Endometriomas and fertility – latest research by Dr Hanekom

What are endometriomas?

Endometriosis is a disease of the female reproductive system that is characterised by the lining of the uterus (the endometrium), which grows elsewhere (learn more about endometriosis, -symptoms and -diagnosis). There are four stages of endometriosis. During stage three and four endometriosis, a type of cyst can form on the ovaries, these cysts are known as endometriomas.

How can we measure female fertility?

At birth women are born with all their eggs (more than a million), which is stored in the ovaries. At least one egg ripens each monthly cycle and is released from the ovary during ovulation. If fertilisation of the egg does not take place the egg will be flushed out with the lining of the womb during the menstruation cycle and so egg reserve declines over time (as we age). One way of investigating the size of the egg reserve is through measuring AMH (Anti-Mullerian Hormone) levels. AMH levels can be confirmed through a blood test.

How is fertility affected when endometriomas are removed?

Aevitas Fertility- and Endometriosis Specialists, Dr Gerhard Hanekom and Prof Igno Siebert recently collaborated on a study within the field of endometriosis.

Endometriosis specialist, Prof Igno Siebert (left) and Dr Gerhard Hanekom (right)

Endometriosis Specialists, Prof Igno Siebert (left) and Dr Gerhard Hanekom (right)

Dr Hanekom’s study objective was to see if the AMH level (egg reserve) can recover in the long term after the surgical removal of endometriomas. Reason being, with the removal of the endometriomas, there is a big chance of damage to the egg reserve. This study also aimed to determine the on-going pregnancy rate in a group of patients trying to conceive after the removal of endometriomas. Prof Siebert acted as supervisor of the study.

Intervention: 59 patients scheduled to undergo laparoscopic cystectomy for suspected endometrioma took part in this study. AMH was collected before the day of the surgery, as well as 6 months after surgery and on average 23.3. months after surgery.

Result and Outcome: The AMH levels declined in 92% of patients at final follow-up, with an on-going pregnancy rate of 38% in the groups trying to conceive.

If you have been diagnosed with endometriomas, what should you consider?

If you have been diagnosed with endometriomas, it’s important to make sure you consult with a gynaecologist, specialising in endometriosis. You need to have a thorough understanding of the surgery, the implications thereof and fertility preservation options. Furthermore, it’s also important to know what your alternative treatment options are, in order  to make an informed decision.