Fertility and Endometriosis Q&A
With March being Endometriosis Awareness Month, the Endometriosis Foundation of America (EndoFound) and My Endometriosis Team are organizing a series of events throughout the month. On Monday, March 7, EndoFound’s Marie Freeberg had a candid discussion about fertility and endometriosis with Dr. Karli Goldstein, a board-certified minimally invasive gynecological surgeon who has been associated with EndoFound since 2017 and has been an endo patient herself.
Dr. Karli Goldstein’s endo journey
Speaking of her own travails with endometriosis, Dr. Goldstein expressed what many women suffering from the disease actually go through. As a young OB-GYN resident, Dr. Goldstein used to wonder about her own symptoms that seemed to be overlapping with those of the patients she had interviewed. Unfortunately, most of her early 20s were spent with an incorrect diagnosis of irritable bowel disease.
“This is unfortunately a disease that’s not a huge focus in medical school”, Dr. Goldstein said.
Her experience is not too unlike the ordeal that patient Carolyn C. had undergone before she found out about Dr. Tamer Seckin online.
Endometriosis can adversely affect ovarian reserves and fertility. Dr. Goldstein described such upheavals in her own life when she found out that she had ovarian insufficiency leading to multiple failed pregnancies and IVF procedures, even losing her baby with a gestational carrier.
Dr. Goldstein’s personal endo journey has shaped a large part of her own understanding of the disease, and she uses these experiences and expertise towards successful outcomes for her patients.
Fertility and endometriosis
Dr. Goldstein assures that most endometriosis patients can get pregnant and that it’s not the end of the road.
“We don’t have to have a doomsday look on it as soon as you get this diagnosis”, said Dr. Goldstein.
Infertility may be caused due to various factors. For example, endometrial lesions can block fallopian tubes and affect ovarian structure and function. Moreover, the disease also has an inflammatory component that can contribute to fatigue and further reduce fertility.
Endometriosis and pregnancy
There’s been a long-standing misconception that endometriosis goes away with pregnancy. Though pregnancy and breastfeeding may provide some symptom relief owing to progesterone levels and lack of periods, they do not solve the root of the problem.
“Many patients, may get pregnant on their own with endo and it may be okay. It may have no effect on the pregnancy”, said Dr. Goldstein
Prospects of egg freezing
Egg freezing is a good strategy for women with endometriosis who may not wish to become pregnant immediately. The best time to isolate and freeze eggs is when a woman is in her 20s or younger than age 35.
“If it’s possible, then you always want to do it on the earlier side, said Dr. Goldstein. If it’s not, any time is still okay.”
Endometriosis and pain management
Chronic pelvic pain is one of the most debilitating symptoms of endometriosis. Pain management can be done based upon the onset of menstruation using anti-inflammatory drugs.
“If you’re taking high doses of these anti-inflammatories, it can affect your stomach lining and cause sensitivity with your stomach.”, said Dr. Goldstein
Depending on the timing of the pain, Dr. Goldstein recommends the use of anti-inflammatory medications alternating with Tylenol before periods set in. In addition, Ponstel can be used to reduce uterine cramps either before the start of bleeding or on the same day and continued for three days. Care must be taken to ensure the right timing and dosing. Other ways to manage the pain include switching to an anti-inflammatory diet, reducing stressors, and exercising.
Of late, there has been a considerable increase in several resources that patients and caregivers can turn to. For instance, EndoFound offers a host of resources to educate patients about the disease and dispel various myths. EndoFound also offers the Endometriosis Education Program aimed at educating adolescents in schools.
“There’s all different resources now, which I think were not there 10 years ago”, said Dr. Goldstein
There are also other resources such as resolve.org and many workplaces are increasingly becoming more endo-friendly including offering universal coverage for fertility.
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