Endometriosis and Infertility

Endometriosis can have a major impact on a woman�s ability to become pregnant. While treatment options exist to help alleviate the effects of endometriosis on female infertility, depending on the severity of the condition, endometriosis can still impact a woman�s chances of getting pregnant. But how exactly does this condition affect female fertility and can endometriosis treatment options significantly increase a woman�s chance of achieving pregnancy?

How Does Endometriosis Cause Infertility?

There are a variety of medical opinions when it comes to explaining how endometriosis causes female infertility.

One such theory is that the scarring that results from endometrial lesions hinders the ability to get pregnant. This is because scarring hinders the fallopian tubes from picking up the egg where it would be fertilized by the sperm. Scarring of the fallopian tubes also prevents the transfer of the egg to the uterus for implantation. The more scarring a woman has due to her condition, the greater her risk of infertility.

Another theory is that menstrual tissue backs up through the fallopian tubes into the abdomen, where it is implanted and then develops.

Other views link endometriosis with infertility because of the biological effect it has on eggs.

Twenty-five to 35% of infertile women have endometriosis.

Other Ways Endometriosis Affects Fertility

Endometriosis can also affect a woman�s ability of getting pregnant in a number of indirect ways. Such effects include:

* scar tissue can result in the development of adhesions around the ovary. This growth limits the area available for a successful release of eggs
* growths can affect the fallopian tubes. As a result, eggs are not picked up and transported to the uterus for fertilization
* in addition, endometrial growths can form inside the fallopian tubes, causing a blockage
* endometriosis can affect fertility by disrupting the regular cycle of egg development and release
* the peritoneal fluid of women with endometriosis contains a higher number of scavenger cells; cells which are capable of destroying sperm cells, decreasing their chances of getting pregnant

Treatment Options

There are a variety of treatment options for endometriosis.

Such options include:

* painkillers. These can help to minimize endometriosis symptoms, such as pelvic pain and painful periods.
* surgery. More serious forms of endometriosis require more invasive forms of surgery.
* assisted reproductive technology (ART). Such options include IVF and Gamete Intra-fallopian Transfer (GIFT), in which the egg and sperm are fertilized inside the fallopian tubes. The latter infertility treatment procedure is reserved for women with endometriosis who have healthy fallopian tubes.

Surgery and ART treatment options are generally recommended around a woman who has endometriosis has tried to conceive without success for a period of about one year.

These endometriosis treatment options give women with endometriosis a 30 to 65% chance of getting pregnant successfully.

Alternative Treatment for Endometriosis

While there are many effective medical treatments available for endometriosis, not all women want to take them. Some women don�t care for the side effects associated with hormonal treatments while others are concerned about having surgery or feel that their endometriosis isn�t severe enough to warrant a surgical procedure. Women who are looking for other options to treat their endometriosis, or would like to complement their medical treatment with other forms of treatment, may benefit from alternative treatments.

Why Go Alternative?

There are many different reasons why some one might choose to turn to complementary medicine to deal with a health issue. Some like the idea of using a treatment that is more natural or organic than conventional medicine while others prefer alternative medicine treatments because of the lack of side effects. Another big draw for many people is the fact that alternative medicine looks to treat the whole person � mind, body and spirit � not just a physical symptom.

Alternative medicine views itself as patient centred care that looks to use the least harmful and least invasive methods to treat you. While this type of medicine is effective, it can take longer for results to become apparent. This is why alternative medicine typically involves a more long-term commitment. There are many different types of alternative treatments that have developed out of various cultures and have been used for centuries. Among the better-known treatments are acupuncture, herbal remedies, and homeopathy.

Acupuncture

In recent years, acupuncture has gained widespread popularity in the West to treat a variety of ailments, from stress to infertility to PCOS. Said to originate in China more than 3000 years ago, there is evidence to suggest that Europeans may have used acupuncture as much as 2000 years before the Chinese. Despite its longevity, it is not exactly clear precisely how acupuncture works.

Acupuncture operates on the belief that the body is comprised of many different pathways or meridians. Along these acupuncture meridians runs an energy force known as "Qi." If qi becomes blocked or stagnate anywhere along a pathway, it will cause your body to become imbalanced and produce physical symptoms, such as pain or illness. By stimulating the energy through various Acupuncture Points found along the meridians, qi can flow freely again, helping your body regain its balance. This is done by inserting long, thin, sterile acupuncture needles along specific pathways associated with an individual�s symptoms. The needles are left in place for 20 to 45 minutes per session.

In the case of endometriosis, it is thought the acupuncture helps ease the symptoms by improving circulation and stabilizing your hormones. It is also thought that acupuncture may contribute to reducing pain by helping your body release more endorphins, your body�s natural defense against pain.

So, just how effective is acupuncture for endometriosis? In one study, that involved 67 women suffering from dysmenorrheal (severe menstrual pain) caused by their endometriosis, half of the women received acupuncture. From this group, 81% of the women reported having less painful periods after the acupuncture.

If you are considering using acupuncture, be aware that it can take several sessions before you benefit from this treatment�s full effects. You and your acupuncturist will decide upon just how many sessions you require. When making an appointment, be sure to look for a fully qualified professional that has received proper training and is certified through the appropriate regulating boards.

Herbs

Although herbal medicine is often scoffed at by modern science, herbal medicines were actually the first type of medicine people used. In fact, herbal medications have typically served as the basis for the drugs prescribed by doctors today. If you are considering herbal supplements, know that they can be used both internally and externally and are administered in the form of pills, tinctures, salves, teas, and creams.

For women with endometriosis, herbs are used to rebalance hormones as well as heal tissue. In some cases, an herbal remedy may also help to strengthen the immune system. While an herbal supplement can be very potent, it may also take a few months before the full effects are noticed. Never use alternative herbal medicine without first consulting with a qualified herbalist. Also, be aware that herbs can interfere with other types of medications, so always tell your herbalist about any medications you are taking. Likewise, inform your doctor about any herbs you are using before starting a new prescription.

A variety of herbs can be used to help your endometriosis and may include:

* Vitex
* Evening primrose oil
* Dandelion
* Black cohosh
* Motherwort
* Burdock
* Wild Yam
* Cramp Bark
* Horsetail

Just which herbs are used to help you will depend on the type and severity of symptoms you are experiencing.

Homeopathy

Another alternative treatment that has been around for some time is homeopathic medicine. With this therapy, a homeopathic specialist attempts to stimulate your immune system in order to encourage your body to heal itself. In some cases, homeopathic remedies may include the use of herbs to alleviate pain symptoms.

When meeting with a practitioner of homeopathy medicine, you will be asked about your medical history and the symptoms you are experiencing. Based on this information, a treatment plan will be formulated to deal specifically with the issues bothering you. There is no one standard form of treatment for endometriosis with homeopathy, as every woman experiences endometriosis differently.

Nutrition and Exercise

An important part of all womens health is nutrition along with exercise. Dietary changes can minimize many of the symptoms you are experiencing. Getting regular exercise has been shown to reduce the severity of menstrual cramps as well as help improve circulation. This is especially important for women with endometriosis as better circulation means that your blood is receiving more oxygen, which helps to relax the uterus thereby easing cramps.

Aim to exercise daily at a moderate level for at least 30 minutes. Even just a daily walk after dinner can make a big difference to your endometriosis symptoms.

Herbal Medicine/Phytotherapy

A proportion of pharmaceutical drugs including current bronchodilators are derived from plants.[14] Most of the recent research in this field focused on pharmacological action and in vitro efficacy of herbal remedies. Li et al.,[15] for example, demonstrate a measurable antiinflammatory activity of Australian and Chinese plants. Since herbal medicine has been used for thousands of years in Chinese and Indian medicine (among others), the interest has always been very strong in such natural remedies. A study by Orhan et al.[16] found that 31% of 304 children with asthma had used herbal medicine, and a study by Lanski et al.[17*] found that 45% of children attending an emergency department had used herbal medicine. Until now, there has been no evidence of efficacy of herbal medicine, as pointed out by the systematic review of Huntley and Ernst.[18**] This is mainly because of very heterogeneous, low-quality studies with small patient numbers. The review by Hofmann et al.[19] on the role of dried ivy (Hedera helix L.) in the treatment of children with asthma in three RCTs showed a significant decrease in airway resistance (but only one trial included a placebo control arm). Because of the meager database, no firm statement can be made on the role of dried ivy in asthma. Zhang et al.[20] assessed the efficacy of xiaoqinglong decoction combined with fluticasone in a RCT with 54 patients with mild or severe asthma and found a statistically stronger improvement of lung function (forced expiratory volume in 1 second [FEV1] and resistance) with the combination treatment than with fluticasone alone. Urata et al.,[21] in their double-blind, randomized, crossover study, found a significant improvement of bronchial hyperresponsiveness and respiratory symptoms after 4 weeks of treatment with 2.5 g of TJ-96 (herbal complex Saiboku-to) three times daily versus placebo. Older trials with Tylophora indica showed some efficacy in improving asthma control, but no newer studies with larger samples were published since then. Szelenyi and Brune[22] concluded in their complete review about herbal remedies that there is insufficient evidence to recommend their use as first-line or even adjunctive therapy for asthma.

Astonishing and perhaps frightening is the lack of information about the safety of these remedies and the widespread advertising of such therapies, mainly on the World Wide Web, where uncontrolled information lives freely and uncensored. Herbal remedies that have a biologic activity also have side effects[23] and interactions.[24] For example, Mizushima and Kobayashi[25] published a series of 24 cases of interstitial pneumonitis induced by herbal remedies.

We urgently need high-quality, double-blinded, randomized, placebo-controlled studies on the safety and efficacy of phytotherapy in asthma because almost one third of our patients use it without solid information about the risks, interactions, and real benefit.

Naturopathy

Naturopathic medicine blends many approaches, including botanical medicine, clinical nutrition, homeopathy, acupuncture, traditional Oriental medicine, hydrotherapy, and naturopathic manipulative therapy. Naturopathic doctors (NDs) also take courses in basic medical sciences like anatomy, cell biology, and physiology.

When naturopathy began as a formal health care system in the United States at the turn of the century, there were more than 20 naturopathic or "eclectic" schools. Naturopathic practitioners emphasize prevention and treatment of disease through a healthy lifestyle and control of risk factors, treatment of the whole person, and use of the body's natural healing abilities. They stress nutrition and the therapeutic use of foods to promote health, and to identify and treat the causes of chronic and degenerative disease.

The two accredited U.S. naturopathic medical schools (the National College of Naturopathic Medicine in Portland, Oregon, and Bastyr University of Natural Sciences in Seattle, Washington) together graduate about 50 naturopathic doctors a year. Two additional colleges are candidates for accreditation: the Southwest College of Naturopathic Medicine in Scottsdale, Arizona, and the Canadian College of Naturopathic Medicine in Toronto, Ontario. A new program at the University of Bridgeport in Connecticut admitted its first students in September 1997. It has been granted a license to operate by the Connecticut Department of Higher Education, and at the end of one year will be eligible to apply as a candidate for accreditation. The Council on Naturopathic Medical Education, based in Eugene, Oregon, is the accrediting agency for naturopathic programs in the United States and Canada.

More than 1,000 naturopathic doctors are licensed in the United States. Eleven states issue these licenses through special boards (Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington). In these states, only licensed persons may use the designation "ND" after their name. Several other states allow the practice of naturopathic medicine. In states that do not have licensure laws, graduates of non-accredited schools, like those offering instruction through correspondence courses, may use the designation ND. They may give seminars, and advise people on lifestyle or nutrition, but they are not permitted to diagnose illness or to prescribe remedies. In New Hampshire, graduates of correspondence schools who were already practicing at the time the licensure law was enacted were allowed to continue doing so under a restricted license. In Tennessee and South Carolina, it is illegal to practice naturopathic medicine.

Massage

The goal of massage therapy is to achieve or increase health and well-being and to help the body heal itself through manipulation of soft tissues. Various techniques are used, and there are different schools of treatment.

Massage, an ancient technique, was introduced into the United States in the mid-nineteenth century. The first known American practitioners were two New York physicians who had received training in Sweden. In the 1870's Swedish physicians opened clinics in New York. At first physicians performed massage, but they eventually delegated the technique to nurses and physical therapists. An upsurge of interest in the field began in the 1970's.

Twenty-two states and the District of Columbia require massage therapists to have 500 or more hours of education from a recognized school, and some states also require them to pass a licensing examination. The American Massage Therapy Association Commission on Massage Training Accreditation/Approval (COMTAA) accredits 23 programs in 28 locations around the country. Forty additional programs have received approval for their curricula but will have to become accredited by March 1999 in order to remain affiliated with COMTAA.

The National Certification Board for Therapeutic Massage and Body Work (NCB) administers the most widely used examination. NCB, which is accredited by the National Commission for Certifying Agencies, administered its first exam in 1992; by September 1997, 27,000 people were certified. Several states have accepted this examination as part of their licensing procedure. Massage therapists are currently licensed in 25 states and the District of Columbia. Some municipalities in states that do not require licensing -- for example, Tucson, Arizona, and Chicago, Illinois -- have passed licensing ordinances.

Some studies indicate that massage helps premature babies gain weight more quickly, reduces swelling of the arm following radical mastectomy, and is effective in relieving pain in patients with soft tissue injuries. Therapeutic touch may be beneficial in wound healing and anxiety

Herbal Medicine

Herbal medicine is also called herbology, phytomedicine, or botanical medicine. Because many plants have medicinal properties, about one quarter of pharmaceutical drugs are derived from plants. Drugs developed from plant sources include digitalis for heart problems, vincristine for leukemia, morphine for pain, and aspirin for aches, pains, and fevers.

Herbs have been used for medicinal purposes in most cultures since ancient times, either as single entities or as complex mixtures of several herbs or of herbs and other substances. In industrialized societies, use of herbal medicines has declined since the development of powerful manufactured drugs.

Herbal remedies are more widely used in Europe (particularly in Germany and France) and in Asia than in the United States. Because herbs cannot be patented, pharmaceutical companies are unlikely to invest the millions of dollars required to test them and then submit them to the FDA for approval as drugs. Moreover, unlike pharmaceutical companies, which isolate the active substances in herbs in order to produce standardized drugs, advocates of herbal remedies believe that the number or combination of substances in each herb results in a synergy that is superior to the singular impact of extracted drugs.

A meta-analysis (review of pooled studies) of the herb St. John's wort (Hypericum perforatum) for mild and moderately severe depression, published in 1996 by German and American physicians, concluded that it was more effective than a placebo and was as effective as standard antidepressants but with fewer side effects. The authors raised questions about its methods and cautioned about its efficacy in seriously depressed patients. The active chemical in the herb, they claimed, was not appropriately standardized. Furthermore, the study only compared St. John's wort with anti-depressant drugs that were given at or below their lowest level of efficacy. And, finally, patients were treated for only 6 weeks. An accompanying editorial concluded that: "longer term studies are needed before it can be recommended in major depression."

This report led Wayne Jonas of NIH's Office of Alternative Medicine to call for a trial comparing St. John's wort with the popular antidepressant fluoxetine (Prozac^TM). The Office of Alternative Medicine (OAM), the National Institute of Mental Health (NIMH), and the Office of Dietary Supplements (ODS) are collaborating on a study to evaluate the efficacy and safety of a standardized extract of Hypericum in major depression. NIMH, the administering agency, issued a Request for Proposals (RFP) for a randomized controlled trial, and Duke University was awarded a three-year contract in the amount of $4.3 million to conduct the study.

Consumers usually choose and administer herbal medicines themselves, following recommendations by friends, employees in health food stores, and the increasing numbers of books, magazines, and magazine articles devoted to the subject. Health food stores display publications by manufacturers that contain articles recommending the use of particular herbs.

Traditional Chinese medicine and Ayurvedic practitioners usually blend several herbs into one mixture. These mixtures have been effective in treating, for example, atopic eczema and acute bronchiolitis caused by respiratory syncytial virus in infants. The National Certification Commission for Acupuncture and Oriental Medicine administers an examination in Chinese herbal medicine.

Herbs that have been beneficial, according to researchers, also include: bromelain (reduced post-surgical pain and swelling); topical capsaicin from chili peppers (decreased tenderness and pain in osteoarthritis, fibromyalgia, diabetic neuropathy, and post-herpetic neuralgia); cranberries (decreased urinary tract infections); evening primrose oil (decreased breast pain, both cyclical and constant, reduced itching in atopic eczema, decreased use of painkillers in rheumatoid arthritis); feverfew (prevented severe migraines); garlic (lowered cholesterol, inhibited blood clotting); ginger (reduced nausea and vomiting); ginkgo (improved blood flow in small blood vessels); licorice (acted as an anti-inflammatory agent during treatment of stomach and intestinal ulcers); milk thistle (helped to restore diseased livers); saw palmetto (decreased symptoms of an enlarged prostate); sweet wormwood (decreased malaria parasites in the blood); and valerian (induced sleep). Some herbs, however, are either dangerous or can interact harmfully with prescription drugs.

Acupuncture

Acupuncture is a branch of traditional Chinese medicine. Its underlying philosophy is that health is a state of harmony, or balance, of the opposing forces of nature. Disease represents an imbalance of these forces that leads to excesses or deficiencies of life energy in various organs, resulting in illness if not corrected. The life energy, called qi, is believed to flow through the body in pathways called meridians which connect its surface with the internal organs. Treatment consists of redirecting and balancing energy flow.

Acupuncture has been used in China for more than 2,000 years. Although it has been applied in some Western countries since the late nineteenth century, it became popular in the United States only in 1971, when a New York Times columnist, James Reston, received acupuncture after surgery and wrote about the experience.

Acupuncture practitioners usually insert fine needles through the skin at points along the meridians. Some practitioners may use pressure (acupressure, also called shiatsu), heat, friction, suction, or electromagnetic energy to stimulate these points. Although in China acupuncture is used to treat many conditions, in the United States, it is applied most often to relieve pain.

There are more than 40 schools and colleges of acupuncture in the United States, 20 of which have either been approved, or are currently being reviewed for approval, by the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine. An estimated 6,500 acupuncturists practice in the United States; of these, about 3,300 have taken the examination administered by the National Commission for the Certification of Acupuncturists. Thirty-two states regulate the practice of acupuncture, according to The Federation of State Medical Boards of the United States.

Acupuncture may also be performed by naturopathic doctors or chiropractors "in at least 12 states," according to the Traditional Acupuncture Institute. An estimated 3,000 physicians have taken short courses in acupuncture and may use it in their practices. Several studies find that acupuncture is helpful in treating chronic low back pain, neck pain, arthritic pain of the knee, post-surgical pain, kidney-stone pain, menstrual cramps, and chronic angina. Other studies offer evidence that acupuncture can reduce the nausea and vomiting that accompany pregnancy, sea sickness, chemotherapy, or surgery. Acupuncture has also been documented as helpful to people who are withdrawing from substances they abuse. Studies have reported that acupuncture helps stroke patients, improves exercise performance in young men, and increases uterine contractions in pregnant women who are past their delivery dates. Some experts make a claim for the value of acupuncture in treating bladder instability, sinus problems, and migraine headaches.

A conference convened by the National Institutes of Health in November 1997 reviewed the scientific and medical data on the use, risks, and benefits of acupuncture and issued a Consensus Development Statement. A panel of experts concluded that "there is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value." Moreover, the panel found that in many cases, the "data supporting acupuncture are as strong as those for many accepted Western medical therapies."