Endometriosis in Infertility
“Whenever there is time in hand, where fertility is not the immediate requirement,
medical management with Dienogest plays a very important role.”
“The disease completely resolves when given continuously for prolonged time period.”
SPEAKER: Dr. Kundan V. Ingale, Chairperson Infertility Committee FOGSI 2020-23; Director Nirmiti Clinic, Centre for Assisted Reproduction & Endoscopy Pune
CHAIRPERSON: Dr. Sumita Verma, Founding Secretary Faizabad ObGyn Society 2009-20; Director Deva Memorial Hospital Institute of Advanced Endoscopy Faizabad
Dr Kundan V. Ingale, renowned IVF expert, shares his invaluable expertise on Endometriosis and infertility and provides management updates. He elaborates when to do laparoscopy and when to go for ART.
Speaking of Dienogest for medical treatment especially in an unmarried girl, where infertility is not being addressed, there is some time to think of her reproduction, Dienogest is documented to reduce 30% of the endometriosis completely, the disease completely resolves when given for prolong time like 1.5- 2 years. With Dienogest therapy for 2-3 years continuously, the endometrioma completely collapses / disappears and disease burden reduces significantly. After her marriage don’t wait for more time, assess the ovarian reserve, and go for IVF, or go for fertility preservation with her consent even if she is not married.
It’s not the cyst size, Dienogest is going to act on the endometriotic implants from where she is having the source of bleeding, which is accumulated in the cyst, so when going for Dienogest therapy size cut-off is not the criteria.
Dienogest therapy for a patient with 6-7 cm endometrioma reduced to 1-2 cm after 2 years. Another patient given Dienogest for 4 cm endometrioma for 1.5 years then stopped as she wanted to plan a pregnancy and has been recurrence free for over 3 years now. So whenever there is time in hand, where fertility is not the immediate requirement, medical management with Dienogest plays a very important role.
Giving a progestin like Dienogest for such a long time, is there any need to keep a watch on liver function test? Dienogest doesn’t have any effect on LFT even when given for upto 5 years. It is quite a safe drug. Dose is Dienogest 2mg per day start from 2nd day of menses continuously.
In the initial 6 months there will be some bone loss seen in the 1st 6 months, but it achieves a steady loss not a progressive loss.
For adenomyosis yes Dienogest is effective, it acts at the endometrium and the abnormal site but adenomyosis reduction of size is not seen, only a lot of fibrous tissue deposition in the myometrium is seen which in turn interrupts the blood flow, so in terms of desire of fertility in future – it can have a dual role, but symptomatically it will have an effect.