Endometriosis in infertility; prevalence, clinical profile and diagnosis
Gajendra S Tomar, Hitesh Parmar, Shweta Gupta
Objective: To find out the prevalence of endometriosis amongst infertile women, the demographic & clinical characteristics associated with endometriosis.
Method: A prospective study conducted at the department of Obstetrics and Gynaecology, Index Medical college hospital &RC, Indore, M.P. From Nov 2015 to Oct 2016. All patients of primary or secondary infertility subjected to diagnostic hystero laparoscopy and chromopertubation test that were diagnosed to have endometriosis were included in the study. Women with PID, adhesions due to previous surgeries or infections were excluded. History, Physical examination. USG, Laparoscopy done, patient categorised and then statistically analysed. Chi Square test and Fisher Exact test has been performed to carry out P-value for categorical data. P-value <0.05 shows statistically significant difference.
Result: Out of 204 patients with infertility 90 (44.11%) patients had laparoscopic evidence of endometriosis. 63 (70.0%) had primary infertility and 27 (30.0%) had secondary infertility. The mean age of patients was 27± 3.6 years. Apart from infertility, the commonest complaints were dysmenorrhea (45.55%) followed by menstrual irregularity (18.88%), menorrhagia (12.2%), dyspareunia (8.8%) and chronic pelvic pain (5.5%). Abnormal USG findings were seen in 14.44% of cases. Presence of cysts/ endometrioma with ground glass appearance was seen in 13.33% of cases. Based on Revised AFS score (1985); STAGE 1 endometriosis was seen in 58 patients (66.44%); STAGE II in 19 patients (21.11%); STAGE III in 7 patients (7.77%); and STAGE IV in 6 patients (6.66%).
Conclusion: Endometriosis in infertile females is not uncommon & is increasingly being detected because of greater use of diagnostic modalities like laparoscopy in evaluation of infertility. Though most females are asymptomatic, dysmenorrhoea, chronic pelvic pain, restricted uterine mobility & adnexal tenderness raises the suspicion of endometriosis. Ultrasound had limited value for diagnosing and determining extent of endometriosis. Laparoscopy remains the gold standard for diagnosing and staging endometriosis.