One-third to one-half of women with endometriosis have difficulty getting pregnant. Many people may have heard of endometriosis, but they are unaware of how this condition can have an effect on fertility. The Mayo Clinic describes endometriosis as, “an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis” (1). There are women who develop endometrial tissue in other areas of the body, but this is typically considered rare. We are going to discuss this diagnosis, as well as natural and medicinal methods to treat it.
How is Endometriosis Diagnosed?
Endometriosis can be difficult to diagnose and most women who are affected by it could struggle to get a diagnosis for many years. Endometriosis has a vast range of symptoms that may mimic other diseases, which can complicate the diagnosis. Some of the main symptoms are:
Painful periods
Pain during sexual intercourse
Infertility
Other symptoms can include:
Pain outside of the period
Digestive problems
Pneumothorax
The cells can attach to major organs and every month during menstruation, those cells shed their lining just like the uterus. This is what causes endometriosis to be so painful.
Diagnosing endometriosis can be completed multiple ways such as: Pelvic exam, ultrasound, magnetic resonance imaging, and laparoscopy
Pelvic Exam
A doctor will insert one or two gloved fingers inside your vagina and while pressing down on your abdomen, they can evaluate your uterus, ovaries, and other pelvic organs. The doctor will be able to feel the difference between normal and abnormal tissue in your pelvis.
Ultrasound
During an ultrasound specifically performed to diagnose endometriosis, a doctor or sonographer will insert a small probe, called a transducer, into the vagina to capture images of the pelvis. They will examine your uterus, ovaries, and fallopian tubes to see if they have any anomaly. Cysts, a large uterus, adhesions with immobile organs can be clues to the presence of endometrial cells.
Magnetic Resonance Imaging
Magnetic resonance imaging, known more commonly as an MRI, can be performed to find endometrial cells deep inside the pelvis. An MRI can also be done to find endometrial cells in other parts of the body, although this is rarely ordered without specific symptoms.
Laparoscopy
The only sure way to diagnose endometriosis is through laparoscopic surgery. This type of surgery is low-risk but is usually still avoided if possible. The surgeon will make a small incision in the abdomen, near or in the belly button. A camera, called a laparoscope, will be inserted into the incision, which the surgeon will use to visualize internal organs looking for signs of endometriosis. If found, the anatomy can be restored and abnormal cells can be removed. This is an important diagnostic tool and can greatly help for relief of symptoms. However, it is temporary and the main treatment will always be medical for long term care and to avoid relapse.
Endometriosis and Fertility
There are many ways, both naturally and medically, to relieve symptoms of endometriosis and help fertility. Let’s first look at the different natural methods available for a woman considering natural childbearing.
Natural Methods
One of the methods to help relieve endometriosis symptoms is to focus on an anti-inflammatory diet that centers around eating foods high in antioxidants, such as fruits, vegetables, herbs, and spices. Studies have found that women who eat more Omega-3 fats experience relief in their symptoms. Some foods that could be incorporated into your diet are:
Spinach, broccoli, beans, and beets
Walnuts, dark chocolate
Salmon
Oranges, Berries
Nutrition is a key component of immune system health, so women with endometriosis could find relief from their symptoms after changing their diet.
Although we do not have evidence that hypnosis, psychotherapy or acupuncture help diminish symptoms or treat endometriosis, they are options that can be considered and explored.
Keep in mind that these natural methods will only treat symptoms and bring relief, not cure endometriosis.
Medical Treatments
Medical treatments are available to relieve and control endometriosis. These treatments can include pain medication, hormone therapy and surgery. Pain medication can bring relief from symptoms but is not a cure-all.
Hormones fluctuate during menstruation, which causes the endometrial cells to thicken and shed. Hormone therapy can be a more permanent pain reliever, sometimes eliminating the pain altogether. It is the main treatment plan for long term relief and prevention of worsening endometriosis. If you stop the treatment, symptoms could return unless you have reached the age of menopause, at which time endometriosis will be much less problematic. Different hormone treatments are available, including progestin therapy and birth control pills.
Another option to treat endometriosis is surgery. Surgeons can perform a laparoscopic procedure to remove endometrial cells while leaving your uterus and ovaries intact. The procedure is like the diagnosis laparoscopy, but the surgeon will actually remove or burn the endometrium tissue to relieve pain. If the surgery is successful, fertility may be improved although this remains controversial. Furthermore, a high number of women would have to get surgery in order to improve fertility for only one of them. Therefore, it is usually avoided when only considered for infertility.
The final option is IVF (in vitro fertilization) to stimulate the ovaries. According to contemporaryobgyn.net, “IVF clinical outcomes were evaluated based on rates of fertilization, implantation, and spontaneous pregnancy. The fertilization rate among patients with endometriosis was 70% compared to 67.1% for patients who did not have the condition” (2).
Natural and medical methods will mainly help relieve endometriosis pain, which is the first step before procreation.
When Treatments are No Longer Sufficient
If you have tried the natural and medical methods above and they are no longer working, that’s when you should contact a professional. Consult a doctor to establish a diagnosis and analysis of fertility beyond endometriosis. If tests are inconclusive, consult a fertility professional who may help identify more serious problems. You should also contact a professional if you experience multiple miscarriages.
Endometriosis Can Affect Fertility, But Each Case is Different
Even though endometriosis is painful, underdiagnosed, and can affect fertility, it does not mean you are infertile. Many women who are diagnosed with endometriosis have successfully conceived and given birth, both naturally and through IVF or other fertility treatments. It can take longer to conceive, but it is still a possibility.
If you have any of the symptoms listed at the beginning of the article or you are struggling with fertility, you should set up an appointment with your primary care doctor to get a diagnosis. The sooner you receive a diagnosis, the quicker your symptoms and pain can be resolved, and the sooner you can start to try to conceive.
A miscarriage occurs when a woman loses her pregnancy before the 20th week. Also called spontaneous abortion, it occurs in most cases during the first trimester (before 14 weeks). It is important to know that the rate of miscarriage increases with the age of the mother or the person providing the eggs. Since it often happens at the very beginning of the pregnancy, it may go unnoticed. However, there are signs that may indicate a miscarriage and should be investigated during any pregnancy. These include bleeding or painful cramps.
Miscarriage: Management
Management depends on the age of the pregnancy at the time of conclusion. It may include a period of observation, medication or a curettage. But it is important to remember that a miscarriage is not only physical but also psychological. It is important to have a support network and sometimes it may even be necessary to consult a psychologist.
How can a fertility specialist intervene in case of miscarriage?
When a woman experiences a miscarriage, it is important that she be accompanied on a moral and psychological level as well as on a medical level. Indeed, a miscarriage can have an impact on the health of the woman as well as on the outcome of future pregnancies. Hence the importance of being accompanied by a health professional who is comfortable and knowledgeable on the subject.
For example, experts recommend that women who have had two or more miscarriages meet with a fertility doctor. Many family doctors or gynecologists can also help. If possible, consulting a fertility specialist is a good idea.
Many women who experience pregnancy loss go on to have healthy pregnancies, but the loss may indicate a fertility problem. This problem needs to be recognized and evaluated if the pregnancy plan is to be pursued.
A fertility specialist will meet with you and propose a personalized treatment plan. He or she will evaluate the potential causes according to your history, such as :
Abnormal shape of the uterus (malformation, myomas, etc);
Genetic abnormalities;
Hormonal disorders;
Infection;
Immunological factors;
Since the majority of miscarriages are due to a chromosomal abnormality of the embryo, the discussion may also include the evaluation of the relevance of a genetic analysis of the embryo before a possible implantation.
Embryos analyzed in this way and considered normal will offer a higher pregnancy rate and limit the risk of genetic abnormality in the embryo, and consequently of miscarriage. Abnormal embryos will generally not be used since they often result in a negative pregnancy test or miscarriage.
Note that all of these risks are directly related to several factors, mainly the woman’s age. Thus, the options may vary depending on your personal circumstances.
Follow-up and advice from doctors
If you have suffered repeated miscarriages, we invite you to make an appointment with a fertility specialist who will be able to help you find the cause of the miscarriage and accompany you.
Ontario patients: We have big news!
On July 19, some refreshing changes are coming to our Newmarket and Vaughan locations.
Newmarket location change
Our Newmarket clinic is moving to a new address July 19th 2021. Freshly renovated with plenty of convenient parking. We look forward to welcoming you to this brand-new location.
Appointments will be at our new address as of July 19th:
1111 Davis Drive East, Unit 39
Newmarket, Ontario L3Y 9E5
T: 905.967.0852 / F: 905.967.0512
New name, new look: Vaughan and Newmarket clinics
Starting on July 19, great patient care will have a brand-new name! The Procrea Fertility clinics in Newmarket and Vaughan clinics will be renamed as Generation Fertility.
Since 2011, our Newmarket and Vaughan teams have been recognized for their caring expertise, innovation and healthy outcomes. We’ve also been growing with the addition of new team members, recently welcoming two new fertility specialists Drs. Hartman and Lai. The new Generation Fertility name and look reflect the energy and expertise of our team. And, while our name is changing, you can expect the excellent patient care and clinical team you’ve come to know.
We’re honored to be your clinic of choice, to help you achieve your dream of family.
The Vaughan clinic is not relocating and will remain at its current address:
955 Major Mackenzie Drive West, Suite 400
Vaughan, ON L6A 4P9
T: 289.357.0100 / F: 289.357.0101
What if I have eggs, sperm or embryos stored at the clinic?
Your storage arrangements are not changing. Rest assured, your samples will not be affected and will remain safely stored in their current location, carefully monitored by our expert staff. Should you have any questions you may email us at [email protected]
What if I have additional questions?
Or team would be happy to communicate with you. Should you have any additional concerns feel free to call us or email us at [email protected]
Information on the COVID-19 Vaccine!
Ontario COVID-19 Vaccine Information:
For those considering the COVID-19 vaccination, our current advice is to follow the recommendations from Public Health.
As of April 23, 2021 pregnant people have been added to the “highest risk” category and can book a COVID -19 vaccine through the provincial website: : https://covid-19.ontario.ca/book-vaccine/ . A doctor’s note is not required.
In making a decision about whether to get vaccinated, each individual should weigh the risk vs. benefit for themselves.
All of the current data suggests that all vaccines that are currently available are considered very safe.
It is likely that the risks associated with COVID-19 infection are significantly greater than any potential risk associated with the vaccines.
For this reason, the benefit of vaccination for most individuals far exceeds the risk.
If you are not pregnant yet, it is likely that the benefit of getting vaccinated far outweighs any risk and we recommend that you get vaccinated if you have the chance.
These vaccines were not specifically studied in pregnant or breastfeeding individuals and for that reason we cannot comment on the specific risks in this population. We also are learning more every day about the risks of COVID-19 infection in pregnancy and breastfeeding. Although we cannot say anything with certainty, it is very likely that the benefit of vaccination will outweigh the risk in this population as well.
The current recommendation is that there is no need to delay pregnancy after vaccination and that the second dose can be received at the usual scheduled time even in pregnancy.
Prior to vaccination, all of the vaccination centers offer information about the vaccines and screen individuals for contraindications to vaccination. If you have an allergy to one of the components of the vaccine or if you have had a previous adverse reaction to vaccination, please discuss this with the vaccination center.
If you are interested in reading more about the COVID-19 vaccination, please see the following information from SOGC, Ministry of Health and CFAS
If you do decide to have the vaccine check with your nurse in timing of any procedure that may be coming up for you, as you may have some symptoms from the vaccine and may not pass the COVID screening of the clinic.
Information on the COVID-19 vaccine
For those considering the COVID-19 vaccination, our current advice is to follow the recommendations from Public Health.
In making a decision about whether to get vaccinated, each individual should weigh the risk vs. benefit for themselves.
All of the current data suggests that both vaccines that are currently available are considered very safe. It is likely that the risks associated with COVID-19 infection are significantly greater than any potential risk associated with the vaccines.
For this reason, the benefit of vaccination for most individuals far exceeds the risk.
There was an update on January 7th that Ontario will allow (encourage) pregnant or breastfeeding people to be vaccinated against COVID-19 according to new recommendations from Ontario Society of Obstetrics and Gynaecology (OSOG) and the Ontario Medical Association Section on Obstetrics and Gynaecology (OMG-OG).
As both vaccines currently available in Ontario, which are mRNA based are “not hypothesized to be a risk to breastfeeding infant” and should be offered. If you are not pregnant yet, it is likely that the benefit of getting vaccinated far outweighs any risk and we recommend that you get vaccinated if you have the chance. Prior to vaccination, all of the vaccination centers offer information about the vaccines and screen individuals for contraindications to vaccination.
If you have an allergy to one of the components of the vaccine or if you have had a previous adverse reaction to vaccination, please discuss this with the vaccination center.If you are interested in reading more about the COVID-19 vaccination, please see the following statement from the Society of Obstetricians and Gynecologists of Canada
Announcement: Changes at the Procrea Fertility Montreal location
Procrea Fertility Montreal and clinique ovo have merged clinics. Patient care in the Montreal area for both Procrea Fertility and clinique ovo has been combined under one roof at clinique ovo. Clinique ovo is located at 8000 Decarie Boulevard and is approximately 4 kms from the former Procrea Fertility Montreal location.
Excellence in patient care is our priority. We will continue to ensure that all our patients have access to the best technologies and resources for optimal care. For more information, please refer to our Frequently Asked Questions.
Patients will be treated by a new medical and clinical team who will make sure the transfer of care goes smoothly. They have access to the best possible care from the renowned ovo clinic team.
What should I do if I wish to declare my Day 1 for treatment?
Please contact clinique ovo to schedule or confirm your appointment at 514-798-2000 ext. 149 or at [email protected].
What should I do to book a prenatal appointment?
You can reach a clinique ovo receptionist at 514-798-2000, option 1, option 2, or [email protected] to schedule your prenatal appointment.
What if I was on the Procrea Montreal waiting list for a consultation?
Clinique ovo will contact patients on the waitlist to schedule an appointment
How does this merger affect the Procrea Fertility Gatineau clinic?
Procrea Fertility Gatineau patients will continue to have their appointments at 444 Boulevard de l’Hôpital, Suite 310, Gatineau, Quebec, J8T 7X6. The phone number is 819-778-5572. The procedures and treatments that were offered at the Procrea Fertility Montreal clinic will now take place at clinique ovo, located at 8000 Decarie Boulevard in Montreal.
How does this merger affect the Procrea Fertility clinic in Quebec City and other branches of clinique ovo?
The Procrea Fertility clinic in Quebec City and other locations of clinique ovo are not affected by this transition. Consultations, treatments, and other patient care will continue as usual. There are no changes for patients at any of the other Procrea Fertility and clinique ovo locations. Patients who were referred by external clinics to Procrea Fertility Montreal for treatments will now be redirected to clinique ovo, located at 8000 Decarie Boulevard, Montreal, Quebec, H4P 2S4.
If you have any questions, please contact the clinique ovo patient care team by email at [email protected].
Fertility Preservation: Your Frequently Asked Questions
At Procrea Fertility, preserving your fertility is one of our priorities. Egg freezing is an excellent option for women who need or want to delay pregnancy. In the interest of transparency, we wish to provide you with all the necessary answers that will allow you to make clear decisions regarding the preservation of your fertility. Here are the most frequently asked questions we have been able to collect on this subject.
The egg freezing process
Do I need a referral from a Health care provider to access the services of a fertility clinic?
A referral is required to access services and care related to fertility treatment or preservation. However, some clinics such as Procrea Fertility grant direct access to fertility specialists without prior consultation with a family doctor or an obstetrician-gynecologist (OB/GYN), in the case of a woman waiting for cancer.
However, it is also advisable to speak with your family doctor about your concerns about infertility before making an appointment with a specialist.
Is it possible to do fertility tests without having to freeze the eggs?
Absolutely! A gynecologist specializing in reproductive medicine is trained to diagnose and treat fertility problems. A fertility specialist will be able to refer you to various tests and treatments to treat the conditions that may affect your fertility. Visit our webite’s pages When to consult a fertility specialist and Fertility Assessment to learn more!
What is the egg freezing process?
Here are the different steps of our egg freezing program:
Ovarian reserve test, ultrasound and laboratory tests to look for various hormones and the presence of STIs
Consultation with a specialist to establish treatment
Controlled ovarian hyperstimulation
Egg retrieval
Egg freezing
How many times does the process need to be done?
This depends on several factors, including the number of frozen eggs and the age at the time of the puncture. The success rate for those who decide to freeze their eggs before the age of 35 can reach up to 95% in cases of 24 or more eggs, while the same rate is up to 50% if freezing is done after the age of 35. It should also be taken into account that freezing your eggs does not guarantee a child.
Is the process painful and/or does it cause side effects?
The egg retrieval procedure itself is not painful. After the procedure, the woman may feel a little pain, a little tired, and recovery may take between 24 and 48 hours to feel normal again. From a side effect point of view, bloating may be felt due to the ovaries becoming larger.
The costs involved in egg freezing
What are the costs associated with egg freezing?
On average it would cost about 5.000$ for an egg retrieval. In addition, there are storage fees (approximately $300/year) that will be paid later on in the process when it’s decided that it’s time to fertilize and transfer the eggs. ICSI (intracytoplasmic sperm injection), and FET (frozen embryo transfer). RAMQ covers the procedure for cancer cases and storage for the first 5 years and Procrea Fertility offers this service free of charge for patients undergoing cancer treatment.
Is fertility preservation covered by the RAMQ/health insurance?
Oocyte freezing is currently not covered by the RAMQ. Currently, infertile Quebecers are entitled to a tax credit ranging from 20% to 80% of the cost of treatment, depending on salary. However, coverage for fertility treatments may vary from one province to another in Canada.
The Ontario government covers the cost of an IVF cycle. Procrea Fertility clinics in Ontario have been officially approved by the Ontario Ministry of Health to provide fertility treatments funded by Medicare.
On November 11, 2020, the Quebec government introduced the long-awaited bill to reinstate free access to certain AHR treatments. Eligible couples will have free access to an in vitro fertilization cycle depending on criteria set forth when this bill is officially passed*.
*Please note this bill has not yet passed.
Egg quality
How is egg quality evaluated?
There is no formal test to determine egg quality. However, quality is directly linked with age. This factor affects the rate of eggs that contain genetic abnormalities and which may increase naturally with age. Freezing the eggs preserves their quality, so we recommend that they be frozen before the age of 35 in order to increase the chances of pregnancy afterwards.
Why does egg quality decrease with age?
Generally, egg quality is related to its age and we begin to see a decline around 37-38 years old.The decline continues until the age of 45, when the natural fertility rate per month is approximately 1%. The success rate in IVF is higher (35% to 40%) in women under 35 years of age, and decreases to approximately 5% in women 42 years of age and older. This is due to the natural ovarian reserve, which decreases with age.
Will a baby born with a frozen egg be as healthy as another?
In 2012, the American Society for Reproductive Medicine (ASRM) reported that no increase in chromosomal abnormalities, birth defects, and developmental deficits were reported in offspring born from cryopreserved oocytes compared to conventional IVF/ICSI pregnancies and the general population. The evidence indicates that oocyte vitrification and warming should no longer be considered experimental.
In fact, more recently in 2020, the European Society of Human Reproduction and Embryology (ESHRE) internationally recognized egg freezing as an acceptable option to offer to women.
How long can eggs be frozen?
The standard storage period for eggs is about 10 years. The period may be extended for circumstances involving women at risk of premature infertility due to medical treatments such as chemotherapy.
Finally, how do I make an appointment with a fertility specialist?
You can make an appointment in one of our clinics by phone call or via our contact form. Inquire about your first visit with us!
We hope to have answered your questions as well as possible. If any doubts persist, do not hesitate to contact us. We will answer as soon as possible!
For more information on other topics, please visit our blog which discusses fertility and related treatments for women, men, and couples in the LGBT2Q+ community.
