Endometriozis ve Fertilitenin Korunması
Özet
Endometriozis infertiliteye neden olabilen kronik inflamatuar bir hastalıktır. Hastalık kendisi fiziksel olarak anatomik yapıyı bozarak, inflmasyon nedenli oosit ve embriyo kalitesini azaltarak infertiliteye neden olabilmektedir. Ancak endometriozisli her kadın fertilitenin korunması için müdahaleye ihtiyaç duymaz. Bu yüzden tedavi her hastaya özel planlanmalıdır. Endometriozisli kadınlarda fertilitenin korunmasına yönelik yaklaşımlarda öncelikli olarak oosit, embriyo veya over doku kriyoprezervasyonu düşünülebilir. Bununla birlikte operasyon ihtiyacı olan hastalarda over rezerv hasarının en aza indirildiği prosedürler uygulanmalıdır. Tekrarlayan cerrahi gereksinimi olan hastalarda öncelikli olarak IVF düşünülmelidir. Gebelik istemi olan ednometriozisli 35 yaşından büyük veya düşük over rezervi olan hastalarda spontan gebelik, IVF seçenekleri sunulmalıdır. Hasta ileryen dönemlerde gebe kalmak istiyor ise fertilite koruyucu teknikler hastaya anlatılmalıdır. 35 yaşından küçük normal over rezervine sahip, tekrarlayan cerrahi, nüks gibi risk faktörü olmayan hastalar takibe alınabilir. Ancak risk faktörü olan 35 yaşından küçük hastalara da fertilite koruyucu teknikler hakkında bilgi verilmelidir.
Endometriosis is a chronic inflammatory disease that can cause infertility. The disease itself can cause infertility by physically disrupting the anatomical structure and reducing the quality of oocytes and embryos due to inflammation. However, not every woman with endometriosis requires intervention to preserve fertility. Therefore, treatment should be planned specifically for each patient. In approaches to preserving fertility in women with endometriosis, cryopreservation of oocytes, embryos or ovarian tissue can be considered as a priority. However, procedures that minimize ovarian reserve damage should be applied in patients who need surgery. IVF should be considered as a priority in patients who need repeated surgery. Spontaneous pregnancy and IVF options should be offered to patients with endometriosis who want to get pregnant, who are over 35 years of age or have low ovarian reserve. If the patient wants to get pregnant in the future, fertility preserving techniques should be explained to the patient. Patients under 35 years of age with normal ovarian reserve, who do not have risk factors such as repeated surgery or recurrence can be followed up. However, patients under the age of 35 who have risk factors should also be informed about fertility preserving techniques.
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