Infertility And Endometriosis - Endometriosis and Immune-Related Miscarriage

Infertility And Endometriosis - Endometriosis and Immune-Related Miscarriage

Whether or not to have surgery to correct endometriosis before IVF treatment is a question many women are asking. The answer is a controversial one based on what stage of endometriosis you have, and is recommended on a case-by-case basis.  Dr. Seckin recommends that patients that have debilitating symptoms of endometriosis, and whose quality of life is severely impacted to have surgical intervention.  The excision surgery, which is the “gold standard”  for removal of the affected tissues is most effective in making sure that no disease is left behind. This increases the likelihood of conceiving and carrying a pregnancy to term in all stages, particularly, in the advance stages of endometriosis.

Dr. Seckin also recommends consulting with an IVF specialist prior to any endometriosis surgery.The knowledge and experience of your reproductive specialist is imperative to successful IVF treatment.  Not all IVF specialists recognize the impact of endometriosis on infertility or look as closely at the immune component on miscarriage as Dr. Jeffrey Braverman of Braverman IVF & Reproductive Immunology. Dr. Seckin recognizes Dr. Braverman as the only specialist who performs extensive blood tests in search of the inflammatory and immune component of infertility and miscarriages due to endometriosis. Below is a guest blog from Dr. Jeffrey Braverman on infertility and miscarriage as it relates to endometriosis. 

Endometriosis and Immune Related Miscarriage

Endometriosis is a potentially debilitating condition affecting a high percentage of women of reproductive age that can cause pain, irregular bleeding, infertility and recurrent miscarriage.  Endometriosis occurs when endometrial tissue, which normally lines the inside of the uterus (eutopic endometrium), inappropriately establishes growths in other areas of the body (endometriotic lesions). Endometriotic lesions are typically established in the abdominal cavity and are thought to occur in part through retrograde menstruation, a process in which sloughed eutopic endometrium enters the abdominal cavity through the fallopian tubes.     

Infertility and miscarriage related to endometriosis is multifactorial, involving impaired folliculogenesis, impaired ovulation, luteal defects and compromised oocyte quality. It is now also known that embryo implantation into the eutopic endometrium is impaired in women with endometriosis. A great deal of research on implantation failure related to endometriosis has revealed reduced endometrial receptivity due to aberrant expression of adhesion molecules, such as integrins, that are involved in binding to the embryo. Reduced expression of these adhesion molecules in endometriosis appears to be related to resistance of the eutopic endometrium to the effects of progesterone – a phenomenon known as “progesterone resistance."

Endometriosis is also characterized as an inflammatory disorder that involves elevated levels of inflammatory mediators (cytokines) and multiple changes in the function of immune-system components including macrophages, NK cells, T cells and B cells. Newer research has now started to explore the potential contributions of these immune-system changes to altered function of the eutopic endometrium. This research has identified, amongst other things, changes in the numbers and function of dendritic cells and regulatory T cells (Tregs) in the eutopic endometrium of endometriosis patients. Additionally, endometriosis is associated with activation of B cells and their production of autoantibodies that bind to molecules in eutopic endometrium (anti-endometrial antibodies). Several of these antibodies, including anti-laminin-1 antibodies, have been found to be associated with infertility and recurrent miscarriage in endometriosis patients.    

At Braverman IVF & Reproductive Immunology we are currently developing tests based on these alterations in eutopic endometrium and immune system function in endometriosis patients to help identify those patients at increased risk for infertility, implantation failure and recurrent miscarriage. These tests will detect specific cellular and molecular defects present in patients with endometriosis that will allow us to further personalize and tailor our treatment protocols for these patients. 

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  • Grace Larsen

    After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin,…

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  • Jacqueline Galindo

    Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well.…

  • Anna Lu

    Dr. Seckin and his staff spared me from years and years of heavy periods and unbearable endometriosis pain. After having surgery with him (my first) I can now function like a regular human. No more eating NSAIDs like candy and calling out sick from work. Thank you, Dr. Seckin!

  • Sheena Wright

    I underwent surgery with Dr. Seckin in 2017 and have felt like a new woman ever since. If you have, or suspect you have endometriosis, Dr. Seckin and his compassionate team of surgeons and staff are a must-see.

  • Angela Aro

    I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We…

  • Emi O

    Seckin and Dr. Goldstein changed my life!

  • Kristin Sands

    Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma…

  • Wilfredo Reyes

    Dr. Seckin literally gave my wife her life back. I am eternally grateful to him for his generous, determined spirit to see that Melanie finally live free from the prison bonds of Endometriosis.

  • Carla

    I am so grateful to Dr Seckin and Dr. Goldstein. My experience was nothing short of amazing. I was misdiagnosed with the location of my fibroids and have had a history of endometriosis. Dr. Seckin was the one who accurately diagnosed me. Dr Seckin and Dr. Goldstein really care about their patients and it shows. They listened to my concerns,…

  • Melissa Boudreau

    When I think of Dr. Seckin these are the words that come to mind. Gratitude, grateful, life-changing, a heart of gold. I feel compelled to give you a bit of background so you can understand the significance of this surgery for me. I am passionate about Endometriosis because it has affected me most of my life and I have a…

  • Jaclyn Harte

    Dr. Seckin and Dr. Goldstein radically changed my quality of life. They treat their patients with dignity & respect that I've personally never seen in the literally 25+ doctors I've seen for endometriosis. This summer, I had a surgery with Dr. Seckin & Goldstein. It was my first with them, but my 5th endo surgery. I couldn't believe the difference,…

  • Megan Rafael Moreno

    I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…

  • Nancy Costa

    Dr. Seckin is one of the best endometriosis surgeon. Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…