, etc. as well as the satisfaction of being consulted by the experienced and renowned specialists in the field of IVF technology.


Mohak IVF centre is not only a common name for the couples looking for Test tube baby centre in Indore or India, but it has also become the preference of couple looking for fertility treatment from all across the world. Being one of the most trusted IVF centres in Indore and in India as well, we are known for providing international treatment standards in the field of infertility treatment as well as assisted reproductive technologies.

We understand that infertility or subfertility condition can be one of the most stressful situations a couple may face. It can be something which can affect you emotionally, physically and sometimes financially as well. At Mohak IVF, we believe in providing the most comfortable treatment by working closely with the patient. In every phase of the treatment, we take care of all the queries of the patient.

Mohak laparoscopy and infertility centre which was established in 2010, is located in the heart of India – Indore. It is a part of a multispecialty advanced care facility. At Mohak IVF, we have fertility professionals who have got their additional education in the fields of medical or surgical remedy for infertility. Our fertility experts devote their full attention and make sure to provide the best possible infertility treatment. We are proud to have Dr Shilpa Bhandari, one of the first reproductive medical specialists of India with us at Mohak IVF centre. She has done her “Doctorate of medicine” (DM) in the field of reproductive medicine and ensures the quality of treatment provided to each patient who visits the clinic under her supervision.

Reach us for your all types of fertility-related issues, we ensure you to provide you with the best infertility treatment.

Are you looking for the Best Test tube baby center in indore? Mohak Infertility Center is one of the Best Test tube baby center and infertility treatment in indore, Madhya Pradesh. The Centre was established in the year of 2011.  Mohak Infertility Center is known for its various services covering Infertility assessment, In Vitro Fertilization (IVF), Intra Uterine Insemination (IUI), Intracytoplasmic Sperm Injection (ICSI), test tube baby treatment and infertility treatment. Don’t wait in a queue, book an instant appointment online with Mohak Infertility Center on https://www.mohakivf.com

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Tuesday, October 15, 2019

IVF failure? Know the reason and How to choose Best IVF Center

Any couple who is going to get IVF process doesn’t want to think, if they may get IVF failure. Because IVF is an expensive technology, couples fail financially and mentally after failure and are forced to think if we will ever become parents. This thought itself is very much depressing.

Based on many researches it is has been observed that the success rate of the IVF process is not 100 percent worldwide, which may cause some couples to disappoint in the first IVF cycle.

Does this mean that all the routes for those couples are closed? Never. The success rate of IVF process depends on a lot of parameters and the first and foremost among them is the choice of IVF center because the success rate of every IVF center is not the same.

The success rate of IVF also depends on the quality of the egg of the female, the sperm of the male and the fetus made from them. The endometrium of the uterus and its inner layer is also necessary to be good and healthy, because the fetus has to stick to the same layer and grow there for nine months.

The success of IVF also depends on the efficiency of the fertility doctor, as for which couple to choose which IVF procedure and how to perform that procedure efficiently also depends on the doctor. IVF Specialist says that the embryology lab, where the embryo is produced and the embryologist who helps in mixing eggs and sperm or incubator in which the fetus develops plays a very important role in IVF success.

The success of IVF also depends on embryology lab and it should be equipped with hi-tech equipment and should be operated under the supervision of a skilled embryologist. Any couple who is willing to get this procedure done should choose IVF center very carefully because the success of IVF also depends on the facilities and technology. And the most important factor is whether the couple is comfortable and confident about the center they choose.


How to choose IVF Center

According to a survey, the cost of IVF cycle and distance from home to IVF center are the first two reasons behind the couple's choice of IVF center, but mostly the couple is unaware of this truth that the success rate of every IVF center is not the same. Quality of Embryo plays the most important role in the choice of IVF centers as the success of the IVF process depends 70 percent upon the quality of Embryo.

Therefore, it is very important to have the latest and advanced hi-tech equipment in the embryology lab. The embryologist (who runs these devices helps to prepare the embryo by mixing eggs and sperm) should be well qualified and experienced. Fertility doctor or IVF specialist, who examines the patient, selects IVF procedure, process of making eggs, removing eggs and implants the fetus in the uterus. The success rate of IVF is highly dependent on these factors.

Points needed to be considered about the center before getting the procedure:

  • Success ratio per embryo transfer pregnancy
  • Pregnancy rates in couples with same-age
  • Affordability of cost per IVF process
  • Clinic’s success rate

Check the treatments spectrum they provide like female-male infertility programs, emergency consultancy service, counselling & support group sessions, complete assistance 24*7 (if required).

The couple should carefully consider the above mentioned points in the selection of an IVF Center. The cost of IVF and distance from home should be kept after all this because IVF cost depends very much on the total cost of injection. The cost of injection, its quality, the success rate of IVF depends very much on each other.


For more details on IVF procedure and techniques you should consult your fertility expert and it is very much needed to resolve all your queries before getting into conclusion on any procedure or center you choose.


Mohak Infertility Center is a world class IVF center in Indore with the objective to provide “Affordable & Advanced” IVF Treatment. Mohak Infertility Center is provide Delivering diverse infertility treatment in indore such as IUI, IVF, ICSI, IVF- egg donation, test tube baby treatment, infertility treatment and more services. Mohak Infertility Center is Best centre for IVF in indore. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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Saturday, October 12, 2019

How does the test tube baby centre work?

Test tube baby or a baby born with the help of assisted reproductive technology is very common these days. IVF or In vitro fertilization is known as the most common and useful type of assisted reproductive technology which helps women become pregnant. In this technology (IVF), an egg is fertilized outside the woman's body, i.e., in a laboratory dish. The next process is implantation of the fertilized egg inside a woman's uterus.

Let's understand the process in brief and see how the test tube baby centre works:

IVF or In vitro fertilization has been used since the late 1970s. It is always done under the supervision of highly experienced doctors and staffs. It involves the use of high-end medical devices and in technically equipped centres. Mohak IVF is one of the best IVF centres across India with all the world-class facilities and highly experienced doctors. There might be specific differences in techniques depending on the clinic, but In vitro fertilization usually involves steps listed below:

1. Natural menstrual cycle suppression
A drug is injected in the form of a daily injection for about two weeks which suppress the natural menstrual cycle.

2.Superovulation
FSH, which makes the ovaries produce more eggs in comparison to usual, is given to the woman.

3.Retrieving the eggs
To collect the egg, a minor surgical procedure "follicular aspiration" is performed. A very thin needle attached with a suction device is inserted through the vagina and into an ovary to suck the eggs out.

4.Insemination and fertilization
The collected eggs are then kept with male sperm under environmentally controlled condition inside a chamber. The sperm enters the egg after a few hours, and the egg gets fertilized, which further divides to become an embryo.

The lining of the womb receives the embryo and for that woman is given progesterone or hCG (human chorionic gonadotrophin).

5.Embryo transfer
With the help of a thin tube (catheter), the embryo is transferred inside the womb through the vagina. A healthy embryo growth can start once the embryo sticks to the lining of the woman's womb.


An IVF centres or a test tube baby centre like Mohak IVF is an institution upon which you can rely and trust for your needs of becoming parents. We have an excellent reputation in the field of assisted reproductive technology, and we proudly say that we fulfilled many dreams of couples by helping them giving birth to healthy babies.

Mohak Infertility Center is one of the Best Test tube baby centers in indore. This Hospital provide the world class infertility treatment in indore.  Dr. Shilpa Bhandari is expert and experienced in male and female infertility treatments. She has to credit her more than thousands of test tube babies and ICSI babies. She has pioneered the advanced techniques in the field of infertility and encouraged the training of IVF specialists by having hand on training workshops of IVF at national and international level. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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Wednesday, October 9, 2019

Repeated cause of Miscarriage

For women who have frequent miscarriages, there may be chances of defect in genetics, chromosomes may be an important reason behind them. Here we are giving some other reasons which can lead to repeated miscarriages:


  • Trying to conceive at an older age: Women who try to conceive at the age of 35 or above may have chances of repeated miscarriages.

  • Too much running or traveling too much: During pregnancy, in the first and third trimesters, women is required to have proper care. In this period if you are doing too much running or traveling, it may become a reason to cause miscarriage.

  • Abdominal pressure or injury: Any kind of injury to the stomach or more pressure during pregnancy can also be one of the cause of miscarriage.
  • Infection to the uterus: It is common in women to have vaginal infections. If the infections spread or repeated, then this may be another reason to cause miscarriage.

Diagnosis and treatment of Miscarriage

Problems like infection into the uterus can be avoided if the abortion is diagnosed at the right time. If this is not done then there are chances of great risk to the life of the women:

  • Pelvic examination: The doctor examine the spread of the cervix.

  •  Ultrasound: During the ultrasound, a doctor check for the foetal heartbeat to diagnose the normal growth and development status of the foetus.

  •  Blood test: During this, the doctor take a sample of women’s blood and compare the level of human chorionic gonadotropin (HCG) with the previous level. If there are changes detected then it can be a sign of problem. Apart from this, general screening of blood serum is done.

  • Tissue test: In case if the tissue starts to come out from the cervix, the doctor take the sample to examine them to find out if it is a case miscarriage or not.

  • Chromosome test: If women had previous history of more than one miscarriage then your doctor can do a blood test for the couple to find out the chances if there is chromosome related problems or not.

Dr. Shilpa Bhandari is one of the best IVF specialists in Indore. she is first reproductive medicine specialist of this country. They have Main area of practice is Infertility treatment. She is the IVF specialist  at Mohak infertility center, Indore where facilities like IVF, IUI with infertility treatment in indore and ICSI with test tube baby treatment. Their dream is to provide affordable, honest patient care to couple seeking to enhance their families. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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Monday, October 7, 2019

Signs and symptoms of miscarriage

The most common symptoms of miscarriage includes severe abdominal cramps and vaginal bleeding. If any of such symptoms appear during pregnancy, it is very important to immediately consult a doctor:

  • Vaginal bleeding: Dark red or brown bleeding, spotting, blood clots or excessive bleeding from the vagina can be the main symptoms of miscarriage and needs immediate visit to a doctor.






  • Severe back pain: Back pain is a common symptom in pregnancy, but if the pain becomes unbearable at times then it may be a sign of miscarriage and in such situation, you should contact a doctor as soon as possible.









  • Lower abdominal cramps: Lower abdominal pain is one of the main symptom of miscarriage. This is a matter of concern as this pain can be intense, much more intense than the pain during the period of menstruation.




Apart from these, there may be times when the symptoms of miscarriage are not felt and the knowledge of miscarriage occurs during the regular visit to the doctor.


Causes of Miscarriage


• Hormonal imbalance
• Immunity or blood clotting problem
• Problems like thyroid or diabetes
• Any problem in the womb or uterus
• Habit of too much Smoke

Specific reasons for Miscarriage

  • Chromosome abnormality: Reason for miscarriage can be abnormal chromosome. These structures carry genes based on which the development and almost all activity of body occur. During fertilization, the sperm of a male fuse with the eggs, if there is a genetic error in any one of the sperm or egg, makes the abnormal combination of the chromosome in the zygote and causes abnormal development of foetus, sometimes the main reason for miscarriage.
  • PCOS: Women with polycystic ovary syndrome are at a higher risk of miscarriage. In such situation, the balance of progesterone and oestrogen hormones is disturbed, due to which the normal development of eggs do not occur and may cause difficulty for conception.
  • Uterine abnormalities and unable cervix: If the size of the woman's uterus and uterine parturition are abnormal, there are more likely chances of miscarriage because the foetus cannot be implanted in the uterus. In this, the inner part of the uterus is divided by the muscle or wall of the fibres.
  • Immunology disorder: Sometimes, due to immunological disorder, the foetus cannot be implanted into the uterus and can cause miscarriage. These immunological disorders can be asthma, auto inflammatory syndrome, allergies, etc.
Are you looking at the Best IVF centre in india for Infertility Treatment? Mohak infertility center is one of the best IVF centers in indore: We provide the Infertility Treatment in Indore within your budget. Contact us for the right guidance about Infertility treatment and ivf Treatment cost in indore. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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Saturday, October 5, 2019

Miscarriage, WHY IT HAPPEN?

After getting the news of conceiving, the happiness comes in the life of a couple is hard to express in words. But sometimes this gets shattered due to some physical issues and suddenly the women become miscarried. This sudden abortion is devastating and makes the woman more mentally weak than physically. We have heard in many cases that after such situation the women is mostly blamed by the family or relatives. But in such situations, the woman needed to be helped emotionally as well as mentally to recover from the shock and conceive again. Most of us don’t know what the difference between a miscarriage and an abortion is, so to understand it better, read below given information.

What is an ABORTION and a MISCARRIAGE?

  •  A miscarriage is a spontaneous/ natural termination of pregnancy, i.e. the body itself expels the pregnancy, without any medication or a surgical procedure.
  •  An abortion is done mostly as a matter of choice, i.e. when a medicated or surgical procedure is done to end a pregnancy.


If the foetus dies in the womb before the 20th week of pregnancy, it is called miscarriage. It is also called as spontaneous abortion. Mainly it depends upon pregnancy status of the women. There are various types of miscarriage and the symptoms of each may be different. Early pregnancy miscarriage is very common and can occur to many women. According to researches one in five pregnant women miscarries before the 20th week of pregnancy.


Types of Miscarriage
  1.  Missed Miscarriage – In this type, pregnancy ends by itself. There is no bleeding nor any kind of symptoms and in such cases, the foetus remains in the womb, miscarriage occurred is detected by ultrasound when the foetus stops developing in the womb.
  2.  Complete miscarriage – In this there is severe abdominal pain and heavy bleeding. In such situation, the foetus comes out completely from the uterus.
  3. Incomplete miscarriage - In this case the woman experience severe pain and heavy bleeding in the lower abdomen. It is called as incomplete because only part of the foetus comes out and ultrasound is done to diagnose such situations.
  4. Inevitable miscarriage – In this condition the cervix opens and continues to bleed and eventually causes the foetus to come out. During this period, the woman experience frequent stomach cramps.
  5. Septic miscarriage – This occurs due to any kind of infection in the abdomen.

Dr. Shilpa Bhandari is one of the best infertility and IVF specialists in Indore, India has more than 10 years of experience in Reproductive medicine. Mohak infertility center is the Best IVF centre in india offering the IVF treatment cost in Indore at affordable price. Ferticity provides the best IVF Centre with Highest Success Rate  Affordable IVF, IUI, ICSI Treatment in indore to achieve pregnancy easily. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com


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Friday, October 4, 2019

Diagnostic laparoscopy, infertility, and endometriosis—5 years experience

Abstract - 

The objectives of this study were to determine the importance of diagnostic laparoscopy for the accurate diagnosis of endometriosis and to correlate the findings with infertility. Participants in this study included 336 women who were 18–45 years old, had no past medical history of abdominal operations, and complained of chronic symptoms of pelvic pain. In all these cases there were no pathological pelvic ultrasound findings. Also, nongynaecological diseases where excluded. Diagnostic laparoscopy was performed in all patients. In 191 women (56.8%) no pathology was found during the diagnostic laparoscopy, and 89 women (26.4%) actually reported improvement or even complete cure from their symptoms after the operation. In the majority of pathological cases the laparoscopy revealed various stages of endometriosis (n = 101; 30%). Other gynecological causes which were diagnosed during the laparoscopy where pelvic adhesions due to inflammatory disease (n = 37; 11%), ovarian cysts (n = 5; 1.5%), and uterine fibroids (n = 2; 0.5%). Diagnostic laparoscopy is the most accurate method for excluding the pathology related with chronic pelvic pain. Endometriosis seems to be responsible for the majority of pathological cases. Almost 60% of women have no pathology when examined with laparoscopy. A high percentage of symptoms can be phycogenic.


Introduction - 

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. While a number of theories have been proposed for the pathogenesis of endometriosis, that of retrograde menstruation is the most popular and plausible. Retrograde menstruation is common and is seen in 75–90% of women who have had laparoscopies at the time of menstruation [1]. Menstrual blood does not always contain endometrial cells and the factors that influence implantation of ectopic endometrium are uncertain, for the prevalence of endometriosis has been estimated as 1–20%. Women with endometriosis appear to have altered immune function, which may permit implantation of regurgitated endometrium. Most endometriotic lesions have the classic blue/black pigmented appearance. Atypical lesions could be similar to blisters, white plaques, nodules, and peritoneal defects [2, 3]. It has been suggested that nonpigmented lesions are more common in younger women and that darker lesions represent older disease [4].

The associated symptoms can impact on general physical, mental, and social well being. However, women may not have any symptoms at all. Laparoscopy is the mainstay of diagnosis and classification of endometriosis. All classification systems for endometriosis are subjective and correlate poorly with pain symptoms but may be of value in infertility prognosis and management.

Materials and methods -

This retrospective study included 336 women who were 18–45 years old. The women in our study group had no past medical history of abdominal operations and all of them complained of symptoms of chronic pelvic pain. The duration of symptoms was at least 6 months in order to be characterized as chronic. Of these women, 106 were also referred for primary or secondary infertility. In all these cases, gynaecological examination and transvaginal pelvic ultrasound were performed. There were no pathological pelvic ultrasound findings. Also, nongynaecological diseases were excluded. Diagnostic laparoscopy was performed in all these women by four different consultant obstetricians gynaecologists.

Results -

In 191 women (56.8%) no pathology was found during the diagnostic laparoscopy, and 89 women (26.4%) actually reported improvement or even complete cure from their symptoms after the operation. In the majority of pathological cases the laparoscopy revealed various stages of endometriosis (n = 101; 30%) that was diagnosed during the procedure on observation of the lesions and, in cases of endometriomas, also by histopathology report. For the women with endometriosis, almost 85% (n = 84) complained of primary or secondary infertility. Other gynecological causes which were identified with laparoscopy were pelvic adhesions due to inflammatory disease (n = 37; 11%), ovarian cysts (n = 5; 1.5%), and uterine fibroids (n = 2; 0.5%). No pathology was found in 16 (15%) women with primary or secondary infertility. The cause for infertility in 6 (5.5%) women was pelvic adhesions due to inflammatory disease. Endometriosis accounted for 80% (n = 84) of infertility cases (Figs.1).


Discussion - 

It is well known that the degree of endometriosis does not correlate with symptomatology: pelvic pain, dyspareunia, and dysmenorrhea. Moreover, it is not possible to predict which patients will develop progressive disease with resultant pelvic adhesions and ovarian cysts. Finding endometriosis may be coincidental in some women [5]. Careful laparoscopic assessment of the pelvis reveals signs of endometriosis in up to 18% of women with proven fertility [6]. For a definitive diagnosis of endometriosis, visual inspection of the pelvis at laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere [5]. A meta-analysis against a histological diagnosis showed that a positive laparoscopic examination increases the likelihood of detecting the disease to 32% (95% CI; range, 21–46%) and a negative laparoscopy decreases the likelihood to 0.7% (95% CI; range, 0.1–5%) [7]. There is insufficient evidence to justify scheduling the laparoscopy for a specific time in the menstrual cycle, but it should not be performed during or within 3 months of hormonal treatment to avoid underdiagnosis [8, 9]. At laparoscopy, deeply infiltrating endometriosis may have the appearance of minimal disease, resulting in an underestimation of disease severity [10]. Positive histology confirms the diagnosis of endometriosis; negative histology does not exclude it. Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal. In cases of ovarian endometrioma and in deeply infiltrating disease, histology should be obtained to identify endometriosis and to exclude rare instances of malignancy.

Laparoscopy is the gold standard diagnostic test in clinical practice for the accurate diagnosis of endometriosis [5]. Compared with laparoscopy, transvaginal ultrasound (TVS) has limited value in diagnosing peritoneal endometriosis, but it is a useful tool to make or exclude the diagnosis of an ovarian endometrioma [11]. At present, there is insufficient evidence to indicate that magnetic resonance imaging (MRI) is a useful test to diagnose or exclude endometriosis compared to laparoscopy [5]. A number of markers for endometriosis have been proposed, and probably the most commonly used is the glycoprotein CA-125, an oncofetal celomic epithelium differentiation antigen. It has been suggested that 35 U/ml could be used as a cut-off serum concentration for CA-125, below which endometriosis is unlikely to be present. Unfortunately CA-125 measurements do not correlate well with either the progression of the disease or the response of endometriosis to treatment. Compared with laparoscopy, measuring serum levels of CA-125 has no value as a diagnostic tool. The test’s performance in diagnosing all disease stages is limited, since it has about 28% sensitivity [12]. The test’s performance for moderate to severe endometriosis is a bit better with a sensitivity reaching 47% [12].

There is still debate about the extent to which endometriosis affects fertility in the absence of pelvic deformity. It has been suggested that the peritoneal environment is altered with interference to the sperm motility, to the oocyte pick-up by the fallopian tube, and to fertilization. Fertility can also be impaired due to dyspareunia caused by endometriosis. It is easy to assume that severe endometriosis can affect fertility by distorting pelvic anatomy with adhesions [13, 14]. The effect of endometriosis on assisted conception therapy results is unclear. According to HFEA (Human Fertilization and Embryology Authority), there is no difference in pregnancy rates in patients with endometriosis, without taking into account the stage of endometriosis [15]. Other authors insist that the fertilization rate, pregnancy rate (PR) per transfer, and birth rate were significantly lower in patients with severe endometriosis (stages III and IV) in comparison with patients with tubal infertility [16].

In almost 50–60% of cases with chronic pelvic pain symptoms, no organic cause is found during laparoscopy [17, 18]. In fact, it may be even more difficult to differentiate the organic from psychogenic pain in patients with symptoms lasting more than 6 months. Whatever the original cause of the chronic pelvic pain, it is quite likely that other facts, mainly psychological, could maintain or exacerbate the symptoms. Patients with chronic pelvic pain are more often found to suffer from depression and somatization disorders. These facts could explain that in a significant percentage of patients, although no organic pathology is found, there is improvement or even cure from the symptoms after a diagnostic laparoscopy [17, 19].

According to our study 85% of women with endometriosis also had infertility problems, and endometriosis accounted for almost 80% of all infertility cases. Of all patients, 30% reported chronic pelvic pain due to endometriosis, and in only 16 of 101 (16%) women with endometriosis no fertility problems were found.

Conclusions - 

Diagnostic laparoscopy is the most accurate method for excluding the pathology related to chronic pelvic pain. Endometriosis seems to be responsible for most pathological cases of chronic pelvic pain and also for the highest percentage of cases who are referred with primary and secondary infertility. Almost 60% of women with symptoms of chronic pelvic pain have no pathology when examined with laparoscopy.




Mohak infertility center is the top leading Best fertility hospital in india, Dr. Shilpa Bhandari is one of the best IVF specialist in indore at Mohak infertility center. providing best IVF treatments, test tube baby treatment and infertility treatment in Indore at an affordable IVF cost in indore. for more info touch with us. Book an appointment Call now 7898047572 For more information, visit - https://www.mohakivf.com

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