Endometriosis is a challenging and understudied disease that many women suffer from. It’s a chronic condition in which tissue similar to the tissue inside the uterus grows outside the uterus. With endometriosis, this uterine type tissue can grow in other parts of the body like the ovaries the pelvic cavity the fallopian tubes and the digestive organs. Endometriosis can cause a range of symptoms from painful periods, to pain during intercourse, to infertility, to gastrointestinal issues like gas bloating and diarrhea. Here, we will talk about the impacts of endometriosis on fertility.
It is becoming increasingly common for reproductive endocrinologists to recommend exploratory laparoscopic surgeries for women who are having difficulty getting pregnant. In many cases, doctors will not proceed with assisted reproductive technologies like IVF and IUI without first determining whether a woman has endometriosis that may be hindering her ability to get pregnant.
Let’s explore a case study in which treatment for endometriosis was used alongside fertility treatment.
Melaney (a pseudonym), had been on hormonal birth control for two decades before she and her husband decided they wanted to have a baby. Once they made this decision, Melanie stopped taking the pill. It was then that she began to have horribly painful symptoms throughout her menstrual cycle. And beyond that, she was not able to get pregnant. After many months of trying with no success, she and her husband visited a reproductive endocrinologist at an IVF clinic. She went through multiple rounds of egg retrievals and multiple failed embryo transfers. Needless to say she and her husband were frustrated and deflated.
After switching providers, it was suspected that she may be dealing with endometriosis. She referred for laparoscopic surgery to determine whether she had endometriosis, and if she did, to excise (cut) it from the tissues.
Melaney followed through with the surgery which showed that she did indeed have numerous lesions of endometriosis throughout her pelvic and abdominal cavity which were affecting the functions of her ovaries her uterus and her digestive functions. The couples’ plan was to heal after the surgery for a few months and then to jump right back into IVF for more egg retrievals, and hopefully a higher chance of success with an embryo transfer.
During the healing process she sought the support of abdominal massage and mercier therapy. When she came to see me, I explained that she had come at just the right time in her journey. Laparoscopic excision surgery for endometriosis can be a very effective intervention to remove harmful scar like tissue from the reproductive organs. It can help restore a persons fertility and help restore their ovarian and uterine function. However, such a surgery can cause additional scar tissue through the process of the excision and incisions that they make in the abdominal and pelvic tissues. Although surgeons remove the endometriosis, they may leave behind scar tissue that can have a similar impact on the functioning of the reproductive organs.
I explained that using abdominal massage during this delicate time after endometriosis excision surgery and before trying to conceive either naturally or through IVF is a wise choice. We proceeded to do six sequential sessions of abdominal manual therapy including visceral mobilization and mercier therapy. During these sessions we were able to address significant pelvic tension that had arisen in Melaney’s body throughout the many years of pelvic pain, painful periods, rounds of IVF, and endometriosis surgery. By mobilizing and softening the tissues of the ovaries the uterus and the pelvic environment, we were also able to address the uncomfortable digestive symptoms she had been experiencing that had persisted after her endometriosis excision.
A month and a half after we had finished the therapy, Melaney became pregnant naturally, without the help of IVF!
Endometriosis surgery can be a critical tool for restoring fertility and comfort, but it is also critical to include adjunct therapies like abdominal massage and visceral mobilization to optimize the function of the reproductive organs, and to combat some of the side effects of the excision surgery like the presence of scar tissue, and tension in the pelvis.
If you are having a difficult time conceiving your baby, and you have symptoms like painful periods, painful intercourse, or digestive issues, it’s possible you may be suffering from endometriosis. The case study presented in this article discusses the positive impact of abdominal massage after endometriosis surgery. However, abdominal massage and visceral mobilization can also be done as a first line of defense if someone does suspect endometriosis and is not yet ready for surgery. There have been many cases in which patients with endometriosis seek abdominal and pelvic manual therapy before seeking surgery and have found great relief in their symptoms, or they have become pregnant!
This is because deep organ mobilization can help to counteract the restrictive effect of scar tissue and adhesions caused by endometriosis. When you mobilize the organs and soften these adhesions, you increase blood flow to the ovaries into the uterus, thereby allowing them to function as they were intended.