Egg Cryopreservation

The Freezing of Human Oocytes (Eggs)
Michael J. Tucker PhD FIBiol
Georgia Reproductive Specialists, Atlanta Georgia 30342

Outline of Chapter:

* Overview of human egg (oocyte) freezing (cryopreservation), and what is currently feasible
* Discussion of the merits and limitations of currently available egg cryopreservation protocols
* Practical issues of cryopreservation: egg selection; how the eggs are used after thawing; and who might actually be helped by this technology
* The future and what alternative cryopreservation technologies might be on the horizon in the next few years.

Terminology
It is worthwhile becoming comfortable with the technical terms for several of the words that will be used interchangeably in this chapter, and in case you wish to make more comprehensive searches of the literature, such explanation of terms will improve your level of understanding. Firstly, the rather loose term egg is usually referred to as an oocyte by biologists, which is the unfertilized female gamete (sex cell). The sperm(atozoon) is the male counterpart gamete. Cryopreservation is the very specific term for all stages involved in the cryostorage of the oocyte, and refers to the freezing, storage and the thawing processes. Cryoprotectant is the term used to refer to the fluid that is used to place the eggs in prior to freezing, and is usually a mixture of sugars and organic chemical liquids that are designed to buffer the egg cell during the stresses of freezing and thawing.

Current Possibilities
The last few years have seen a significant resurgence of interest in the potential benefits of human egg freezing. In essence these potential benefits are as follows:

* Formation of donor “egg banks” to facilitate and lessen the cost of oocyte donation for women that are unable to produce their own oocytes.
* Provision of egg cryostorage for women wishing to delay their reproductive choices.
* Convenient cryopreservation of ovarian tissue taken from women about to undergo therapy harmful to such tissue, which may threaten their reproductive health; e.g. prior to cancer treatment by chemotherapy.

To put egg freezing into context, it is interesting to consider that human sperm (spermatozoa) have been successfully frozen for decades, and that the first successful report of human embryo freezing that generated a pregnancy was in 1983. Subsequently both human sperm and embryo cryopreservation have become considered routine and consistent technologies. Frustratingly human egg freezing has not yet reached such apparent levels of acceptance or consistency.

The technology so far applied clinically has been based directly on traditional human embryo cryopreservation protocols, and has produced relatively few offspring when compared with human embryo cryopreservation. Fortunately to date, no abnormalities have been reported from these pregnancies, regardless of the persistent concerns that freezing and thawing of mature oocytes may disrupt the chromosomal apparatus in these cells (meiotic spindle), and so increase the potential for chromosome abnormalities (aneuploidy) in the embryos that arise from such eggs. With respect to cryostorage of donated oocytes, for use eventually as eggs to donate to recipient women, there have been several reports that have shown some success with this approach. In fact, it has been reported that there have been 10 babies born from frozen-thawed donor oocytes. In another unusual case, frozen donor eggs after thawing have been used, not for whole egg donation, but actually for ooplasmic transfer which gave rise to the successful delivery of a twin following thawed ooplasmic donation. In this procedure the cytoplasm of the egg was injected into the eggs of another woman. The cytoplasm is the part of the egg outside of the nucleus that does not contain the genetic elements (chromosomes), but contains elements of cellular functioning. Transfer of this is thought to bolster the quality of the recipient egg making it healthier, and possibly more likely to give rise to a healthy embryo.

The first successful cryostorage of women’s own oocytes occurred with the reporting of three births over a decade ago by two centers in Australia and Germany. However, at that time reports of egg freezing studies in mice suggested that although eggs could survive freezing and thawing, they might possess higher levels of chromosomal anomalies following this procedure when compared to fresh eggs. Of note, is the fact that these studies were not performed on human tissue, and the procedures used were totally different from that utilized with the successful human egg freezing cases.

Nevertheless, the suspicion of this problem was enough to prompt a sort of voluntary worldwide moratorium on clinical oocyte cryopreservation, until studies prove the fear of chromosomal abnormalities to be unsubstantiated. Unfortunately for oocyte freezing research, human embryo cryopreservation was just starting to be undertaken much more routinely and successfully in the mid-eighties, due to the growing ethical concerns with the fate of surplus embryos following in vitro fertilization (IVF). This presented a pressing clinical problem that drove embryo freezing research, while egg freezing languished without any clear clinical need, worsened still by the worries over its safety.

Sporadic research reports continued to investigate egg freezing principally in animal models, and occasionally in the human. However, these reports tended to underline the complications and lack of consistency between cross-species comparisons. For example, while the mouse can be a useful model it must be remembered that its eggs are only just over half the volume of the human egg, and this can have a major impact on the approach to cryopreservation in these two very different species cell types. Eventually though, driven by a series of papers published by an Australian researcher called Debbie Gook from Melbourne, clinical application of egg cryopreservation began to find favor by the middle of the nineties.

Recently then, the early successes have been reproduced by others in both Italy and the USA giving rise conservatively to 10 babies from the freezing of women’s own eggs. Also at least one other baby has arisen from a clinical circumstance that is not completely unfamiliar to IVF clinics. In this case eggs had been collected during a routine IVF case, but no sperm were retrievable for insemination. So the oocytes were frozen, and donor semen was selected for a later IVF attempt. Ultimately both sets of gametes were thawed and used in a subsequent IVF procedure, which achieved a health delivery. This rather specific area of application is of great potential benefit to infertile couples undergoing IVF therapy where perhaps problems arise unexpectedly necessitating a halt to treatment prior to insemination of the eggs with sperm. For example, in another actual situation where an IVF couple suffered an untimely death in the family at the time of their procedure, they then chose to freeze all the eggs that had been retrieved until such time as they felt able to move forward with their therapy.

All of these pregnancies and reports arose from work with frozen-thawed mature oocytes (see Figure 1 “Two Mature Oocytes”), but for one notable exception, where a pregnancy arose from an immature germinal vesicle (GV) stage egg (see Figure 2 “Germinal Vesicle Immature Egg”). This may not sound to be of such great importance, but it could be that this stage of egg development may prove to be a more successful approach for egg cryopreservation. Such “young” eggs are approximately one to two days away from full maturity, and as such require further growth in the laboratory in culture after thawing. They currently appear as a by-product of less than optimal ovarian stimulation for IVF where not all eggs collected are mature. However, they survive freezing well, and possess certain features that help to maintain their integrity during the rigors of cryopreservation. For example, their membranes are more permeable to the cryoprotectant (“antifreeze”), and their chromosomes are more conveniently and safely packaged in the nucleus protecting them from disruption. Such eggs, however, still have to undergo nuclear breakdown and full maturation before they can be fertilized, and therefore their developmental competency is not so clearly established as with fully mature oocytes that are frozen. The source of these GV eggs, and whether they have been exposed to any external hormones may play a key role in the competency of these eggs. Harvesting of these eggs and the conditions for maturation remains to be resolved fully. But provisional studies in this area are the first to lend credence to the possibility that immature follicles and the immature eggs inside isolated from ovarian tissue, may one day be fully grown in the laboratory outside of the body.

How does Cryopreservation work, and what are the present limitations?
Whether eggs are mature or not, standard cryopreservation technologies appear to have their ultimate limitations not only in terms of cryosurvival (% of eggs that are alive after thawing), but also more importantly in their lack of consistency. 50% cryosurvival may be an adequate overall outcome and is now commonly reported, but not if it is a statistic that is arrived at by 90-100% survival in one case, and 0-10% in the next. Consequently, radically different types of freezing protocol may provide the answer to increased consistent success. Different approaches have been applied, and include replacing the principal salts in the freezing solutions in an attempt to help reduce the stresses on the egg membranes during cryoprotectant exposure. This has provided significant improvements in mouse egg freezing, though it has yet to be applied clinically in the human.

Traditional freezing protocols aim to achieve several things in a minimal amount of time. Firstly, the human egg is the largest cell in the human body, and as such is full of water. This is problematic as this water will turn to ice upon freezing, and will disrupt the egg’s internal and membrane structure. Therefore cryoprotectants (“antifreezing solutions”) are used to replace this water to reduce ice formation. The issue is that it takes time to replace the water with these liquid chemicals by diffusion across the egg membrane. These membranes, especially in the mature human egg, are notoriously impermeable to such agents, in particular the cryoprotectants with large molecular sizes. Thus the exposure time of eggs to these chemicals before freezing can be long to achieve good levels of water replacement, but the dilemma is that these cryoprotectants tend to be cytotoxic! As such they will tend to kill the egg if exposure is too long at “high” temperatures (4 to 37oC). So cryobiology is all about compromise: how to remove as much water as quickly as possible, without toxifying and damaging the egg. Notably, mature eggs are both the largest and the least permeable of all eggs having the smallest surface to volume ratio, and this explains the appeal of investigating the freezing of less mature eggs that reach equilibrium with cryoprotectants faster having less water to replace.

Alternatively, traditional cryopreservation protocols which impose “slow” cooling rates of about minus one to two degrees Celsius per minute might be replace by more ultrarapid freezing technology. Vitrification refers to a form of cryopreservation where cooling rates are so rapid (>minus 20,000o/minute) that ice does not have a chance to form, and the mixture of cryoprotectant and egg forms a “glass-like” gel. The first reports of success with this approach have very recently come from Italy and South Korea. From a practical standpoint, vitrification is very simple and actually removes the need for the expensive programmable controlled-rate freezers currently used to freeze egg and embryos.

While the overall aim of egg cryopreservation is to get the egg to survive upon thawing, certain damage or consequences of the procedure may not kill the cell but may render it less viable. A major issue is that eggs do not fertilize well after thawing. This is due to the partial disruption of the membrane which causes a block to the conventional fusion and penetration of sperm with the egg surface. So artificial forms of assisted insemination have to be used to achieve acceptable fertilization outcomes with thawed eggs. This procedure is referred to as intracytoplasmic sperm injection (ICSI), and is a very commonplace procedure in all infertility centers worldwide. It involves the direct injection of a single sperm into an egg, thereby avoiding most of the usual barriers to fertilization (see Figure 3 “ICSI of a Mature Egg”). Originally this procedure was designed specifically to treat male infertility where sperm count is low and sperm functioning is poor. It is now applied to many cases of IVF where fertilization needs to be maximized. Indeed, some IVF centers only undertake insemination by ICSI.

Other Forms of Egg Freezing
All the situations discussed so far address egg freezing in the context of retrieval of individual eggs and freezing these as separate units. It can be difficult to isolate and collect individual eggs near full maturity by aspiration of follicles in the ovary without the aid of current IVF technology. This involves the use of relatively large amounts of “fertility drugs” (gonadotropins) to stimulate growth of a whole group of maturing oocytes, which are then collected using a fairly simple surgical procedure while under sedation. It is usual, for example, after a couple of weeks of monitoring and drug injections for say a 32 year old woman to have up to 20 to 30 eggs collected in one go. These eggs can then be processed for cryopreservation, and may allow between one to three attempts at IVF after thawing, assuming the eggs survive adequately, and that they fertilize normally and develop successfully as embryos. Embryos can be and have been frozen following earlier egg cryopreservation, and may improve overall utilization of the original frozen eggs. The majority of investigations to date have used eggs from this source. There is no reason to suspect that such frozen eggs cannot survive in that state for many years without harm, assuming they remain cooled in liquid nitrogen at minus 196oC. However, the most plentiful source of oocytes potentially is the ovary itself, containing as it does many thousands of primordial follicles in its outer layer (cortex). Earlier successful work with cryopreservation of rat ovarian tissue has led the way to successful cryostorage of both sheep and human tissue in the last few years. Up to 80% survival of the egg containing follicles has been reported, but the real issue is how to handle this tissue following its thaw. Tissue that has been removed, for example, from a woman about to undergo cancer therapy may contain cancerous cells, and therefore may not be safely used for grafting back into such a woman if she were to survive post-cancer therapy. So the tissue might be screened before or after thawing for the presence of malignant cancerous cells to allow some assessment of the safety of this approach.

The alternative to grafting thawed ovarian tissue straight back into the body, is to take the tissue and culture it instead in the laboratory for an extended period of time may be even as long a six to eight weeks to grow very young follicles all the way to full maturity when they are ready to ovulate mature eggs. The steps to achieve this are only just now being investigated and may take some years to resolve. A part way step, would be to take the human tissue and grow it in a host animal (e.g., mouse or rabbit) until such time as in vitro maturation of such tissue could be undertaken more effectively in the lab during the last few days/weeks of follicle/egg maturation. So far in research studies, extended culture of the very immature ovarian follicles to get the eggs to full maturity with subsequent embryonic development and birth, has only been recorded in the mouse, and this was not from cryopreserved ovarian tissue. Early studies are being undertaken in the human to achieve this, though there is much to be done. Where grafting post-thaw has been undertaken, fertility has been restored in sheep, which is a good model for the human ovary, and this seems the most likely successful clinical model for restoration of fertility of women who are at risk of losing their ovarian function. This may include not only women about to undergo cancer therapy, but also women who have a family history of early menopause, and those with non-malignant diseases such as thalassemia or certain auto-immune conditions which may be treated by high-dose chemotherapy. Amazingly, it was very recently reported that ovarian function was restored by successfully grafting ovarian tissue in a human. This was in a 29year old American woman suffering from hypothalamic amenorrhea subsequent to removal of both her ovaries for persistent cysts at age 17.

The Future of Egg Cryopreservation
The multiple potential routes for cryostorage of the female gamete makes for a confusing vision of where clinical applications might occur. However, different clinical needs may actually be met by differing technological approaches, whether they incorporate whole ovarian tissue freezing, separate ovarian follicle storage, or cryopreservation of mature or near-mature oocytes themselves.

It is probable that oocyte cryopreservation will slowly enter the mainstream of techniques in Assisted Reproductive Technologies (ART) in humans, most likely in the area of oocyte donation. Here information, in terms of clinical success of protocols, is generated within months not years, as would be the case with freezing of eggs for single women concerned with their future reproductive choices. In accepting that cryopreservation of human eggs and embryos seems here to stay, in remains important that we research the consequences of these therapies carefully to ensure that we truly do no harm. With respect to this, there is increasing proficiency in the area of egg and embryo genetic screening through micro-biopsy procedures that analyze in particular the chromosomal status of these microscopic entities. This is of particular relevance for thawed eggs, and embryos arising from them, ultimately permitting screening of all embryos that come from cryopreserved female gametes. Indeed, extended culture of human embryos in vitro in the lab for up to six days to the blastocyst embryo stage (see Figure 4 “Blastocyst: A Human Six Day Old Embryo”) acts as a form of non-invasive screen of both the embryo’s viability and potentially its chromosomal normality. This is the latest stage to which an embryo can be grown outside of the human body before it is ready actually to implant into the uterus. As human in vitro fertilization in general becomes more consistent, the desire to minimize the production of excess and unwanted human embryos will increase. The need to reduce embryo production initially may prompt the limited insemination of fresh oocytes, with the surplus being stored frozen as eggs for future use, rather than freezing surplus embryos after fertilization. This is already being undertaken by some couples who have ethical and moral objections to embryo freezing.

Intriguingly, the reason why the research and development of egg cryopreservation may have been so retarded to this point is possibly due to the difficulty of finding an easy clinical area of application. As the initial concerns with egg freezing are being eroded by better understanding of the principals of cryopreserving such large and delicate cells, and by better technology, there becomes less and less reason not to start taking this form of tissue storage more seriously. Specific clinical niches are now appearing, such as creating effective donor egg banks to allow responsible quarantine of donated material (a possibility not currently available with fresh human egg donation), and also it is hoped to reduce the costs of egg donation. Additionally, with technologies available for consistently freezing parts of or whole ovaries, it is feasible that routine ovarian biopsy should eventually be available to any woman of reproductive age about to undergo treatment that may be detrimental to her ovarian functioning, or even as an effective option for young women wishing to store some of their “young eggs” for use in later life. This would allow cryopreservation of this tissue for future resuscitation of women’s fertility by either grafting of this tissue directly back into the body, or by extended growth of this tissue in the laboratory to grow the eggs entirely outside of the body.

From: http://www.ivf.com/freezing.html

What to Expect from Laparoscopic Surgery for Endometriosis

Laparoscopic surgery for endometriosis

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. If the surgeon needs better access, he or she makes one or two more small incisions for inserting other surgical instruments. If your doctor recommends a laparoscopy, it will be to:

* View the internal organs to look for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a “no endometriosis” diagnosis is never certain. Growths (implants) can be tiny or hidden from the surgeon’s view.
* Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary (endometrioma), it is likely to be removed.

Laparoscopy procedure

You will be advised not to eat or drink for at least 8 hours before a laparoscopy. Laparoscopy is usually done under general anesthesia, although you can stay awake if you have local or spinal anesthetic. A gynecologist or surgeon performs the procedure.

For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide). The gas, which is injected with a needle, pushes the abdominal wall away from the organs so that the surgeon can see them clearly. The surgeon then inserts a laparoscope through a small incision and examines the internal organs. Additional incisions may be used to insert instruments to move internal organs and structures for better viewing. The procedure usually takes 30 to 45 minutes.

If endometriosis or scar tissue needs to be removed, your surgeon will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery). After the procedure, the surgeon closes the abdominal incisions with a few stitches. Usually there is little or no scarring.

What To Expect After Surgery

Laparoscopy is usually done at an outpatient facility. Sometimes a surgery requires a hospital stay of 1 day. You will likely be able to return to your normal activities in 1 week, maybe longer.

Why It Is Done

Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:

* Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
* Endometriosis pain that has continued or returned after hormone therapy.
* Severe endometriosis pain (some women and their doctors choose to skip medicine treatment).
* An endometriosis cyst on an ovary (endometrioma).
* Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.

When laparoscopy may not be needed

Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis. But this is not always needed. For suspected endometriosis, hormone therapy is often prescribed.

How Well It Works
Pain relief

As with hormone therapy, surgery relieves endometriosis pain for most women. But it does not guarantee long-lasting results.

* Between 70% and 100% of women report pain relief in the first months after surgery.1
* About 45% of women have symptoms return within the first year after surgery.2 This number increases over time.1

Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.3

Infertility

If infertility is your primary concern, your doctor will probably use laparoscopy to look for and remove signs of endometriosis.

* Research has not firmly proved that removing mild endometriosis improves fertility.4
* For moderate to severe endometriosis, surgery will improve your chances of pregnancy.5
* In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.

After laparoscopy, your next steps depend on how severe your endometriosis is and your age. If you are older than 35, egg quality declines and miscarriage risk increases with each passing year. In that case, your doctor may recommend infertility treatment, such as fertility drugs, insemination, or in vitro fertilization. If you are younger, consider trying to conceive without infertility treatment.

Endometrioma

There are various ways of surgically treating an endometrioma, including draining it, cutting out part of it, or removing it completely (cystectomy). Any of these treatments brings pain relief for most women but not all. Cystectomy is most likely to relieve pain for a longer time, prevent an endometrioma from growing back, and prevent the need for another surgery.1

Risks
Complications from the surgery are rare but include:

* Pelvic infection.
* Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
* Scar tissue (adhesion) formation after surgery.
* Damage to the bowel, bladder, or ureters (the small tubes that carry urine from the kidneys to the bladder).

What To Think About

The benefits of laparoscopic surgery compared with open abdominal surgery include less tissue trauma and scarring and smaller incisions along with being able to have an outpatient procedure or a shorter hospital stay and a shorter recovery time. The skill of the surgeon is critical when surgery is used to treat endometriosis that is causing infertility. The use of a laparoscope, lasers, and some of the operative procedures require additional training for a surgeon. Doctors report varying pregnancy rates after endometriosis surgery. In vitro fertilization (IVF), an assisted reproductive technology, is an alternative to surgery to correct infertility caused by endometriosis.

Citations

1.

Speroff L, Fritz MA (2005). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1103–1133. Philadelphia: Lippincott Williams and Wilkins.
2.

American College of Obstetricians and Gynecologists (1999, reaffirmed 2007). Medical management of endometriosis. ACOG Practice Bulletin No. 11. Obstetrics and Gynecology, 94(6): 1–14.
3.

Johnson N, Farquhar C (2006). Endometriosis, search date April 2006. Online version of Clinical Evidence (15).
4.

Winkel CA (2003). Evaluation and management of women with endometriosis. Obstetrics and Gynecology, 102(2): 397–408.
5.

American Society for Reproductive Medicine (2006). Endometriosis and infertility. Fertility and Sterility, 86(Suppl 4): S156–S160.

Author Sandy Jocoy, RN
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH – Obstetrics and Gynecology
Last Updated July 28, 2009

From: http://www.webmd.com/infertility-and-reproduction/guide/laparoscopic-surgery-for-endometriosis

Endometriosis & Bowel Symptoms

Endometriosis and Bowel Symptoms

by Ken Sinervo MD, OBGYN.net Editorial Advisor
Center for Endometriosis Care

Many of the women seen at the Center for Endometriosis Care have been told they have Irritable Bowel Syndrome or a spastic colon. A few of them do. But many of them have endometriosis somewhere in their intestinal tracts. Endometriosis patients who present with bowel symptoms may experience a long delay in getting a diagnosis or have other medical conditions related to the bowel considered before their physicians consider the possibility of endometriosis.

Bowel symptoms are extremely common in patients with endometriosis. While the exact percentage of endometriosis patients affected with bowel symptoms is difficult to pin down, information from the database Dr. Albee and I have compiled suggests that as many as 60% or more may have at least one symptom referable to their gastrointestinal tracts. Because of the nature of our practice we tend to have more patients with stage III and IV (moderate to severe) disease than may occur in the general population. Such patients may have more symptoms related to their bowels. Even so, the incidence is still very high.

Based on the pre-operative questionnaires that all of our patients complete, intestinal cramping and painful bowel movements occur in approximately 25% of patients; constipation occurs in 35% of patients and diarrhea occurs in more than 60% of patients. These numbers reflect the patients with severe or crippling symptoms only. When patients with mild or moderate symptoms are included, these symptoms become even more common.

There is a constellation of bowel symptoms that can occur in endometriosis patients. These include:

* Painful bowel movements
* Constipation
* Diarrhea
* Alternating constipation and diarrhea
* Intestinal cramping
* Nausea and/or vomiting
* Abdominal pain
* Rectal pain
* Rectal bleeding

Some patients will only have one of these symptoms, while others may have all of them. Often these symptoms are more problematic during their periods or pre-menstrually. These women may seek medical help and undergo a series of GI tests, and when no clear answer is found, their frustration grows. However, a negative colonoscopy can actually be somewhat reassuring, because it indicates that endometriosis has not penetrated through the wall of the bowel.

What Causes Bowel Symptoms in Endo Patients?
In the great majority of patients, endometriosis is not found directly on the bowel. In general, fewer than 10-15% of patients actually have endometriosis directly on their bowel. When endo is found on the bowel, approximately 90% have superficial or localized disease. This disease can usually be effectively removed with simple laparoscopic excision, much as it would be removed from any other surface affected with endometriosis. The serosal or outer layer of the bowel can often be “peeled off” leaving the muscularis or muscular portion of the bowel undamaged. Occasionally, a portion of the muscularis must also be excised to ensure complete treatment of the endo. In these cases, the muscularis is oversewn laparoscopically. This just means one or more reinforcing sutures are placed to maintain the integrity of the bowel wall.

One to two percent of our patients require more significant surgery for their bowel endometriosis. These patients may have large segments of bowel involved with deeper or multi-focal implants (several areas are affected along a portion of the bowel). A segmental bowel resection may be required to completely treat their disease. This means the diseased portion of the bowel is removed entirely, and the healthy ends are reconnected. These procedures are usually performed with the assistance of a general surgeon or colorectal surgeon, and virtually always laparoscopically.

Even when endometriosis does not occur directly on the bowel, it can cause bowel symptoms. Inflammatory mediators can affect the bowel and contribute to them. Inflammatory mediators are released by tissues in response to inflammation or injury, and include prostaglandins, tumor necrosis factor (TNF), interleukins and cytokines. They create changes within the tissues and can cause new blood vessel growth, attract other things to the area such as white blood cells or contribute to scarring. Prostaglandins, which are released from the endometriosis implants and uterus during menses, can cause smooth muscle contractility. This not only affects the uterus, but can also cause increased contractility of the bowel. In these cases, diarrhea and intestinal cramping can result. There are likely other mediators that are released that can also contribute to bowel symptoms.

Occasionally, deep implants in adjacent structures such as the uterosacral ligaments or rectovaginal septum can also cause bowel symptoms. Painful bowel movements and occasionally rectal bleeding can result from endometriosis in these locations.

The Dreaded Bowel Prep
In order to have these procedures at the time of surgery, most of our patients undergo a bowel prep. While this is not the most enjoyable way to spend the afternoon before surgery, it is worth enduring to get to the desired result of completely removing all the endometriosis. The prep is usually clear liquids and an agent to thoroughly clean out the bowel. If a prep were not performed, bowel surgery becomes extremely risky, because fecal matter could spill and put the patient at high risk for serious infection. If a prep is not done, and bowel surgery is needed, a second surgical procedure would be required at a later date.

Other Causes for Bowel Symptoms
While endometriosis can cause or contribute to bowel symptoms, there are other important causes of bowel symptoms. Inflammatory Bowel Disease (IBD), or Crohn’s Disease and Ulcerative Colitis can be seen. As many as 8% of endometriosis patients with bowel symptoms may eventually be diagnosed with inflammatory bowel disease. IBD is usually characterized by abdominal pain, constipation, diarrhea, or alternating bouts of constipation and diarrhea as well as intestinal cramping. Patients with Crohn’s Disease may also have mouth ulcers, fatigue, anemia and hemorrhoids. Rarely, patients can have abscesses or bowel obstruction. A colonoscopy is usually required to confirm the diagnosis. IBD is usually treated with medical therapy that aims to keep the disease in remission or to treat flare ups. Occasionally, surgery is required for complications such as bowel obstruction or abscesses.

Women with symptoms similar to those of IBD but without any abnormalities on colonoscopy are often diagnosed with Irritable Bowel Syndrome (IBS). IBS is usually treated with dietary changes to avoid food triggers, and increasing dietary fiber. In some patients, stress can be a trigger. Avoiding stress or learning to deal more effectively with stress may help reduce the number of episodes. Exercise is beneficial for many patients. Medications are necessary for some patients. These may include anti-depressants, anti-spasmodics and other medications. In addition, medications that work better for patients with predominantly diarrhea or constipation are also available and have been shown to be beneficial for some, but not all patients.

Adhesions can also cause or contribute to bowel symptoms (as well as other symptoms associated with endometriosis). Often the bowel is stuck to other structures such as the ovaries, uterus or pelvic sidewall. This scarring can lead to pain during bowel movements or constipation or diarrhea. Abdominal bloating is also associated with adhesive disease, and carefully treating the adhesions may help reduce many of these symptoms.

What about the Appendix?
The appendix is another gastrointestinal organ that may contribute to bowel symptoms, or abdominal or pelvic pain. Some studies have demonstrated endometriosis in up to 20% of appendices. Although endometriosis may not be present, other conditions such as scarring or fibrosis may be found, as well as acute or chronic appendicitis, and even carcinoid tumors (a form of cancer) have been found in appendices that have been removed. We are more likely to recommend removal of the appendix if the patient has a history of right lower quadrant pain. However, if the appendix appears to have pathology at the time of surgery, it can usually be removed with minimal additional risk of complication and usually only adds a few minutes to the surgery. When required, appendectomy can almost always be performed laparoscopically.

Will My Symptoms Improve?
The incidence of bowel symptoms does improve significantly after excision surgery for endometriosis. Based on the post-operative follow-up questionnaires that our patients complete yearly, there is an 80% reduction in most bowel symptoms. Of the more than 1000 patients in our database, only 3 to 7% continue to have more severe episodes of painful bowel movements, constipation or intestinal cramping. Diarrhea, which was present in 63% of our endometriosis patients, is only significant in 13% following surgery.

While most patients have improvement in their bowel symptoms following excision surgery for their endometriosis, some will have a persistence of these symptoms. This may be due to another underlying medical condition (IBD or IBS). In those patients in whom a work-up has not been performed, it may be indicated at this time. Blood tests that detect antibodies associated with IBD may be helpful. Often a colonoscopy or other studies are required.

Many gynecologists have little or no experience treating bowel endometriosis. They choose not to treat it. Sometimes they refer these patients to a general surgeon for later treatment. At the CEC, these procedures can almost always be performed laparoscopically. It is worthwhile to ask your doctor how he or she would deal with endometriosis if it were found on your bowel. If you are not satisfied with the answers, keep searching until you find the right person to work with.

From: http://www.obgyn.net/hysteroscopy/hysteroscopy.asp?page=/hysteroscopy/articles/endometriosis_bowel_symptoms

Ovarian Cysts & Endometriosis

OVARIAN CYSTS AND ENDOMETRIOSIS

Ovarian cysts are enlargements of the ovary that appear to be filled with fluid. They can be a simple fluid filled bleb or contain complex internal structures. The term cyst is used to differentiate them from solid enlargements. Simple cysts have no internal structures and are less worrisome than those with complex structures or solid components. A sonogram or ultrasound test can determine if a cyst is simple or complex.

Ovarian cysts are frequently encountered. Every menstruating woman develops an ovarian cyst each cycle. The menstrual cycle requires the coordinated functioning of the pituitary gland, ovary, uterus and the cervix. The pituitary gland in the head produces the hormones, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). These hormones are released into the blood stream and are the messengers that tell the ovary what to do.

The ovary responds to FSH by maturing an egg. While doing this the ovary makes and releases the hormone estrogen. The maturing egg is in a follicle cyst that grows to about one half inch in diameter. When the pituitary releases a surge of LH the follicle breaks and the egg floats out and eventually enters the tube. The remnant of the follicle cyst is called the corpus luteum and makes the hormone progesterone.

The lining of the uterus is stimulated to proliferate and grow under the influence of estrogen. Progesterone converts the lining of the uterus to become a secretory lining that is prepared to accept a pregnancy. If a pregnancy does not occur that cycle the corpus luteum stops making progesterone. When the progesterone level falls the support for the lining of the uterus is lost and it sloughs. This is the menstrual bleeding. Then the cycle starts all over again: estrogen, ovulation, progesterone and the menstrual period.

Sometimes the ovary does not ovulate and the follicle cyst persists. It will continue to enlarge and can become as big as a baseball. Eventually it will break and the woman may not even be aware that this has happened. The period may be delayed because there is no progesterone phase of the cycle to respond to. The corpus luteum can also become cystic. If these cysts are detected during an examination the woman will be told that she has a cyst. Usually this will cause considerable consternation. Now everybody is upset. Could the cyst be a cancer? Will an operation have to be done? How are these questions to be answered?

If a sonogram shows this to be a simple cyst without any internal structure.
If it is only on one side.
If it is less than 4-5 inches in diameter.
If it occurs in an ovulating woman or an early pregnant woman.
If there are no associated findings such as nodules or fluid in the pelvis.
If there are no major symptoms of pain.

Then wait.

Schedule a reexamination for 4 weeks. If it is gone or getting smaller then it was a functional cyst: either a follicle cyst or a corpus luteum cyst. Nothing more needs to be done. If it persists then a diagnosis must be arrived at surgically.

Women on birth control pills should not develop functional cysts. The function of the pill is to suppress ovulation, although some women ovulate on their pills. Premenarchal and postmenopausal women should not develop functional cysts. Women in these groups with a cyst as well as those with a complex or a solid cyst will have to be evaluated surgically. This is the only way to make sure that the cyst is or is not a cancer. A Ca-125 test is of no value. It can be elevated for a variety of reasons and a normal value is meaningless. A surgical evaluation must be done. Most of the “cysts” will be shown surgically to be things other than cancers.

CAUSES FOR AN APPARENT OVARIAN CYST

Benign neoplastic ovarian cystadenomas
Benign teratomas such as a dermoid
Cysts of structures next to the ovary
Fluid filled Fallopian tubes
Infections in the tubes and or ovaries
Endometriosis and endometrial ovarian cysts
Fibroid tumors of the uterus that are on a stalk
Abscess of the appendix
Abscess of a colon diverticulum

In many instances, the surgical evaluation can be accomplished by laparoscopy. Laparoscopy is an outpatient procedure, but will in most cases, require a general anesthetic and a trip to the operating room.

Any ovarian or uterine enlargement in a post menopausal woman must be taken seriously. Women in this age group do not develop functional ovarian cysts. If they have fibroid tumors of the uterus these should begin to shrink at menopause. Fibroid tumors are benign tumors of the smooth muscle of the uterine wall and are common in younger women. A newly diagnosed fibroid tumor in a post menopausal woman should be an alarm signal and should be verified surgically.

ENDOMETRIOSIS

Endometriosis is a condition in which tissue similar to the lining of the uterus is located outside the uterus. Usually there are implants of this tissue in the pelvis. When the lining of the uterus bleeds during the menstrual cycle, these implants also bleed. This causes pain and scarring in the pelvis. The other pelvic structures react to this bleeding by becoming adherent to each other so that tubes, ovaries and intestine are stuck together. If the endometrial tissue is within an ovary, that ovary will fill with blood. These are called endometriomas and are cysts in the ovary filled with old blood. This old blood has the appearance of thin chocolate or motor oil. They are also called chocolate cysts of the ovary. Endometriomas are frequently found at surgery for ovarian cysts. An elevated Ca-125 is often associated with endometriosis.

The treatment of endometriosis is usually by hormonal suppression of the menstrual cycle. This can be accomplished by using birth control pills. If the symptoms persist during the menses then the pills can be taken in a continuous fashion and not interrupted for menses. This is easily done with monophasic pills where every active pill is exactly the same. Most pills are packaged with 21 active pills followed by 7 empty or “dummy” pills. Taking the empty pills is the same as taking no pill at all. The period only occurs when you stop taking the pill. Normally this occurs on the days when the empty pills are being taken. If the empty pills are ignored and an active pill is taken each day, then every day will be exactly the same. As long as the active pill is being taken there will be no menses. The active pills can be taken daily for as long as a year without any problem and without any bleeding.

Monophasic oral contraceptive pills each contain the same amount of an estrogen and a progestin. The net effect is that of the progestin. A continuous progesterone influence on the lining of the uterus produces thinning or atrophy of the uterine lining. This influence will also atrophy the endometrial implants.

Hormonal suppression can also be accomplished by injection of a long acting progesterone every 2 or 3 months. This drug is called Depo Provera and can be continued indefinitely. There is also a monthly injection of a GnRH type hormone. This is a Gonadotropin Releasing Hormone agonist. It basically stops all pituitary and ovarian function. It is very effective, but is useful for only 9 months at a time. There is a final solution if nothing works which is removal of the uterus and ovaries. Pregnancy also has a beneficial effect on endometriosis because it is a time of high progesterone levels.

William M. Rich, M.D.
Clinical Professor of Obstetrics and Gynecology
University of California, San Francisco
Director of Gynecologic Oncology
University Medical Center
Fresno, California

From: http://www.gyncancer.com/ovarian-cysts.html

Endometriosis & Infertility

Endometriosis and Infertility

Endometriosis is a chronic problem that manifests itself differently in different people. It occurs when tissue that normally grows inside the uterus is growing elsewhere. Endometrial tissue is designed to support and nurture an early embryo. When it grows outside the uterus, it produces substances that don’t belong there. Different people’s bodies react to these substances in different ways. Endometriosis in the pelvic cavity has a range of appearances. Endometriosis that looks a particular way may cause very different symptoms in different people. Although there is a set of symptoms that increases the likelihood that a person has endometriosis (painful periods, painful intercourse, irregular uterine bleeding and infertility), endometriosis can only be diagnosed through surgery (visually or with tissue diagnosis). Endometriosis can be present without any physical symptoms.

Generally, treatment for endometriosis is directed at improving or solving the problem associated with endometriosis that concerns the patient. In my practice, this is usually infertility. Endometriosis has been associated with infertility through many studies. The mechanism for causing infertility is likely multiple. The best-established cause is structural damage caused by adhesions (scar tissue) that the body forms in response to the foreign secretions produced by the endometrial tissue. The next best cause is related to the fact that endometriosis changes the environment in the abdomen. There is increased fluid (ascites) in the abdomen, which is filled with activated macrophages. These are scavenger cells, which in this context, destroy many sperm before they can get to the egg. There are many publications attempting to define other problems that occur with fertility due to endometriosis.

The problem with treating endometriosis to achieve pregnancy is that getting pregnant is a complex event in which there are frequently many contributing factors (commonly including ncreasing age). Most of the time established endometriosis is a contributing factor and not the only reason that pregnancy has not occurred. Getting pregnant is a probabilistic event and having endometriosis just decreases that probability. Helping someone get pregnant efficiently requires looking at the whole picture and developing a strategy directed at pregnancy. It does not always even require that the diagnosis of endometriosis be established with surgery (if that doesn’t change the therapeutic approach).

Although the American Society of Reproductive Medicine grades endometriosis as stage I through stage IV, for purposes of this discussion, it is simpler to think of endometriosis as mild, moderate or severe. A well-designed multi-center study showed that surgical treatment of mild endometriosis tripled the pregnancy rate after surgery compared to controls. This study justifies surgical evaluation in anyone without apparent other causes of subfertility who has not gotten pregnant in a normal time period. However, there are alternative approaches to surgery especially if an additional period of waiting for pregnancy to occur would potentially decrease a patient’s chance of ever getting pregnant.

Severe endometriosis involves extensive adhesions, which interfere with the ability of the fallopian tubes to pick up an egg, or large endometriomas (a quantity of endometriosis in ovarian cysts). Surgical therapy with the objective of getting pregnant is less valuable since there is a high probability of recurrent scar tissue forming within hours of the surgery since severe endometriosis often involves extensive inflammation or fused adhesions. In the process of healing, damaged or tissue that has been operated on, will attach to nearby or especially normal tissue and establish a new blood supply in order to facilitate transfer of healing substances. These connections often become permanent and prevent normal pickup of the egg by the tube.

Treatment of moderate endometriosis, which either involves extensive endometrial implants or limited adhesions, is the most useful. Surgery for moderate endometriosis is less likely to result in recurrent detrimental adhesions and the abdominal environment can be changed by surgery significantly for the better. Generally this surgery should be laparoscopic (minimally invasive) and use infertility techniques. Even after all visible endometriosis is removed and normal anatomy has been re-established, there is still subfertility associated with endometriosis compared to someone who has not had endometriosis. The reason for this is not well established and it may be that there are differing reasons for this subfertility. I believe it often is an immunological effect of the person’s propensity to develop endometriosis. In my practice, we usually try to compensate for it by a fertility enhancing therapy.

With the gradually improving success rate with IVF, the best way to get pregnant with severe endometriosis is IVF. This is because the risk benefit ratio when the objective is pregnancy favors therapy over fixing the pathology caused by endometriosis, especially when the cost in terms of lost potential for pregnancy due to the aging process is factored in. Severe endometriosis usually involves severe adhesions or abnormal connections between pelvic structures or endometriomas, which are endometriotic cysts (which contain a thick irritating chocolate syrup-like material). Recurrent adhesions after such surgery are almost certain to occur. One can hope the location of those adhesions is not significant, but without a second-look laparoscopy one cannot know this. Such adhesions begin to form within hours of the initial surgery. The surgery to correct severe endometriosis also has potential to harm the blood supply to ovary as well as destroy eggs on the surface (cortex) of the ovary as one is destroying the endometriosis. The optimal management in this setting depends on a number of variables. Here again the solution is to individualize the approach to a person’s situation and findings.

From: http://www.infertilitysolutions.com/thoughts_endometriosis.html

Endometriosis: Living Without Pain

Living without Pain

Picture a puffy white dandelion that has gone to seed blowing in the wind, with all the tiny parachuted seeds spawning new dandelions across your front lawn. Now picture yourself trying to get rid of all of those deep-rooted weeds that crop up again and again and again, even after being pulled, mowed and sprayed. Think also of how your whole body hurts after a day spent on your knees wrestling with these yellow devils.

By now you have a pretty clear picture of what endometriosis is all about: easily spread, hard as heck to get rid of and downright painful.

Of course, endometriosis is a whole lot harder to live with than a lawn full of dandelions—almost impossible for many women whose menstrual cycles become monthly nightmares of extreme cramping and bleeding. But help may be on the horizon, say the experts, and it may be as close as your local supermarket.

“We’ve found that adopting a healthy lifestyle goes a long way in preventing and relieving the symptoms of endometriosis,” says Susan M. Lark, M.D., author of Fibroid Tumors and Endometriosis: A Self-Help Program, director of the PMS and Menopause Self-Help Center in Los Altos, California, and a physician specializing in women’s health. As part of her practice, Dr. Lark helps women with endometriosis live pain-free through a wide variety of dietary regimens and herbal and nutritional supplements.

Before you start stocking your pantry, it will help to understand what causes endometriosis and how it affects your body.

Strange Tissue in Strange Places

Endometriosis is simply tissue growing where it doesn’t belong. During normal menstruation, cells from the uterine lining, the endometrium, break off and are flushed out through the vagina. In someone with endometriosis, these cells back up into the fallopian tubes. From there, they flow into the pelvic cavity and, like dandelion seeds, implant themselves in places you’d rather they not be, such as the cervix and the bowels. Being uterine tissue, these implants respond to hormone stimulation, swelling and bleeding each month just as they would if they were still inside the uterus. Except this blood doesn’t have the vagina for an escape route. It gets trapped in the pelvic cavity, where it can cause pain, inflammation, cysts, scar tissue and even structural damage and infertility.

No one knows why these implants occur in some women but not others. Some researchers believe excessive circulating estrogen may be to blame. Others say that an impaired immune system is likely at fault.

Bad Times Call for Good Nutrition

That’s why nutrition is so important, say the experts. Whether estrogen or immunity is to blame, all of your body’s systems need to be operating at maximum efficiency to properly regulate your hormones, maintain your immunity and keep endometrial implants at bay.

This is not to say that medical treatments such as estrogen-blocking hormones and surgical removal of endometrial growths aren’t effective, says Dr. Lark. They are. But too often endometrial implants recur even after surgical removal.

“Nutritional plans are particularly successful for women who have recently undergone traditional treatment,” says Dr. Lark. “I don’t suggest that women not use medications, because hormone treatments can really help lessen endometriosis. But to prevent the pain from recurring, nutritional programs work very well.”

The following are nutrients that many experts recommend for controlling endometriosis.

Note: Because the required doses are high and vary from woman to woman, be sure to consult your doctor before starting a nutritional regimen. Because getting the Daily Values of all of the essential nutrients is important if you have endometriosis, doctors who use nutritional regimens recommend starting with a general multivitamin/mineral supplement and adding additional supplements as needed.

Food Factors

The best line of dietary defense for women with endometriosis is a healthful diet full of fruits, grains and vegetables and void of fatty foods, which can aggravate the disease. Here’s what many experts recommend.

Lighten up on dairy products. One of the most common recommendations made by endometriosis experts is to eliminate or limit consumption of dairy products.

Dairy products contain saturated fat, which puts stress on the liver and increases circulating estrogen, says Susan M. Lark, M.D., author of Fibroid Tumors and Endometriosis: A Self-Help Program, director of the PMS and Menopause Self-Help Center in Los Altos, California, and a physician specializing in women’s health. Saturated fat also produces a muscle-contracting component in the body called prostaglandin F2-alpha, which can make the cramps and inflammation of endometriosis much worse, says Dr. Lark.

Stick to veggies. Because meats also contain saturated fat, experts recommend getting your nutrients from whole-grain and vegetable sources whenever possible.

Go organic. When shopping for veggies, buy organic whenever you can; when you can’t, scrub or peel your fruits and vegetables before eating them. Several studies show a direct correlation between exposure to dioxin, a chemical found in pesticides, and the incidence of endometriosis in laboratory animals.

Cut caffeine. Caffeine depletes the body’s B vitamin stores and hampers healthy liver function, which can increase estrogen levels and worsen endometriosis symptoms. Women should limit coffee, black tea,

Banish alcohol. Since optimum liver function is essential for mopping up excess estrogen and controlling endometriosis, imbibing alcohol is a definite no-no, says Dr. Lark. Eliminating alcohol from the body stresses the liver, she explains. Dr. Lark recommends that women with endometriosis avoid alcohol entirely, if possible.

B Vitamins Lower Estrogen Levels

If you’re looking for a natural way to keep your estrogen levels low and thus reduce recurrent episodes of endometriosis, try boosting your intake of B-complex vitamins, say the experts.

“The liver is responsible for breaking down and disposing of excess estrogen,” explains Dr. Lark. “The B vitamins are important in regulating estrogen because they promote a healthy liver. Studies dating back to the 1940s show that if you remove B vitamins from animals’ food, they can no longer metabolize estrogen.” Studies have also shown that B vitamin supplementation helps alleviate other symptoms of excess estrogen, such as premenstrual syndrome and fibrocystic breasts, she says.

Some women apparently find that supplements alone do the trick for them. Dian Mills, for example, a nutrition consultant in London and author of Female Health: The Nutrition Connection, became a strong advocate of B vitamin supplements through personal experience.

“I was in absolute crawl-around-the-house agony. And none of the traditional treatments was taking the pain away,” recalls Mills. Her doctor even recommended a hysterectomy, advice she flatly refused. “So I went to doctors of nutritional medicine in London, and I’ve been pain-free ever since.”

Mills’s supplement regimen included B vitamins, particularly thiamin, riboflavin and vitamin B6. Not only did her pain disappear, but she was so inspired by her success with the nutrition program that she went on to study clinical nutrition at the Institute of Optimum Nutrition in London and is now pursuing her master’s degree in health education at the University of Brighton in England.

Dr. Lark recommends that women with endometriosis take considerably more than the Daily Values of the B vitamins. She suggests approximately 50 milligrams each of thiamin, riboflavin, niacin and pantothenic acid, 30 milligrams of vitamin B6, 50 micrograms of vitamin B12, 400 micrograms of folic acid and 200 micrograms of biotin.

You can also fortify your diet with B vitamins by eating whole-grain cereals, pastas and rice, fish, legumes and green, leafy vegetables.

Prescriptions for Healing

Increasingly, endometriosis specialists are discovering the power of nutritional healing. But since the necessary doses can be high and vary from woman to woman, they recommend consulting a physician before starting a vitamin and mineral regimen.

Because getting the Daily Values of all of the essential nutrients is important if you have endometriosis, doctors who use nutritional regimens recommend starting with a general multivitamin/mineral supplement and adding other supplements as needed.

Nutrient Daily Amount

Beta-carotene 25,000-50,000 international units

Biotin 200 micrograms

Folic acid 400 micrograms

Niacin 50 milligrams

Pantothenic acid 50 milligrams

Riboflavin 50 milligrams

Selenium 25 micrograms

thiamin 50 milligrams

Vitamin B6 30 milligrams

Vitamin B12 50 micrograms

Vitamin C 1,000-4,000 milligrams

Vitamin E 400-2,000 international units

MEDICAL ALERT: If you have symptoms of endometriosis, you should see a doctor for proper diagnosis and treatment.

Doses of vitamin C exceeding 1,200 milligrams a day may cause diarrhea.

Before taking the amount of vitamin E recommended here, you should discuss it with your doctor. Doses of vitamin E exceeding 600 international units a day can cause side effects in some people. If you are taking anticoagulant drugs, you should not take vitamin E supplements.

Antioxidant Onslaught

Another way to thwart the effects of endometriosis is by upping your intake of these antioxidant nutrients: vitamins C and E, beta-carotene (which converts to vitamin A in the body) and the mineral selenium. Antioxidants are best known for their ability to fight free radicals, the naturally occurring unstable molecules that cause tissue damage in the body by stealing electrons from healthy molecules to balance themselves. Doctors know that antioxidants can also build immunity, lessen cramping and reduce excessive menstrual bleeding. All of these are useful functions in treating endometriosis.

“While you can’t just pop these supplements and expect instant relief from acute pain, I’ve found that doses of antioxidants, along with dietary changes, can treat the chronic problem of endometriosis,” says Dr. Lark.

Dr. Lark recommends a daily regimen of 1,000 to 4,000 milligrams of vitamin C, 25,000 to 50,000 international units of beta-carotene, 400 to 2,000 international units of vitamin E and 25 micrograms of selenium. These are dosages at which she has arrived during her many years of treating women’s health problems.

Because the recommended doses of vitamin C and vitamin E are many times the Daily Values of these nutrients, you should check with your doctor before trying this therapy. Vitamin C can cause diarrhea when taken in doses exceeding 1,200 milligrams a day.

And just because symptoms improve, that doesn’t mean you can stop taking supplements, cautions Dr. Lark.

Antioxidants can have a dramatic effect on the regulation of bleeding as well as on the reduction of pain and cramps that may accompany endometriosis, says Dr. Lark. “Vitamin C is good for controlling excessive bleeding,” she explains. “Vitamin A has also been shown to lessen profuse menstrual bleeding. And vitamin E has antispasmodic effects, which help in pain management.”

To get more antioxidants in your diet, start by hitting the farmers market. Broccoli, spinach and cantaloupe are excellent sources of vitamin C and beta-carotene; cabbage, celery and cucumbers are great sources of selenium. For more vitamin E, try sautéing these veggies in sunflower oil or safflower oil. Or reach for a handful of almonds, another good source of vitamin E.

From: http://www.mothernature.com/Library/Bookshelf/Books/10/56.cfm

Happy 2010! Article: Endometriosis & Cancer Risk

Women who have endometriosis appear to have a higher risk of developing several different kinds of cancer, say researchers. Endometriosis is a condition in which the type of tissue that lines the inside of the womb is found elsewhere in the pelvis. Since the natural menstrual cycle of a woman involves the swift growth, then shedding of the womb lining during her period, this is not beneficial. Typical symptoms include pelvic pain, heavy menstrual bleeding, bloating and fatigue. It has also been linked with difficulty conceiving.

Researchers from Huddinge University Hospital in Stockholm, Sweden, looked at whether there was a link between having endometriosis and cancer risk. They found a woman’s risk of developing ovarian cancer increased by just under half, for endocrine tumors by a third, for non-Hodgkin’s lymphoma approximately a quarter and for brain tumors just over a fifth.

However, the risk of cervical cancer fell by roughly a third.

No panic. The author of the study, presented at the annual meeting of the European Society for Human Reproduction and Embryology in Madrid, said that as these were relatively uncommon cancers, even apparently large increases in lifetime risk were not necessarily anything to be concerned about. Dr. Anna-Sofia Berglund said, “It is very important to keep these findings in perspective. The overall risk of cancer does not increase after endometriosis, and where there are slightly increased risks, they are in some of the less common cancers. For instance, in Sweden just under 20 women in every 100,000 develop ovarian cancer each year. My study shows that for women with endometriosis, another eight women in 100,000 could develop it – and it may be even fewer than that.”

The study found that women who had a hysterectomy before or at the time that endometriosis was diagnosed did not show this increased risk of ovarian cancer – suggesting a preventive effect. Dr. Berglund said the study did not prove endometriosis caused cancer – but that it was possible that whatever led to endometriosis might increase the risk.

From: http://www.medicalnewstoday.com/articles/3890.php

Endometriosis & Acupuncture

Endometriosis and Acupuncture By Christina Morris, L.Ac.

According to the Journal of the American Medical Association, endometriosis affects approximately 5 to 7 million American women. Most of the women affected are between the ages of 30 and 40. Some women are debilitated by this condition while others may have mild to no symptoms. Traditional Chinese medicine (TCM), including acupuncture and herbs, have been used successfully in treating a wide range of female health disorders including endometriosis.

Endometriosis is a disorder in which the cells that form the lining of the uterus or endometrium grow outside the uterus. This abnormal cell growth is most commonly found on the ovaries, the lining of the pelvic cavity, and on the fallopian tubes but may also be found in the bladder, intestines, or distal parts of the body such as the head, lungs, or arms. Each month the endometrium builds up in the uterus then breaks down and sheds off, resulting in vaginal bleeding or menstruation. It is speculated that this same cycle occurs with the endometrial tissue located outside the uterus. However, endometrial tissue outside the uterus that sheds off and bleeds is trapped inside the body and is slowly absorbed. This process can create pain and inflammation and may lead to the development of local lesions, masses, and larger amounts of endometriosis.

Women with endometriosis may experience pelvic pain 5-7 days before menstruation, during menstruation or with ovulation. Many women experience low back pain with periods, nausea, vomiting, intestinal upsets, fatigue, pain with sexual intercourse, and pain with urination or bowel movements. It is estimated that 30 to 40 percent of women who report infertility problems have endometriosis. Women that have endometriosis may also experience irregular menstruation, excessive bleeding and clotting during their menses.

The cause of endometriosis is unclear in conventional medicine, although there are many theories. Western medical treatments include drug therapy and surgery. Endometriosis is diagnosed through a laparoscopy. This procedure allows the surgeon to see inside the abdominal cavity through a tiny lighted optical tube that is inserted through a small incision in the navel.

Traditional Chinese medicine is able to understand endometriosis based on the differentiated clinical manifestations associated with each individual. It is important in TCM to diagnose the patient according to their own specific pattern. Each individual has a pattern that marks the foundation and progression of the disorder.

When determining the pattern of disease in the treatment of endometriosis, TCM takes into account the menstrual history, duration of the cycle, as well as pain, including the time that it occurs, the location, and the nature and severity. In TCM theory, there are several disease causing factors including blood stagnation, energy stagnation and deficiency, as well as cold and heat conditions that can lead to endometriosis.

The origin of the pattern differs according to the individual. Other factors that are taken into consideration when determining the pattern for endometriosis include: emotional stress, anxiety, constitutional weakness, surgical history, exposure to cold temperatures especially during menstruation, diet, chronic illness or weakness, or a history of genital infections. Acupuncture points and herbal formulas are chosen in accordance to the individual’s TCM diagnosis and can vary from person the person. The acupuncture points commonly used in the treatment of endometriosis can be located on the ears, abdomen, wrists, feet, legs, and back. Needles are usually retained for 20 to 45 minutes. Prescribed herbal formulas vary from person to person. The acupuncture points and herbs chosen help to facilitate the free flow of energy through the body. Some of the points and herbs are used to move blood, break up stagnation and stop pain. Each point and herb selected has its own therapeutic importance in the treatment of endometriosis depending on the TCM diagnosis of the individual.

In a study published in the December 2002 issue of The Journal of Traditional Chinese Medicine researchers selected 67 women diagnosed with dysmenorrhea (painful periods) due to endometriosis. Half of this group received ear acupuncture. It was reported that 81 percent of these women had less painful periods after receiving the acupuncture treatments. Researchers speculate that acupuncture promotes blood circulation and regulates the endocrine system. They also suggest that acupuncture could act as an analgesic by elevating levels of endorphins in the blood.

Traditional Chinese medicine can treat a wide range of health concerns and has been used effectively throughout the world in treating many women’s health conditions. TCM can also be used as a preventative treatment to help maintain optimum health. If you suffer from endometriosis acupuncture and herbs may benefit you.

From: http://www.endo-resolved.com/acupuncture.html

Food Combining

Food Combining

‘Food combining’ refers to the combination of foods which are compatible with each other in terms of digestive chemistry. Food combining is a basic component of optimal nutrition because it allows the body to digest and utilize the nutrients in our foods to their full extent.

The discomforts of indigestion are so common in today’s society that indigestion is almost considered normal. The fact that over 2 billion dollars are spent each year on antacids is proof of this. Rather than using drugs to suppress symptoms, wouldn’t it be wiser to remove the causes of indigestion? Food combining is based on the theory that different food groups require different digestion times. Digestion is helped the most by using foods which have roughly the same digestion time.

Correct food combinations are important for proper digestion, utilization, and assimilation of the nutrients in our diet. The principles of food combining are dictated by digestive chemistry. Different foods require different digestive enzymes to aid in the digestive process – some acid, some alkaline. As any student of chemistry will assure you, acids and bases (alkalis) neutralize each other. When acids and alkalines come in contact, they neutralize each other and this retards digestion.

Protein foods require a highly acidic environment for digestion while carbohydrates (starches, fruit and sugars) and fats require a more alkaline medium. Anytime 2 or more foods are eaten at the same time, and those foods require opposite conditions for digestion, the digestive process is compromised.

When starches and proteins are combined their stimulation to the digestive juices generates a conflicting response and produces a medium which does not digest either food very well. This situation often leads to indigestion, bloating, gas, abdominal discomfort, and poor absorption of nutrients. Any quick digesting foods – such as fruit – must wait until the slowest digesting foods leave the stomach before they can leave – a process which can take up to 6 or 8 hours. While waiting, the fruit and some of the starches undergo some decomposition and fermentation, producing gas, acid and even alcohol along with indigestion.

Proponents of food combining advocate the following principles:

The most important rule, is this: Don’t mix starch foods with protein foods at the same meal.

Here are the other principles which proponents of food combining adhere to:

1. Eat starches and acids at separate meals. Acids neutralize the alkaline medium required for starch
digestion and the result is indigestion and fermentation.

2. Eat carbohydrate foods and protein foods at separate meals. Protein foods require an acid medium for digestion.

3. Eat only one kind of protein food at a meal.

4. Eat proteins and acid foods at separate meals. The acids of acid foods inhibit the secretion of the
digestive acids required for protein digestion. Undigested proteins putrefy in bacterial decomposition and produces some potent poisons.

5. Eat proteins and fats at separate meals. Some foods, especially nuts, are over 50% fat and require hours for digestion.

6. Eat proteins and sugars (fruits) at separate meals.

7. Eat starchy foods and sugars (fruits) at separate meals. Fruits undergo no digestion in the stomach and are held up if eaten with foods which require digestion in the stomach.

8. Eat melons alone. Melons combine with almost no other food.

9. Forget the desserts. Eaten on top of meals they lie heavy on the stomach, requiring no digestion there, and ferment. Bacteria turn them into alcohols, acetic acids and vinegars.

Food combining: chew all food close to liquid consistency.

One principal of food combining which I find hard to argue with is the idea of chewing all foods close to a liquid before swallowing, to help digestion.

In the 14th edition of Howell’s Textbook of Physiology (p.777) is some very interesting research:

Abbe Spallanzani (1729 – 1799), one of the oldest observers on gastric digestion, found that grapes and cherries, when swallowed whole, even if entirely ripe, were usually passed unbroken in the stools. “As proof that the triturating power (ability to reduce to a powder by rubbing or friction) of the stomach is not very great, he swallowed some wooden tubes made very thin, so that the slightest pressure would crush them, and they were voided uninjured.” This shows the tremendous importance of thorough mastication of all foods. We can assimilate only those foods which are the most liquified.

Food combining is a controversial practice. Many people swear by it, while others find it ineffective and frustrating. There is no detriment to the food combining diet – if it works for you, use it. Food combining is an area where everyone seems to have an opinion. One way to find out what is right for yourself is to experiment. Try it and see how you feel. Listen to your body. What works for one person may not work for another person.

A Note from the Administrator of Endometriosis Journey: Food combining is a good dietary practice for those with endometriosis who suffer from abdominal bloating/stomach weight gain (such as myself).

From: http://www.healingdaily.com/detoxification-diet/food-combining.htm

Merry Christmas!!