FERTILITY AND ENDOMETRIOSIS FAQS
Frequently Asked Questions Pertaining Infertility and Surgery
- Who will be doing my surgery?
- Nezhat is the main surgeon who performs the entire surgery. He has 3-4 other assistants to help him during the surgery. One assistant stands beside him; two across from him and one is between the patient’s legs. Similar to the picture on the last page
- What is endometriosis?
- Endometriosis develops when endometrial-like cells similar to those lining the inside of the uterus (endometrium) begin growing in other areas or organs of the body
- Endometriosis is a chronic estrogen dependent disease that can cause incapacitating pain, organ failure, infertility, and other severe medical consequences if not adequately treated
- In patients with endometriosis and infertility, pain may not be the symptom at all. In Dr. Nezhat’s practice, more than 90% of normal, infertile couples have endometriosis and they respond excellently to his treatment
- How does endometriosis affect my fertility?
- Endometriosis is like a poison in the body. It harms egg, sperm and embryo quality. It also impairs implantation
- Patients with untreated endometriosis have higher rates of IVF failures. In patients undergoing surgical treatment of their endometriosis by Dr. Nezhat, IVF success rates increase dramatically
- How does Dr. Nezhat diagnose endometriosis?
- A basic pelvic exam can help determine a preliminary diagnosis and can often uncover conditions such as reproductive tract anomalies, fibroids, and endometriosis with a surprisingly high degree of accuracy
- A transvaginal ultrasound can detect conditions such as ovarian cysts, uterine fibroids, and adenomyosis. Conditions such as endometriosis are more difficult to distinguish in this manner. However, endometriomas (endometriosis of the ovaries) can sometimes be detected using this technology
- In cases of suspected endometriosis and unexplained infertility, video assisted laparoscopy is one of the most accurate and useful diagnostic tools available. Dr. Camran Nezhat invented and pioneered this technology and is the world’s expert in video assisted laparoscopy
- I don’t have any pain issues. How can I be sure I have endometriosis?
- Patients may not experience the most well-known symptom of endometriosis: painful periods. Women and girls may also experience acyclic chronic pelvic pain; that is, pain at any time during the month. In other cases, patients have no symptoms and don’t know they have the disorder until years later when they’re experiencing fertility issues
- Even if you have no pelvic pain and don’t experience any of the classic symptoms, you still may have fertility-compromising endometriosis. The majority of infertility patients do not have any pelvic pain
- Endometriosis is an enigmatic disease and not always prevents fertility
- How soon after the surgery can I get pregnant?
- This depends on several factors and Dr. Nezhat makes further recommendations regarding time to pregnancy, embryo transfers and suppression therapy based on his findings during surgery
- How many months after surgery do patients usually get pregnant?
- Patient can start trying to conceive a few days after standard surgery if no uterine incisions were made. Some patients can likely try to conceive on her own and may not need IVF for conception after surgery. Best outcomes for fertility is first two years after surgery
- Should I freeze embryos before surgery to have a backup plan if my ovary is damaged during endometrioma excision?
- Patients can freeze eggs or embryos prior to surgery if financially feasible. But in our experience, patients younger than mid 30s usually have an excellent chance of getting naturally pregnant after surgery on their own if the semen analysis is normal.
- Does having an endometrioma classify me as stage IV? Does having an endometrioma mean that my endometriosis is likely elsewhere and is severe?
- Many patients with endometriomas do also have concurent endometriosis in other locations, particularly in the pelvis on the reproductive organs. Dr. Nezhat will thoroughly evaluate the entire, abdominal and pelvic cavity to assess and treat by excision of endometriosis
- After surgery, is it likely the endometriosis will come back?
- It is possible that endometriosis can recur but it depends on the severity of the disease, use of fertility medication after surgery etc. If endometriosis is thoroughly treated a surgeon who knows how to thoroughly treat endometriosis, the likelihood of re-growth is extremely unlikely. Some patients with endometriosis who are not trying to conceive may need to be on hormonal suppressive therapy after surgery otherwise their rate of recurrence increases by 8-9 times. With Dr. Nezhat, generally the rate of recurrence is extremely low and more than 85% of his patients do not need a repeat surgery if they are on hormonal suppression therapy post operatively
- Can endometriosis cause miscarriages?
- Yes it can. But after surgery the chance of success of pregnancy is greatly improved and miscarriage rates decrease
- Is the surgery an excision or ablation of endometriosis?
- Endometriosis is removed via excision with exception of the ovary. The ovary is handled delicately as the patients desire fertility. In some cases precise vaporization may be done to minimize the injury to the ovary
- Can scarring from surgery cause more adhesions and make it more difficult to get pregnant later?
- Risk of adhesions formation does exist but the chance of pregnancy after surgery is much more thus the benefit of surgery outweighs the risk of adhesions. There are also techniques that can be used to decrease the chance of adhesion formation. The more experienced the surgeon, the better the results.
- How many incisions are made?
- Four total incisions are made. 1) belly button 2) either side of ovaries 3) bikini line
- Refer to picture below
- What are the complications from this surgery?
- Complications from this surgery are similar to any other laparoscopic surgery like bleeding, infection, injury to bowel, bladder or vasculature or need for blood transfusion. Dr. Nezhat is an extremely skilled and careful surgeon and takes all necessary precautions before, during and after surgery to minimize complications. In his hands, major complications are rare.
- How long do the benefits of laparoscopic surgery last?
- About 85% of patients will have their pain symptoms resolved or decreased and won’t need further endometriosis treatment. In terms of fertility, the best outcomes are seen within the first two years after surgery
- What is the difference between depot lupron and surgery outcomes?
- Lupron is an injection that suppresses endometriosis by a maximum of 60% but does not eliminate the endometriosis itself. In Dr. Nezhat’s opinion, patients around 40 years old should be cautious when using lupron as they may undergo irreversible premature menopause. However surgery performed in the hands of a very skilled surgeon like Dr. Nezhat can fully eliminate disease and improve pain and fertility outcomes in the majority of cases
For further information, please refer to the published papers:
1) Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles. Fertility and Sterility, Volume 84, Issue 6, 1574 – 1578
Eva Littman, M.D., Linda Giudice, M.D., Ruth Lathi, M.D., Bulent Berker, M.D., Amin Milki, M.D., Camran Nezhat, M.D.
2) BCL-6 overexpression as a predictor for endometriosis in patients undergoing in vitro fertilization. Journal of the Society of Laparoscopic & Robotic Surgeons
Camran Nezhat M.D, Anupama Rambhatla M.D, Catarina Miranda-Silva M.D, Atena Asiaii M.D, Kimsa Nguyen M.D, Aimee Eyvazzadeh M.D, Salli Tazuke M.D, Shruti Agarwal D.O, Sunny Jun M.D, Azadeh Nezhat M.D, Robert A Roman M.D
We currently accept the following PPO plans:
- Anthem BC
- United Healthcare
- Blue Shield of California
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- Endometriosis FAQs
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- Protocols and Best Practices for Treating Diaphragmatic Endometriosis
- Thoracic Endometriosis and Catamenial Pneumothorax Article
- Excision of Endometriosis Informational Article 11/2011
- Excision of Endometriosis vs. Vaporization 02/2012
LAPAROSCOPY MYTHS : There are many misconceptions among doctors and patients concerning laparoscopy, the most common of which are discussed HERE.
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